Diversity of arbuscular mycorrhizal fungi in soil from the Pampa Ondulada, Argentina, assessed by pyrosequencing and morphological techniques.

The aim of this study was to assess the effects of agronomic practices on the arbuscular mycorrhizal (AM) fungal community in soils from the Pampa Ondulada region (Argentina), and to compare conclusions reached when using pyrosequencing or a morphological approach. The AM fungal diversity of 3 agricultural exploitations located in the Pampa Ondulada region (Argentina) was assessed by using 454 amplicon pyrosequencing and morphological (based on spore traits) approaches. Two kinds of soil managements are found in these sites: agronomic and non-agronomic. A total of 188 molecular operational taxonomic units and 29 morphological species of AM fungi were identified. No effect of soil management on AM richness was detected. AM fungal communities were more diverse and equitable in the absence of agronomic management. In contrast, the results on ß-diversity varied according to the methodology used. We concluded that agronomic management of soil has a negative effect on AM fungal community biodiversity in the Pampa Ondulada region. We also conclude that both methodologies complement each other in the study of AM fungal ecology. This study greatly improved the knowledge about AM fungi in South America where the molecular diversity of AM fungi was practically unknown.

La Interoperabilidad como base de la Historia Clínica Digital en el Sistema Nacional de Salud / Interoperability as the basis of digital medical records in the National Health System

La utilización de las Tecnologías de la Información y las Comunicaciones (TIC) en nuestras organizaciones sanitarias ha sido muy notoria en la última década. Ello ha sido especialmente relevante en e tratamiento de la Historia Clínica dando lugar en el Sistema Nacional de Salud (SNS) a la implantanción de soluciones e Historia Clínica Electrónica (HCE) distintas en los diferentes servicios de salu, tanto en lo funcional, como en lo tecnológico. La movilidad de lso ciudadanos, impne la necesidad de que estas diferentes soluciones operen entre si transmitiéndose información resecto del mismo paciente y, en este momento, la tecnología está madura para hacerl y ya existen instrumentos semánticos para poder trabajar en su desarrollo. El Sistema Nacional de Salu bajo a coordinación del Ministerio de Sanidad y Consumo, junto a todas las Comunidades Autónomas y las Ciudades Autónomas del territorio español está desarrollando las estrategias que hagan posible la interoperabilidad técnica, semántica y organizacional de las historias clínicas de los pacientes (AU)

This paper aims to describe certain strategies, outlining the background, working methods, advances achieved and future projection within the National Health System (AU)

[Computed tomographic colonography: applications, advantages and disadvantages]. / Colonografía tomográfica computarizada: aplicaciones, ventajas e inconvenientes.

INTRODUCTION: Complete preoperative study of the colon is required in the management of colorectal cancer, due to the frequent association of primary colonic neoplasms with colonic adenomas (28%) and/or synchronous carcinomas (5%) of the colon. We present a series of patients who underwent computed tomographic colonography, the indications for this procedure, and the results. PATIENTS AND METHODS: We performed a descriptive prospective study. Between May 2003 and August 2004, 50 computed tomographic colonographies were performed in 50 patients with suspected stenosing colorectal cancer and incomplete conventional colonoscopy. RESULTS: Fifty computed tomographic colonographies were performed. The findings were as follows: three were normal (6%), and in the remainder, one was a false positive for a suspected neoplastic pelvic mass (3.125%) and two were false positives (11.7%) for colonic polyps. Fifty percent of the findings (n = 32) were related to peritoneal metastases and colonic neoplasms. There were 12 technical complications [lack of cleaning of the colon (5), lack of distension (2), little air insufflation (5)]. Patient complications included vegetative manifestations in one (vomiting) and rectal bleeding in another. The overall complication rate was 27.4% (23.4% corresponded to technical complications and the remaining 4% were patient-related). There was no mortality related to the procedure. CONCLUSION: Because computed tomographic colonography is safe, effective and well tolerated by the patient, it should be considered as a technical alternative in the study of stenosing neoplasms of the proximal colon with incomplete colonoscopy. In addition, it allows other associated findings, both intra- and extracolonic, to be obtained and improves the diagnostic and therapeutic management of the patient.

Colonografía tomográfica computarizada: aplicaciones, ventajas e inconvenientes / Computed tomographic colonography: applications, advantages and disadvantages

Introducción: El estudio preoperatorio completo del colon es necesario para el tratamiento del cáncer colorrectal, debido a la frecuente asociación de la neoplasia primaria de colon con adenomas colónicos (28%) y/o carcinomas sincrónicos (5%) de colon. El objetivo de este trabajo es presentar nuestra serie de pacientes a los que se ha realizado colonografía tomográfica computarizada, sus indicaciones y sus resultados.Pacientes y métodos: Estudio descriptivo y prospectivo. Entre mayo de 2003 y agosto de 2004, se llevaron a cabo 50 colonografías tomográficas computarizadas en 50 pacientes con sospecha de cáncer colorrectal estenosante y colonoscopia preoperatoria incompleta. Resultados: Se realizaron 50 colonografías tomográficas computarizadas. Los hallazgos fueron los siguientes: 3 de ellas fueron normales (6%) y en las restantes se encontró un falso positivo para masa pelviana sospechosa de neoplasia (3,125%) y 2 falsos positivos (11,7%) para pólipos colónicos. El 50% de los hallazgos (n = 32) estuvo en relación con metástasis peritoneales y neoplasias de colon. Hubo 12 casos de complicación técnica (5 falta de limpieza del colon, 2 falta de distensión, 5 escasa insuflación de aire) y 2 del paciente (1 manifestación vegetativa [vómitos], 1 sangrado rectal). La tasa global de complicaciones fue del 27,4% (el 23,4% debidas a complicaciones técnicas y el 4% restante a los pacientes). No hubo mortalidad relacionada con el procedimiento. Conclusión: La colonografía tomográfica computarizada, por su seguridad, eficacia y buena tolerancia por parte del paciente, debe considerarse una técnica alternativa de estudio del colon proximal ante una neoplasia estenosante con colonoscopia incompleta. Además, permite obtener otros hallazgos asociados, intra y extracolónicos, así como mejorar el manejo diagnóstico y terapéutico del paciente

Introduction: Complete preoperative study of the colon is required in the management of colorectal cancer, due to the frequent association of primary colonic neoplasms with colonic adenomas (28%) and/or synchronous carcinomas (5%) of the colon. We present a series of patients who underwent computed tomographic colonography, the indications for this procedure, and the results. Patients and methods: We performed a descriptive prospective study. Between May 2003 and August 2004, 50 computed tomographic colonographies were performed in 50 patients with suspected stenosing colorectal cancer and incomplete conventional colonoscopy. Results: Fifty computed tomographic colonographies were performed. The findings were as follows: three were normal (6%), and in the remainder, one was a false positive for a suspected neoplastic pelvic mass (3.125%) and two were false positives (11.7%) for colonic polyps. Fifty percent of the findings (n = 32) were related to peritoneal metastases and colonic neoplasms. There were 12 technical complications [lack of cleaning of the colon (5), lack of distension (2), little air insufflation (5)]. Patient complications included vegetative manifestations in one (vomiting) and rectal bleeding in another. The overall complication rate was 27.4% (23.4% corresponded to technical complications and the remaining 4% were patient-related). There was no mortality related to the procedure. Conclusion: Because computed tomographic colonography is safe, effective and well tolerated by the patient, it should be considered as a technical alternative in the study of stenosing neoplasms of the proximal colon with incomplete colonoscopy. In addition, it allows other associated findings, both intra- and extracolonic, to be obtained and improves the diagnostic and therapeutic management of the patient

Arbuscular mycorrhizas in coastal sand dunes of the Paraguaná Peninsula, Venezuela.

Arbuscular mycorrhizal colonization was measured in the most abundant plant species of the Paraguaná Peninsula, northwestern Venezuela. These plant species included: Acacia tortuosa, Argusia gnaphalodes, Croton punctatus, Croton rhamnifolius, Egletes prostrata, Melochia tomentosa, Panicum vaginatum, Scaevola plumieri, Sporobolus virginicus, Suriana maritima, Leptothrium rigidum, and Fimbristylis cymosa. Mycorrhizal colonization was assessed using the Trouvelot et al. (1986) method that allows for simultaneous evaluation of frequency of colonization (%F), intensity of colonization (%M), and the proportion of arbuscules (%A) and vesicles (%V) present in the roots. Average frequency of colonization was 69%. The highest frequency of colonization was around 92% in C. rhamnifolius and A. tortuosa; in the other species, it varied from 49 to 86%. L. rigidum and F. cymosa were considered nonmycorrhizal because its colonization was very scarce and at all times appeared without arbuscules. Average intensity of colonization was 7%. The highest intensity of colonization was 18% in C. rhamnifolius. In the other species, it varied from 3 to 15%. Paspalum vaginatum, A. gnaphalodes, M. tomentosa, and S. maritima had their fungal structures tightly packed in modified little ovoid roots. In general, frequency of AM colonization was high and similar to those reported for other tropical ecosystems, whereas the intensity of AM colonization was low and similar to values obtained in analogous studies in disturbed ecosystems.

Mortality following laparoscopic ventral hernia repair: lessons from 90 consecutive cases and bibliographical analysis.

The popularity of laparoscopic repair of ventral hernias is increasing due to the apparent advantages of the procedure, but this approach is still a controversial technique. The aim of our study was to evaluate the mortality rate of laparoscopic ventral hernia repair and analyse the literature. The authors performed a prospective study in 90 patients with ventral hernia who were treated by laparoscopic repair. Clinical parameters and intra- and postoperative complications were evaluated. A case of mortality was reported due to a nonrecognised bowel injury. The mean follow-up (100%) was 42 months (range: 1-5 years). A bibliographical analysis was carried out (MEDLINE). Four bowel injuries were presented (4.4%): three recognised, which required conversion (two treated with minilaparotomy and completed afterwards by laparoscopy, and one by laparotomy); and one nonrecognised, which was re-operated on but evolved to sepsis and multiorgan failure and resulted in death in 48 h (1.1%). Four further mortality rates have been documented in the literature (0.6%, 1.1%, 3.1%, and 3.4% of their series). Bowel injury and mortality show a statistically significant tendency to decrease with the number of operations ( P<0.05). In conclusion, in our study the risk of mortality with laparoscopic ventral hernia repair has been higher than 1%, which must be made known. It is a risk that depends on the surgeon's experience but which does not seem to be predictable.

Hombre de 48 años con dolor abdominal recurrente de 8 meses de evolución, anemia y pérdida de peso / A 48 year old man with recurrent abdominal pain of months of evolution, anemia and low weight

No disponible

Treatment of long-standing extensive perianal hidradenitis suppurativa using double rotation plasty, V-Y plasty and free grafts.

BACKGROUND: Perianal hidradenitis suppurativa is a chronic recurrent inflammatory, suppurating, and fistulizing disease of apocrine glands, adjacent anal canal skin, and soft tissues. The standard treatment used for extensive cases is a staged surgical procedure allowing the wound to heal by secondary intention or the delayed use of skin grafts. CASE PRESENTATION: A long-standing case, disabling for the patient, with extensive involvement of the buttock region, treated in one stage, which for reconstruction required the use of sliding plasties and free skin grafts, is reported. RESULTS: The outcome was satisfactory. Primary closure after wide excision using plastic-surgery techniques may help us resolve complex situations and obtain good results and a rapid recovery. CONCLUSION: The method of closure with a combination of skin flaps and skin graft in one stage can be considered a valid surgical option for a group of patients with extensive perianal hidradenitis.

Short myotomy for vigorous achalasia.

Vigorous achalasia has been considered an indication for surgery, in which a thoracic approach is recommended for extending the myotomy along the whole of the oesophageal body to the point where manometry shows high-amplitude waves. Clinical results and postoperative manometric findings in 16 patients with vigorous achalasia undergoing abdominal surgery with myotomy limited to the lower oesophageal sphincter (LOS) were analysed to assess whether extended myotomy is necessary in surgery for this form of achalasia. The clinical results were excellent or good in all cases. Surgery induced a significant decrease (P < 0.01) in the diameter of the oesophagus as determined radiologically. The most significant postoperative manometric changes were a decrease in the resting pressure of the LOS and oesophageal body, a lowering of wave amplitude at all levels of the oesophagus, and a reduction in the proportion of repetitive waves. The results suggest that vigorous achalasia can be treated surgically in the same way as classical achalasia and question, at least from a therapeutic viewpoint, the use of the term vigorous achalasia.

Role of Helicobacter pylori infection and duodenogastric reflux in the pathogenesis of alkaline reflux gastritis after gastric operations.

In patients undergoing gastric operations, we studied the relationship between data suggesting alkaline reflux gastritis (symptoms, endoscopic alterations and histologic lesions) and two factors that produce chronic gastritis (helicobacter pylori and duodenogastric reflux). Of 225 patients who underwent operations for gastroduodenal gastric ulcer at our General Surgery Unit between 1980 and 1982, 63 agreed to undergo endoscopy and biopsies. Of these 63 patients, 38 agreed to a test to quantify duodenogastric reflux (24 hour gastric pH monitoring associated with the determination of bile acids in gastric juice). According to the clinical questionnaire, patients were classified as symptomatic and asymptomatic. Endoscopy was considered either normal with mucosal lesions or mucosal lesions plus bile. In the histologic study, we considered normal mucosa, superficial chronic gastritis and atrophic chronic gastritis. Furthermore, the presence of atrophy, metaplasia, foveolar hyperplasia and helicobacter pylori was studied. Symptoms, endoscopic alterations and histologic lesions were not significantly related to helicobacter pylori, but were significantly related to the quantity of duodenogastric reflux. The symptomatic patients presented with a greater quantity of reflux than the asymptomatic patients (p < 0.05). The patients with mucosal lesions plus bile who had endoscopy showed a greater quantity of reflux than those with normal endoscopy (p < 0.001) and those with mucosal lesions without bile (p < 0.02 for pH values and p < 0.001 for bile acids). The patients with atrophic chronic gastritis presented with a greater quantity of reflux than those with normal mucosa and superficial chronic gastritis (p < 0.05, respectively), and the patients with atrophy and metaplasia and foveolar hyperplasia had more reflux than those without (p < 0.001, respectively). The patients who were helicobacter positive and negative presented with similar quantities of reflux.

Antireflux mechanism of Nissen fundoplication. A manometric study.

To analyze the mechanisms by which Nissen fundoplication controls gastroesophageal reflux, the pre- and post-operative manometric findings in 34 patients were compared. The postoperative assessment showed an increase in both the infradiaphragmatic length and basal pressure of the lower esophageal sphincter and a notable improvement in esophageal motility (increase in the amplitude of the waves and decrease in the mean percentage of deglutitions without response and tertiary waves) in those who preoperatively presented with defective esophageal peristalsis.

Surgery improves defective oesophageal peristalsis in patients with gastro-oesophageal reflux.

Postoperative manometry was carried out in 12 patients with gastro-oesophageal reflux associated with hypomotility of the oesophageal body. A Nissen fundoplication was carried out in all patients. After a median follow-up of 3.5 years, patients underwent clinical, endoscopic, radiological, manometric and pH-metric evaluation. Manometric results revealed an overall improvement in oesophageal motor function with an increase in the amplitude of deglutition waves and a decrease in the percentage of deglutitions without response. Six of the patients (one with complete motor failure) recovered normal peristaltic function. Non-specific oesophageal motor disorders may be secondary to gastro-oesophageal reflux and are reversible in nature.

[Barrett's esophagus does not revert after medical or surgical therapy for gastroesophageal reflux]. / El esófago de Barrett no revierte tras el tratamiento médico o quirúrgico del reflujo gastroesofágico.

An evaluation was made of 34 patients having Barrett's oesophagus. Medical therapy consisted of antacids, H2 blockers, orthopramides, and postural measures (20 cases, mean follow-up 2.9 years). A Nissen fundoplication was done in 14 cases (mean follow-up 2.5 years). Clinical, endoscopic and histologic evaluation was done in all patients and pH measurements also done in all operated cases. Clinical results have been excellent in 70% of medically treated patients and in 100% of surgically treated ones, pH measurements were between normal limits in all operated patients. However, recovery of the normal epithelium did not occur in any case, except for some partial improvement in one patient treated surgically.

[Cancer of the anus: incidence and behavior of melanoma in our series]. / Cáncer de ano: incidencia y comportamiento del melanoma en nuestra serie.

From January 78, to December 88, we have treated 717 cases of colorectal carcinoma; 136 were located less than 5 cm from the anal margin. There were 117 adenocarcinomas; it was difficult to decide if the origin was the anal canal or the rectal ampulla. The remaining 19 tumors were: 9 malignant melanomas, 6 squamous cell carcinomas, 3 cloacogenic carcinomas, 1 rectal carcinoid, 1 leiomyosarcoma. We point out the high incidence of anal melanoma, 47.36% of total number of anal cancers, excluding adenocarcinomas. The clinical diagnosis was cancer of the anus; melanoma was not suspected in any of the cases. In 5 cases the preoperative biopsy did not diagnose melanoma. Since lesions were considered resectable, surgical treatment was always abdominoperineal resection. Pathological study of the surgical specimen showed lymph node metastases in all cases, in contrast to only 45.87% of adenocarcinomas. When lymph nodes were infiltrated by the tumor there were no differences in survival of patients with malignant melanoma and adenocarcinoma; nevertheless, when comparing the total group of patients with adenocarcinoma there were important differences. Summarizing, the diagnosis of malignant melanoma of the anus, compared to adenocarcinoma, implies a poor prognosis, probably related to the highest tendency to spread to the lymph nodes.

[Blood transfusion worsens the prognosis in colorectal cancer. Preliminary study in a series of 717 cases]. / La transfusión sanguínea ensombrece el pronóstico del cáncer colorrectal. Estudio preliminar en una serie de 717 casos.

We have conducted an investigation on the relationship between blood transfusion and recurrence of resected colorectal cancer and survival of the patients. During the past ten years 717 patients have been surgically treated of colorectal cancer in our hospital; 442 of the cases were Duke's stages B or C, and the resection had been considered radical. In both groups, recurrences were most frequent in patients who received blood transfusions; survival was also lower in this group of patients.