Resultados preliminares en la implementación de una técnica de detección de ganglio centinela en cáncer de cuello uterino y endometrio en un hospital público y centro formador en chile / Preliminary results in the implementation of a sentinel node detection technique in cervical and endometrial cancer in a public hospital and training center in Chile

Resumen Objetivo Evaluar el rendimiento diagnóstico de la técnica de azul patente (disponible en todo el territorio nacional) en el ganglio centinela para la estadificación del cáncer cérvico uterino y en-dometrial. Método Estudio prospectivo realizado entre enero de 2014 y diciembre de 2018. Se evaluó la técnica de azul patente para la detección de ganglio centinela en la estadificación del cáncer cérvico uterino y endometrial, antes de la linfadenectomía pélvica estándar. La inyección del azul patente se aplicó en el cuello uterino (1 cc 1 cm de profundidad y 1 cc superficial) a las 3 y 9 horas, 20 minutos antes del inicio de la cirugía (laparotomía o laparoscópica). La identifica-ción y extracción del ganglio centinela fue realizado por un ginecólogo oncólogo certificado y evaluado mediante histología tradicional con hematoxilina y eosina (H&E). Resultado Se realiza-ron un total de 80 cirugías. El ganglio centinela se identificó en 75 (94%) pacientes, 60 (75%) bilateralmente; Con una detección media de 1,9 nodos por paciente. El sitio de identificación más frecuente fue la fosa obturatriz (43,9%), seguida de los vasos ilíacos externos. Otro 2,6% de los nodos fueron encontrados en sitios poco comunes. Entre los ganglios linfáticos seleccio-nados, 10 casos fueron positivos para el cáncer. No hubo ganglio centinela falso negativo. La tasa de detección fue del 83%, con una especificidad del 95%. Conclusiones Los datos aquí expuestos nos permiten estandarizar e implementar el uso de gan-glio centinela con azul patente. El uso de GC adecua la cirugía a la necesidad de la paciente, con una clara disminución en la incidencia de complicaciones asociadas a la linfadenectomía. Este trabajo forma parte de un estudio inicial el cual se debe complementar con el uso de la tin-ción de verde de indocianina y el estudio anatomo patológico con ultraestadiaje para obtener una validación e implementación adecuada del GC en la etapificación en cáncer de cérvix y endo-metrio.

SUMMARY Objective To assess the diagnostic performance of patent blue dye technique (available in the whole country) in sentinel lymph node for cervical and endometrial cancer staging. Methods A prospective cohort study was conducted between January 2014 to December 2018. Patent blue dye technique was assessed for the detection of sentinel lymph node in cervical and endometrial cancer staging, before standard pelvic lymphadenectomy. Blue dye injection was applied in the cervix (1cc 1cm deep and 1cc superficial) at 3 and 9 hour, 20 minutes prior start-ing a surgery (laparotomy or laparoscopic). The sentinel lymph node was collected by a certified surgeon and assessed by traditional histologic hematoxylin and eosin stain. Results A total of 80 surgeries were performed. The sentinel lymph node was identified in 75 (94%) patients, 60 (75%) bilaterally; with an average detection of 1,9 nodes per patient. The most common site of identifi-cation was the obturator fossa, followed by the external iliac vessels (43,9%). 2,6% of the nodes were found in uncommon sites. 10 lymph nodes were cancer-positive. There were no false neg-ative sentinel node.Overall in our cohort the detection rate was 83% for specificity 95%. Conclusions Our data presented in this publication allow us to safely standardize and implement a sentinel lymph node technique with patent blue. This technique will allow us to adapt the sur-gery for the patient's needs, diminishing the incidence of complications associated with lym-phadenectomy. This is the first stage of our work which we must complement with indocyanine green and pathological study with ultrastaging to obtain an adequate validation and implementa-tion of sentinel node in cervical and endometrial cancer staging.

Reporte de un caso: embarazo gemelar con un feto vivo y mola completa / Case report: twin pregnancy with a live fetus and complete mole

RESUMEN La coexistencia de una mola completa y un feto vivo es una condición infrecuente que puede evolucionar con múltiples complicaciones tanto maternas como fetales; entre ellas aborto, preeclampsia, hipertiroidismo, metrorragia, parto pretérmino y enfermedad trofoblástica gestacional persistente. No existe consenso internacional respecto al manejo de esta condición, aun conociéndose el mal pronóstico para el feto y los elevados riesgos maternos asociados. El siguiente es un reporte de un caso clínico de embarazo gemelar con feto vivo y mola completa, diagnosticado a las 12+1 semanas. Luego de realizar consejería, y en contexto de la legislación chilena en el año 2015, se decide continuar con el embarazo. La paciente es monitorizada en policlínico de alto riesgo obstétrico con controles seriados de b-HCG, ecografía fetal y RNM pélvica. Desde las 13 semanas presenta hipertensión arterial que se maneja con antihipertensivos orales; posteriormente, a las 20+2 semanas, desarrolla un cuadro de preeclampsia severa por lo que, en conjunto con la paciente, se decide realizar histerectomía en bloque. Dada la persistencia de valores de b-HCG elevados a las 12 semanas post interrupción del embarazo, se decide tratamiento con metotrexato. El caso fue analizado en Comité de Ginecología Oncológica donde se decidió seguimiento con b-HCG, lográndose la negativización a las 38 semanas post metotrexato. Se confirmaron valores negativos de b-HCG por 6 meses, tras lo cual fue dada de alta.

ABSTRACT The coexistence of a complete mole and an alive fetus is a rare condition that can evolve with multiple complications both maternal and fetal; among them abortion, preeclampsia, hyperthyroidism, uterine bleeding, preterm labor and persistent gestational trophoblastic disease. There is no international consensus regarding the management of this condition, despite the poor prognosis for the fetus and the associated high maternal risks. The following is a report of a clinical case of twin pregnancy with live fetus and complete mole, diagnosed at 12+1 weeks. After counseling, and in the context of Chilean legislation in 2015, it is decided to continue with pregnancy. The patient is monitored in a high-risk pregnancy outpatient clinic with follow ups b-HCG, fetal ultrasound and pelvic MRI. From 13 weeks, the patient presents high blood pressure that is managed with oral antihypertensives; and later, with 20+2 weeks, developed severe preeclampsia which is why, in conjunction with patient, it was decided to perform a block hysterectomy. Given the persistence of elevated b-HCG values at 12 weeks post-termination of pregnancy, treatment with methotrexate was decided. The case was analyzed in the local Committee of Oncological Gynecology, in which it was decided to follow the b-HCG curve, achieving negative values at 38 weeks post-methotrexate. Negative values of b-HCG were confirmed for 6 months, after which it was discharged.

Molecular design of high performance zwitterionic liquids for enhanced heavy-oil recovery processes.

Branched gemini zwitterionic liquids, which contain two zwitterionic moieties of linked quaternary-ammonium and carboxylate groups, are proposed as chemicals to be applied in the Enhanced Oil Recovery (EOR) from fractured carbonate reservoirs. The zwitterionic moieties are bridged between them through an alkyl chain containing 12 ether groups, and each zwitterionic moiety has attached a long alkyl tail including a CC double bond. A theoretical molecular mechanism over which EOR could rest, consisting on both the disaggregation of heavy oil and the reservoir-rock wettability alteration, was suggested. Results show that chemicals can both reduce the viscosity and remove heavy-oil molecules from the rock surface.

Absceso del psoas como presentación de tuberculosis vertebral: reporte de un caso / Psoas abscess as spinal tuberculosis presentation: case report

Introducción: El absceso del psoas es un cuadro infrecuente cuyo principal agente etiológico es el Staphyloccocus aureus, y que con baja frecuencia puede ser de etiología tuberculosa como complicación de una afección vertebral por Mycobacterium tuberculosis. Presentación del caso: Mujer de 58 años, mapuche, con antecedentes de enfermedad pulmonar obstructiva crónica y alcoholismo crónico, consultó por cuadro de dos meses de evolución de dolor lumbar, baja de peso y paresia de extremidad inferior derecha que impedía la marcha. Tomografía computada (TC) de columna evidenció espondilodiscitis y absceso del psoas derecho, iniciándose tratamiento antibiótico cubriendo Staphyloccocus aureus. Los hemocultivos y los cultivos de la colección resultaron negativos por lo que se decidió mantener tratamiento ambulatorio. Paciente consultó cuatro meses después por exacerbación de su disnea basal de dos semanas de evolución, radiografía de tórax y TC de tórax de alta resolución compatibles con tuberculosis pulmonar con diseminación miliar bilateral, por lo cual, se inició tratamiento antituberculoso, realizándose baciloscopías que resultaron negativas. Además, se solicitó identificación del bacilo de Koch mediante reacción de polimerasa en cadena que resultó positiva, con lo que se confirmó el diagnóstico de tuberculosis miliar y mal de Pott. Se decidió reevaluar con TC de columna una vez finalizado el tratamiento antituberculoso para decidir conducta quirúrgica. Discusión: Es importante la sospecha activa de etiología tuberculosa ante una espondilodiscitis y un absceso del psoas, pese a su baja frecuencia. El inicio del tratamiento en forma precoz puede modificar la progresión de una infección que puede ser invalidante e incluso mortal.

Introduction: The Psoas abscess is an infrecuent condition which main ethiology is the Staphyloccocus aureus and with less frequency can be a vertebral tuberculosis complication caused by Mycobacterium tuberculosis. Case Report: a 58 years old female, Mapuche, with Chronic Obstructive Pulmonar Disease and chronic alcoholism antecedents, was admitted in the emergency room with a two month old lumbar pain, loss of weight and right inferior extremity paresia which didn't allowed her to walk. The column's Computed Tomography (CT) showed spondylodiscitis and a right psoas abscess, the antibiotherapy, covering Staphyloccocus aureus, was started. The hemoculives and abscess' cultives were negative, so it was decided to continue with ambulatory treatment. The patient was admitted four month later because of two weeks of exacerbation of her basal dysnea. The thorax Radiography and high resolution CT were compatibles with pulmonary tuberculosis with bilateral miliar disemination. Antituberculosis treatment was started, bacilloscopies were negative, also, a Polymerase Chain Reaction identification of Koch's bacillus was performed, resulting positive, confirming the diagnosis of miliar tuberculosis and Pott's disease. Once antituberculosis treatment was finished, a new column's CT was requested to decided surgical conduct. Discussion: Is important to actively suspect of tuberculosis ethiology in presence of spondylodiscitis and psoas abscess, despite it's low frequency. The early treatment start may modify the progresion of an infección that can be invalidating and even mortal.

Dinámica espacio-temporal de organismos precursores de marea roja en la costa Pacífica de América del Norte y Centroamérica / Spatial-temporal dynamics of red tide precursor organisms at the Pacific coast of North and Central America

La región costera del Pacífico de Centro y Norte America ha sido afectada de manera frecuente por fenómenos que se denominan proliferaciones algales nocivas o en inglés, "Harmful Algal Blooms" (HAB). A pesar de la gran cantidad de efectos en la salud pública, las actividades económicas y el medio ambiente, aún existe una abrumadora carencia de información en el tema. Esto no permite establecer si las causas principales de este evidente aumento en el número e intensidad de los eventos son naturales o antropogénicas. La incrementada utilización de las zonas costeras para actividades humanas encuentra paralelo en el denominado cambio climático, lo que dificulta discriminar entre la posible influencia de estos dos fenómenos. Series de datos de larga duración en regiones reducidas, así como las observaciones esporádicas realizadas cuando se presenta algún evento, nos permite comparar regímenes climáticos, condiciones geográficas, disponibilidad de nutrientes (incluyendo la eutroficación) y parámetros oceanográficos que promueven o permiten el desarrollo y mantenimiento de las proliferaciones, haciendo evidentes cambios drásticos en la biodiversidad y la biogeografía de los organismos productores de HAB

The Pacific coast of Central and North America has long been and still is impacted by the flourishing of microalgal populations known as Harmful Algal Blooms (HABs). The organisms that have caused recent HABs episodes in the region are among others, Gymnodinium catenatum, Pyrodinium bahamense var. compressum, and recently Cochlodinium cf. catenatum. In spite of the accumulated effects on the human health, the economic activities and the environment, scarce information is available on the subject. The augmented use of coastal zones for human activities is also paralleled by increased awareness of global climate changes. Thus, it is not an easy task to discriminate anthropogenic or natural phenomena, or both, as the major driving forces. The long-term data sets available for limited regions, as well as some sporadic observations during notorious blooms, allowed us to discriminate major changes in the biodiversity and biogeography of HAB organisms. Main changes refer to number of events, covered area, duration and frequency, number of blooming species and appearance of not previously reported harmful taxa. The variables more clearly related to these dynamic phenomena, seems to be sea surface temperature and wind force, but it is not yet possible to weight their contributions. The participation of rain is not fully evaluated to date. The collaborative communication among small-budget monitoring operations in the region allowed to "pass the voice" about peaking concentrations of HAB organisms, diminishing the risk of poisoning

[Spatial-temporal dynamics of red tide precursor organisms at the Pacific coast of North and Central America]. / Dinámica espacio-temporal de organismos precursores de marea roja en la costa Pacífica de América del Norte y Centroamérica.

The Pacific coast of Central and North America has long been and still is impacted by the flourishing of microalgal populations known as Harmful Algal Blooms (HABs). The organisms that have caused recent HABs episodes in the region are among others, Gymnodinium catenatum, Pyrodinium bahamense var. compressum, and recently Cochlodinium cf. catenatum. In spite of the accumulated effects on the human health, the economic activities and the environment, scarce information is available on the subject. The augmented use of coastal zones for human activities is also paralleled by increased awareness of global climate changes. Thus, it is not an easy task to discriminate anthropogenic or natural phenomena, or both, as the major driving forces. The long-term data sets available for limited regions, as well as some sporadic observations during notorious blooms, allowed us to discriminate major changes in the biodiversity and biogeography of HAB organisms. Main changes refer to number of events, covered area, duration and frequency, number of blooming species and appearance of not previously reported harmful taxa. The variables more clearly related to these dynamic phenomena, seems to be sea surface temperature and wind force, but it is not yet possible to weight their contributions. The participation of rain is not fully evaluated to date. The collaborative communication among small-budget monitoring operations in the region allowed to "pass the voice" about peaking concentrations of HAB organisms, diminishing the risk of poisoning.

[Annual distribution and abundance of Ceratium dens (Peridinales: Ceratiaceae) in the Gulf of California, Mexico]. / Distribución y abundancia anual de Ceratium dens (Peridinales: Ceratiaceae) en el golfo de California, México.

Ceratium dens distribution in the Gulf of California was studied based on three oceanographic campaigns, monthly abundance (1995-96) and during three red tide events in Mazatlán Bay. 52 phytoplankton samples with a Bongo net and 64 microns mesh light, during the year 120 water samples with a van Dorn bottle were collected in two sampling stations and from three red tide events. All samples were counted by the inverted-microscope method. The results showed that C. dens was present in the upper Gulf of California and surroundings of Cabo San Lucas. Two peaks were observed during spring and autumn in Mazatlán Bay during 1995-1996. The highest densities (20-360 cells.-l-1) were observed in coastal areas, whereas the lowest densities (1-14 cells.-l-1) were recorded in the open sea. During red tide events in 1985, 1989 and 1997, 144,000-256,000 cells.-l-1, 100,000-400,000 cells.-l-1, and 189,000-592,000 cells.ul-l was observed, respectively. During the red tide events C. dens varied, although sometimes was replaced by Skeletonema costatum or Pseudonitzchia spp and Ceratium furca. C. dens, seems to prefer areas with high productivity.

Successfully establishing laparoscopic surgery programs in developing countries. Clinical results and lessons learned.

BACKGROUND: Laparoscopic surgery has not been widely established in developing countries due to the lack of access to training and lack of money. We describe our experience using on-site training programs to efficiently teach and propagate laparoscopic surgery in Leon, Nicaragua; La Paz, Bolivia; and Santa Cruz, Bolivia. METHODS: A group of well-trained and motivated local surgeons was identified in each country as the initial target for teaching. Participants were taught basic and advanced laparoscopic surgery during on-site didactics, animal laboratories, and proctoring sessions. Follow-up courses were held until the target group of surgeons was capable of independently teaching and supervising laparoscopic surgery among other surgeons in each country. RESULTS: Multiple technical and logistic difficulties were encountered. In Leon, Nicaragua, and La Paz, Bolivia, a total of eight surgeons were fully trained and proctored in laparoscopic cholecystectomy. In La Paz and Santa Cruz, Bolivia, a total of seven surgeons were instructed in advanced laparoscopic procedures. To date, over 180 patients have undergone laparoscopic cholecystectomy or advanced procedures with a morbidity similar to that reported in literature series in the United States. CONCLUSIONS: Our experience demonstrates that in spite of numerous limitations, basic and laparoscopic surgery can be efficiently and safely taught in developing countries. Many lessons were learned in how to safely and efficiently use laparoscopic equipment and instruments within strict financial constraints.

[Presence of red tides along the eastern coast of the Gulf of California]. / Presencia de mareas rojas en la costa este del Golfo de California.

Records of the occurrence of red tides during the last 24 years in Guaymas and for the last 16 years in Mazatlán, on the coast of the Gulf of California, Mexico are presented here. The results indicate the presence of 4 dominant species in 34 red tides in Guaymas and 9 dominant species in 60 red tides in Mazatlán. The most common species is Mesodinium rubrum, while the toxic one is Gymnodinium catenatum. Noctiluca scintillans and Gonyaulax sp. were also present in Guaymas. In Mazatlán Scrippsiella trocoidea, Prorocentrum dentatum, Ceratium tripos var. ponticum, C. furca, Gymnodinium splendens and Gonyaulax triacantha were also present. Red tides occur frequently during winter in Guaymas and during the late winter and early spring in Mazatlán. Both periods coincide with the upwelling season in the region. The absence of the red tides is related to the "El Niño" phenomenon, which is significant in the Mazatlán area. Ciliates decrease 11.4%, while dinoflagellates increase from 1.6 to 3.8%. The duration period of red tides increase (5.6%) from 3 to 6 days, as compared with the records between 1979 and 1990.

[Red tides in México: a review]. / Mareas rojas en México: una revisión.

With the purpose to make a review on the red tides occurence at mexican coasts, previous studies were analyzed. Dinoflagellates seem to be the main cause of toxic events mainly Gonyaulax polygramma, Gymnodinium catenatum, Pyrodinium bahamense var. compressum and Ptychodiscus brevis. There are other species which cause red tides but are not toxic. They are: Mesodinium rubrum, Gonyaulax triacantha, Noctiluca scintillans, Prorocentrum dentatum, Gymnodinium splendens, G. sanguineum, Ceratium tripos var. ponticum, C. furca, Scrippsiella trocoidea and Oscillatoria erythraea. The first of these is the most common cilliate of the Pacific coastlines and the last one is the most common cyanophyceae during the strong events of "El Niño". The magnitude is quite variable, from small stains of a hundred square meters to several square kilometers and its density ranges from 0.5 to 36 million cells/l. Their residence time goes from 1 or 2 days to as long as 5 months. The great densities are due to Prorocentrum dentatum and P. minimum, the latter is only observed in estuarine ponds for shrimp cultivation, they have not been related to poisoning episodes. New areas of the red tide occurrence have been recorded during the last decades, such as Acapulco Bay, Huatulco, Salinacruz and Puerto Madero. These localities and also Mazatlán, are the only regions in which paralytic shellfish poisoning (PSP) have registered fatal cases and in the Gulf of Mexico a great mortality of fishes has been noted due to ictiotoxin produced by Ptychodiscus brevis. On the other hand, at Yucatan and west coast of the Peninsula of California red tide events are little known.

Hemobilia por ruptura de aneurisma de la arteria hepática / Hemobilia due to ruptured hepatic artery aneurism

We report two patients with hemobilia caused by hepatic artery aneurism that ruptured to the biliary tract. In the first patient, the diagnosis was made during an exploratory laparotomy. In the second patient, the aneurism was diagnosed with a selective hepatic artery arteriography and embolized during the procedure. The evolution of both patients was satisfactory