Neurofibromatosis Type I Presenting with Incomplete Ileal Volvulus in a Pediatric Patient.

BACKGROUND Neurofibromatosis 1 is a neurocutaneous disorder with multisystemic manifestations. When patients are lacking overt cutaneous manifestations, diagnosis may be delayed and may complicate diagnosis and management of atypical presentations of this disease. It is thus important to strive to obtain relevant and/or complete history to arrive at the appropriate diagnosis. Furthermore, maintaining an index of suspicion in cases of vague abdominal pain may guide the clinician in establishing the correct diagnosis of mesenteric plexiform neurofibroma in the setting of known/presumed neurofibromatosis 1 patients presenting with acute and/or chronic vague abdominal symptoms. CASE REPORT This is a case of a teenage boy who presented with acute, vague abdominal pain over a period of 2 weeks. Laboratory tests and physical exam findings in primary and secondary care settings were unremarkable, and thus the patient was discharged home only to continue with abdominal pain, thus seeking additional medical care. After admission to our facility and exhaustive history taking, physical examination, and imaging, a prospective diagnosis of neurofibromatosis with mesenteric neurofibroma was made. Upon surgical exploration, a mesenteric mass with corresponding volvulized, ischemic small bowel was removed. Histopathology confirmed a plexiform neurofibroma. The patient recovered adequately and was discharged home without complications. CONCLUSIONS This case highlights the importance of exhaustive history taking to obtain an accurate diagnosis as well as the importance of a high index of clinical suspicion for mesenteric neurofibromatosis in patients with presumed or known neurofibromatosis and presenting with vague abdominal symptoms.

Genotipificación del gen RHD en ADN fetal libre en plasma de embarazadas RhD negativo / Genotyping of the RHD gene in free fetal DNA in plasma of RhD negative pregnant women

Objetivo: Determinar el grupo RhD fetal a través del estudio del gen RHD en ADN fetal que se encuentra libre en plasma de embarazadas RhD negativo. Método: Se analizó la presencia de los genes RHD, SRY y BGLO en ADNfl obtenido de plasma de 51 embarazadas RhD negativo no sensibilizadas, utilizando una qPCR. Los resultados del estudio genético del gen RHD se compararon con el estudio del grupo sanguíneo RhD realizado por método serológico en muestras de sangre de cordón, y los resultados del estudio del gen SRY fueron cotejados con el sexo fetal determinado por ecografía. Se calcularon la sensibilidad, la especificidad, los valores predictivos y la capacidad discriminativa del método estandarizado. Resultados: El gen RHD estaba presente en el 72,5% de las muestras y el gen SRY en el 55,5%, coincidiendo en un 100% con los resultados del grupo RhD detectado en sangre de cordón y con el sexo fetal confirmado por ecografía, respectivamente. Conclusiones: Fue posible deducir el grupo sanguíneo RhD del feto mediante el estudio del ADN fetal que se encuentra libre en el plasma de embarazadas con un método molecular no invasivo desarrollado y validado para este fin. Este test no invasivo puede ser utilizado para tomar la decisión de administrar inmunoglobulina anti-D solo a embarazadas RhD negativo que portan un feto RhD positivo.

Objective: To determine the fetal RhD group through the study of the RHD gene in fetal DNA found free in plasma of RhD negative pregnant women. Method: The presence of the RHD, SRY and BGLO genes in fetal DNA obtained from plasma of 51 non-sensitized RhD negative pregnant women was analyzed using qPCR. The results of the genetic study of the RHD gene were compared with the RhD blood group study performed by serological method in cord blood samples, and the results of the SRY gene study were compared with the fetal sex determined by ultrasound. Sensitivity, specificity, predictive values and discriminative capacity of the standardized method were calculated. Results: The RHD gene was present in 72.5% of the samples and the SRY gene in 55.5%, coinciding 100% with the results of the RhD group detected in cord blood, and with the fetal sex confirmed by ultrasound, respectively. Conclusions: It was possible to deduce the RhD blood group of the fetus through the study of fetal DNA found free in the plasma of pregnant women with a non-invasive molecular method developed and validated for this purpose. This non-invasive test can be used to make the decision to administer anti-D immunoglobulin only to RhD-negative pregnant women carrying an RhD-positive fetus.

Absceso en miocardio secundario a neumonía adquirida en la comunidad por Pseudomona aeruginosa en lactante inmunocompetente: reporte de caso / Myocardial abscess secondary to community acquired Pseudomona aeruginosa pneumonia in an immunocompetent infant: case report

La Pseudomona aeruginosa es una causa importante de infecciones asociadas a la atención de la salud y en las neumonías adquiridas en la comunidad, rara vez se identifica como el agente patógeno, siendo estas de progresión rápida y de mal pronóstico. Se trata de un menor de un año de edad inmunocompetente el cual fallece en casa una semana después de una lesión en la planta del pie derecho que según familiares le sacaron "pus", tratado con antinflamatorios y analgésicos. Se le realizó necropsia que evidenció cicatriz en planta de pie derecho sin lesiones traumáticas. Pulmones de consistencia indurada, con adherencias y áreas que impresionan necróticas, asociada a efusión pleural. El estudio histológico reportó un proceso infeccioso pulmonar agudo abscedado que se diseminó por continuidad a tejido cardiaco y en estudios microbiológicos de pulmón y bazo se reportó Pseudomona aeruginosa.

Pseudomona aeruginosa is an important cause of health care-associated infections and in community-acquired pneumonias, it is rarely identified as the pathogenic agent, being of rapid progression and poor prognosis. This is a one-year-old immunocompetent minor who died at home one week after a lesion in the sole of the right foot which, according to family members, caused "pus", treated with anti-inflammatory and analgesic drugs. A necropsy was performed, which showed a scar on the sole of the right foot with no traumatic lesions. Lungs of indurated consistency, with adhesions and areas that appear necrotic, associated with pleural effusion. The histological study reported an abscessed acute pulmonary infectious process that spread by continuity to cardiac tissue and microbiological studies of lung and spleen reported Pseudomona aeruginosa.

Heridas atípicas producidas por proyectil de arma de fuego Reporte de caso / Atypical wounds caused by firearm projectile Case report

Resumen Las heridas por proyectil de arma de fuego se definen como los efectos que producen sobre el organismo los disparos realizados con armas cargadas de proyectiles o diversos tipos de pólvora u otros explosivos. La valoración médico legal en estos casos, en personas vivas, se realiza en la Sección Clínica Médico Forense del Departamento de Medicina Legal del Organismo de Investigación Judicial, esta incluye la historia médico legal, el examen físico, el análisis de documentos médicos aportados, pericias conexas efectuadas y revisión de bibliografía, esto para tener todos los elementos de juicio que permitan realizar un análisis objetivo y basado en la evidencia científica, y así poder responder a las interrogantes de la Autoridad Judicial. El presente artículo abarca algunos de los aspectos principales a tomar en cuenta ante hallazgos atípicos de los orificios de entrada y salida de los proyectiles, mediante la presentación y abordaje de un caso clínico.

Abstract Firearm projectile injuries are defined as the effects produced on the body by shots fired with weapons loaded with projectiles or various types of gunpowder or other explosives. The legal medical assessment in these cases, in living persons, is carried out in the Forensic Medical Clinical Section of the Department of Legal Medicine of the Organismo de Investigación Judicial, this includes the legal medical history, physical examination, analysis of medical documents provided, expert carried out and bibliography review, this to have all the elements of judgment that allow an objective analysis based on scientific evidence, and thus be able to answer the questions of the Judicial Authority. This article covers some of the main aspects to be considered when faced with atypical findings of the entry and exit holes of the projectiles, through the presentation and approach of a clinical case. Ver bases de datos

Tromboembolismo pulmonar como posible reacción adversa a Quetiapina Reporte de caso / Pulmonary thromboembolism as a possible adverse reaction to Quetiapine Case report

Resumen Algunos estudios sugieren que existe una relación entre el uso de antipsicóticos y el riesgo de tromboembolismo venoso (TEV) y embolia pulmonar (EP). Sin embargo, los resultados siguen sin ser concluyentes. Se trata del caso de un Masculino de 23 años con antecedentes de Esquizofrenia y Depresión tratado quetiapina 800 mg, el cual es encontrado muerto en la cama de un hotel. En la necropsia sin lesiones traumáticas visibles, hallazgos histológicos de tromboembolismo pulmonar masivo con infartos pulmonares secundarios. Laboratorio de Toxicología detectó la presencia de quetiapina, no se detectó alcohol o drogas de abusos. Mediante el Algoritmo De Karch & Lasagna Modificado el tromboembolismo pulmonar fue una reacción adversa con una probabilidad de relación causal posible. Se han informado muchos casos de muerte súbita causada por EP con la exposición a antipsicóticos, pero la relación de su uso y el riesgo de TEV y EP sigue siendo controvertida.

Abstract Some studies suggest a relationship between antipsychotic use and the risk of venous thromboembolism (VTE) and pulmonary embolism (PE). However, the results remain inconclusive. This is the case of a 23-year-old male with a history of schizophrenia and depression treated with quetiapine 800 mg, who was found dead in a hotel bed. At necropsy with no visible traumatic lesions, histological findings of massive pulmonary thromboembolism with secondary pulmonary infarcts. Toxicology laboratory detected the presence of quetiapine, no alcohol or drugs of abuse were detected. Using the Modified Karch & Lasagna Algorithm, pulmonary thromboembolism was an adverse reaction with a probable causal relationship. Many cases of sudden death caused by PE have been reported with exposure to antipsychotics, but the relationship of their use and the risk of VTE and PE remains controversial.

Hemotórax mortal secundario a lesiones de arterias intercostales posteriores: Reporte de caso / Fatal hemothorax secondary to posterior intercostal artery injuries: case report

Resumen La lesión de la arteria intercostal es un diagnóstico diferencial poco sospechado. Puede complicarse con una inestabilidad hemodinámica por un hemotórax o un hematoma intratorácico, lo que contribuye a su morbilidad y mortalidad. Se reporta el caso de un paciente de 61 años sin antecedentes patológicos conocidos que acudió al servicio de urgencias por dolor asociado a dificultad respiratoria posterior a un trauma torácico cerrado por caída de 8 días de evolución. Los estudios de imagen revelaron un hemotórax derecho, que ameritó la colocación de un tubo pleural. Se realizó una laparotomía exploratoria sin evidencia de hemorragias ni colecciones intrabdominales, y que posteriormente falleció. En el examen de necropsia se evidenciaron fracturas del noveno y décimo arco costal posterior derecho, asociado a un hematoma. El hemotórax secundario a la lesión de la arteria intercostal es poco frecuente, pero es una emergencia que requiere un diagnóstico asertivo y una intervención oportuna.

Abstract Intercostal artery injury is a poorly suspected differential diagnosis. It can be complicated by hemodynamic instability due to hemothorax or intrathoracic hematoma, which contributes to morbidity and mortality. We report the case of a 61-year-old patient with no pathological history known, who was presented to the emergency department for pain associated with respiratory distress following a blunt chest trauma due to a fall 8 days earlier. The Imaging studies revealed a right hemothorax, which required the placement of a pleural tube. An exploratory laparotomy was performed without evidence of bleeding or intra-abdominal collections, and he subsequently died. The necropsy examination revealed fractures of the ninth and tenth right posterior costal arch, associated with a posterior costal hematoma. The hemothorax that is secondary to an intercostal artery injury is rare, but it is an emergency that requires assertive diagnosis and timely intervention.

Effects of High-Intensity Interval Training on Inflammatory Biomarkers in Patients with Type 2 Diabetes. A Systematic Review.

BACKGROUND: Due to the prevalence and incidence worldwide of type 2 diabetes, and the significant role physical activity plays in these patients, a systematic review has been conducted to find out the effects that high-intensity interval training has on inflammatory biomarkers in subjects with type 2 diabetes. This project aims to determine the effect this training modality has on inflammatory biomarkers, in addition to observing its effects on the values of body composition and determining if this is a more effective, less effective or equally effective alternative to standard aerobic or resistance training. METHODS: A search was conducted in the months of November and December 2020 on different databases: Pubmed, WoS and PEDro. A protocol for this systematic review was registered in PROSPERO (Registration number: CRD42021281186). The studies selected met the previously defined inclusion criteria, and the methodological quality of the papers used was evaluated according to the Downs and Black Checklist. RESULTS: Out of 46 studies found, seven were included. The most relevant data concerning the characteristics of the clinical trials and HIIT characteristics, the values of body composition and the biomarkers under study were extracted from each study. Moreover, the results obtained from the different studies were described. CONCLUSIONS: HIIT could have an effect on inflammatory biomarkers. There is likely to be a relationship between changes in inflammatory profile and fat loss. A controlled diet may be a good complement to reduce the inflammatory profile. Further studies are required to determine whether HIIT is a better, worse or an equivalent alternative to medium-intensity aerobic exercise to improve the inflammatory profile.

Análisis comparativo de casos de suicidio por ahorcadura, precipitación e intoxicación atendidos en la Morgue Judicial en la provincia de Ancón, Panamá de marzo del 2019 a febrero de 2020 y marzo del 2020 a febrero de 2021 / Comparative analysis of suicide by hanging, precipitation and intoxication cases attended at the Judicial Morgue in the province of Ancón, Panama from March 2019 to February 2020 and March 2020 to February 2021

Resumen Introducción: La crisis por la Covid-19, en muchas maneras, podría exacerbar ciertas dimensiones del proceso suicida a través de su impacto psicológico, social, económico o, incluso, biológico. El estudio comparará los casos de suicidio por ahorcadura, precipitación e intoxicación atendidos en la morgue judicial de la provincia de Panamá, entre marzo del 2019 a febrero del 2020 y marzo del 2020 a febrero del 2021. Material y métodos: Se trata de un estudio descriptivo, transversal y retrospectivo; cuya población de análisis comprende todas las autopsias médico-legales realizadas en la Morgue Judicial de Panamá por casos de ahorcadura, precipitación e intoxicación, de marzo del 2019 a febrero del 2021. Resultados: En el estudio se registró un total de 117 casos. De estos, 73 practicados de marzo del 2019 a febrero del 2020, de los cuales el 78 % (n=57) correspondió al sexo masculino, con una media de 41 años, y el 22 % (n=16) al sexo femenino, con una media de 36 años; mientras que, en el lapso de marzo del 2020 a febrero del 2021 la muestra fue de 44 casos, lo que representó el 93 % (n=41), de sexo masculino, con una media de 42 años y el 7 % (n=3) de sexo femenino, con una media de 47 años. Conclusión: Durante el año posterior al inicio de la pandemia y la aplicación de las medidas de cuarentena en la provincia de Panamá hubo una disminución de la frecuencia de los casos de suicidios por ahorcadura e intoxicación en comparación con el año previo y un aumento en cuanto a los casos por precipitación.

Abstract Introduction: The Covid-19 crisis in many ways could exacerbate certain dimensions of the suicidal process through its psychological, social, economic or even biological impact. In this study we will compare the cases of suicide by hanging, precipitation and intoxication carried out in the Judicial Morgue of Ancon from March 2019 to February 2020 and from March 2020 to February 2021. Materials and methods: This is a descriptive, cross-sectional and retrospective study; the population studied will be all the medicolegal autopsies performed in the Judicial Morgue of Panama, due to hanging, precipitation and intoxication in the period from March 2019 to February 2021. Results: A total of 117 cases were recorded in this period studied; 73 cases from March 2019 to February 2020 of which 78% (n=57) corresponded to the male sex, with an average of 41 years and 22% (n=16) to the female sex, with an average of 36; while, in the period from March 2020 to February 2021, of the sample of 44 cases 93% (n=41) corresponded to the male sex, with an average of 42 and 7% (n=3) to the female sex, with an average of 47 years. Conclusión: During the year after the beginning of the pandemic and the quarantine measures in the Province of Panama, there was a decrease in the frequency of suicide cases by hanging, precipitation and intoxication compared to the previous year.

Influence of ACE Gene I/D Polymorphism on Cardiometabolic Risk, Maximal Fat Oxidation, Cardiorespiratory Fitness, Diet and Physical Activity in Young Adults.

There is controversy about the relationship between ACE I/D polymorphism and health. Seventy-four healthy adults (n = 28 women; 22.5 ± 4.2 years) participated in this cross-sectional study aimed at determining the influence of ACE I/D polymorphism, ascertained by polymerase chain reaction, on cardiometabolic risk (i.e., waist circumference, body fat, blood pressure (BP), glucose, triglycerides, and inflammatory markers), maximal fat oxidation (MFO), cardiorespiratory fitness (maximal oxygen uptake), physical activity and diet. Our results showed differences by ACE I/D polymorphism in systolic BP (DD: 116.4 ± 11.8 mmHg; ID: 116.7 ± 6.3 mmHg; II: 109.4 ± 12.3 mmHg, p = 0.035) and body fat (DD: 27.3 ± 10.8%; ID: 22.6 ± 9.7%; II: 19.3 ± 7.1%, p = 0.030). Interestingly, a genotype*sex interaction in relativized MFO by lean mass (p = 0.048) was found. The DD polymorphism had higher MFO values than ID/II polymorphisms in men (8.4 ± 3.0 vs. 6.5 ± 2.9 mg/kg/min), while the ID/II polymorphisms showed higher R-MFO values than DD polymorphism in women (6.6 ± 2.3 vs. 7.6 ± 2.6 mg/kg/min). In conclusion, ACE I/D polymorphism is apparently associated with adiposity and BP, where a protective effect can be attributed to the II genotype, but not with cardiorespiratory fitness, diet and physical activity. Moreover, our study highlighted that there is a sexual dimorphism in the influence of ACE I/D gene polymorphism on MFO.

Pleistocene aridification underlies the evolutionary history of the Caribbean endemic, insular, giant Consolea (Opuntioideae).

PREMISE: The Caribbean islands are in the top five biodiversity hotspots on the planet; however, the biogeographic history of the seasonally dry tropical forest (SDTF) there is poorly studied. Consolea consists of nine species of dioecious, hummingbird-pollinated tree cacti endemic to the West Indies, which form a conspicuous element of the SDTF. Several species are threatened by anthropogenic disturbance, disease, sea-level rise, and invasive species and are of conservation concern. However, no comprehensive phylogeny yet exists for the clade. METHODS: We reconstructed the phylogeny of Consolea, sampling all species using plastomic data to determine relationships, understand the evolution of key morphological characters, and test their biogeographic history. We estimated divergence times to determine the role climate change may have played in shaping the current diversity of the clade. RESULTS: Consolea appears to have evolved very recently during the latter part of the Pleistocene on Cuba/Hispaniola likely from a South American ancestor and, from there, moved into the Bahamas, Jamaica, Puerto Rico, Florida, and the Lesser Antilles. The tree growth form is a synapomorphy of Consolea and likely aided in the establishment and diversification of the clade. CONCLUSIONS: Pleistocene aridification associated with glaciation likely played a role in shaping the current diversity of Consolea, and insular gigantism may have been a key innovation leading to the success of these species to invade the often-dense SDTF. This in-situ Caribbean radiation provides a window into the generation of species diversity and the complexity of the SDTF community within the Antilles.

Maximal fat oxidation capacity is associated with cardiometabolic risk factors in healthy young adults.

It is unknown whether resting fat oxidation (RFO), maximal fat oxidation (MFO) and FatMax (intensity at which MFO is reached) are related to cardiometabolic risk (CMR). Thus the aim of this study was to examine the association of RFO, MFO and FatMax with CMR. 81 healthy adults (n = 31 women; 22.72 ± 4.40 years) participated in this cross-sectional study. Glucose and triglycerides were analysed in plasma. Body composition, anthropometry, physical activity, blood pressure (BP) and heart rate measurements were taken. RFO and MFO were determined through indirect calorimetry. Maximal oxygen uptake (VO2max) test was performed until exhaustion after MFO test. The CMR cluster was created from individual CMR factors: waist circumference, body fat percentage, systolic BP, diastolic BP, blood glucose and plasma triglycerides. Groups of high and low MFO and VO2max were created. RFO was not associated with CMR (p < 0.05). FatMax, MFO and VO2max were associated with individual CMR factors as waist circumference (R2 = 0.144; R2 = 0.241; R2 = 0.285; p = 0.001; respectively) and plasma triglycerides (R2 = 0.111; p = 0.004 and R2 = 0.130; p = 0.002 and R2 = 0.093; p = 0.008; respectively) and clustered CMR factors (R2 = 0.105; p = 0.008 and R2 = 0.162; p = 0.001 and R2 = 0.239; p = 0.001; respectively). VO2max was also associated with body fat percentage (R2 = 0.105; p = 0.003) and diastolic BP (R2 = 0.083; p = 0.01), even adjusting for sex or age (p < 0.05). Groups with high level of MFO or VO2max obtained lower CMR (p = 0.001), even adjusting for sex or age (p < 0.01). FatMax, MFO and, especially, VO2max are associated with CMR, regardless of age and sex. However, RFO is not associated with CMR.

Impacto de la gastrectomía vertical sobre la cinética de consumo de oxígeno en mujeres post cirugía bariátrica / Impact of sleeve gastrectomy on the kinetics of oxygen consumption in women after bariatric surgery

Introducción: La obesidad es considerada uno de los principales problemas de salud de la sociedad moderna, existiendo variados tratamientos para revertirla, siendo la cirugía bariátrica (CB) el método más efectivo en los casos de obesidad severa. La capacidad cardiorrespiratoria (CCR) es un componente de la condición física valorada a través del consumo máximo de oxígeno (VO2max); la cinética del VO2 es un aspecto poco estudiado de la CCR; se ha descrito que esta variable permite estimar la CCR sin elevados esfuerzos físicos en comparación con otras formas de evaluación; a pesar de lo anterior, no existe información respecto del impacto que tiene la gastrectomía vertical (GV) sobre la CCR evaluada a través de esta variable. Objetivo: Determinar el impacto de la GV en la cinética del VO2 de mujeres con obesidad. Material y método: Estudio de tipo cuasi experimental, participaron 15 mujeres con edad de 32,9±10,3 años y un IMC inicial de 35,2 ± 3,9 kg/m2. La muestra es de tipo no probabilística a través de grupo de voluntarios evaluados en tres momentos: previo a la cirugía (pre), 30 y 90 días post gastrectomía vertical (30post y 90post respectivamente). Se evaluó peso corporal, índice de masa corporal (IMC), circunferencia cintura (CC), VO2peak y cinética del VO2. Resultados: Post cirugía las variables peso corporal, CC e IMC reportan disminución significativa (p < 0,001) respecto del momento pre-cirugía. El VO2peak relativo (ml/kg/min) aumentó entre 30post y 90post (p < 0,001); el VO2peak absoluto (L/min) disminuyó entre los momentos pre con 30post y pre con 90post (p < 0,05); la cinética del VO2 presentó un incremento del tiempo a los 30post (p < 0,05). Conclusión: La cinética del VO2 se ve incrementada en mujeres obesas intervenidas con GV a los 30 días post cirugía, lo que evidencia un deterioro de la capacidad cardiorrespiratoria

Introduction: Obesity is considered one of the main health problems of modern society, there are several treatments to reverse it, being bariatric surgery (BS) the most effective method in cases of severe obesity. Cardiorespiratory fitness (CRF) is an aspect of physical condition assessed through maximum oxygen consumption (VO2max); the kinetics of VO2 is a less studied aspect of CRF; it has been described that this variable allows estimation of the CRF without high physical efforts in comparison with other forms of evaluation; In spite of the above, there is no information regarding the impact that sleeve gastrectomy (SG) has on the CRF evaluated through this variable.Objective: To determine the impact of SG on the VO2 kinetics of women with obesity. Material and method: Quasi-experimental study, 15 women with an age of 32,9 ± 10,3 years and an initial BMI of 35,2 ± 3,9 kg/m2 participated. The sample is non-probabilistic through a group of volunteers evaluated at three times: before surgery (pre), 30 and 90 days post vertical gastrectomy (30post and 90post respectively). Body weight, body mass index (BMI), waist circumference (WC), VO2peak and VO2 kinetics were evaluated. Results: After surgery, the variables body weight, CC and BMI reported a significant decrease (p < 0,001) compared to the pre-surgery moment. The relative VO2peak (ml/kg/min) increases between 30post and 90post (p < 0,001); the absolute VO2peak (L/min) decreased between the pre moments with 30post and pre with 90post (p < 0,05); the kinetics of VO2 showed an increase intime at 30post (p < 0,05). Conclusion: The VO2 kinetics is increased in obese women undergoing SG at 30post surgery, which shows a deterioration of this capacity

Paragangliomas bilaterales del cuerpo carotideo / Bilateral paragangliomas of the carotid body

El paraganglioma del cuerpo carotideo, lo describe la literatura universal, como una neoplasia muy rara que se origina a partir de las células tipo I del glomus carotideo normal, presente en la bifurcación de la carótida común. Afecta ambos sexos proporción 3:1 a predominio femenino con un bajo potencial de malignidad. Se ha relacionado con vivir en las alturas. Los tumores paraganglionares carotideos son de poca frecuencia, lo que hace importante su presentación. Se trata de un paciente masculino de 52 años de edad, de color de piel blanca, el cual comenzó a notar un aumento de volumen en ambos lados del cuello. Al examen físico se palparon tumoraciones pulsátiles en ambas regiones laterales del cuello con signo de Fontaine positivo. Al estudio por ultrasonido doppler se constataron masas hipervascularizadas a ambos lados del cuello, la mayor del lado izquierdo, las cuales recibían aferencias por ramas de la carótida externa. El diagnóstico temprano es de suma importancia y es la imagenología el procedimiento que facilita esta condición ya que proporciona diagnósticos más sensibles y específicos, que permite la detección del tumor incluso antes de ser palpable. El tratamiento definitivo fue quirúrgico con buenos resultados(AU)

International literature describes the paranganglioma of the carotid body as a very rare neoplasia that originates in type I cells of the normal carotid glomus present in the bifurcation of the common carotid. It affects both sexes at a ratio of 3 to 1, being predominant in females with low malignancy potential. It has also been related to living in high places. Carotid ganglionic tumors are infrequent, so their presentation is significant. This is a 52 years-old Caucasian male patient, who noticed swellings at both sides of the neck. On the physical examination, pulsating tumors were detected in both sides of the neck with positive Fontaine's sign. The color Doppler ultrasound revealed the existence of hypervascularized masses at both sides of the neck, being the largest those located on the left side, which received afferents through the external carotid branches. Early diagnosis is of utmost importance and imaging is the method that makes it easier to detect this condition and that provides the most sensitive and specific diagnosis, thus leading to the detection of a tumor even before it becoming palpable. Surgical treatment is the therapy of choice with good results(AU)

Paragangliomas bilaterales del cuerpo carotideo / Bilateral paragangliomas of the carotid body

El paraganglioma del cuerpo carotideo, lo describe la literatura universal, como una neoplasia muy rara que se origina a partir de las células tipo I del glomus carotideo normal, presente en la bifurcación de la carótida común. Afecta ambos sexos proporción 3:1 a predominio femenino con un bajo potencial de malignidad. Se ha relacionado con vivir en las alturas. Los tumores paraganglionares carotideos son de poca frecuencia, lo que hace importante su presentación. Se trata de un paciente masculino de 52 años de edad, de color de piel blanca, el cual comenzó a notar un aumento de volumen en ambos lados del cuello. Al examen físico se palparon tumoraciones pulsátiles en ambas regiones laterales del cuello con signo de Fontaine positivo. Al estudio por ultrasonido doppler se constataron masas hipervascularizadas a ambos lados del cuello, la mayor del lado izquierdo, las cuales recibían aferencias por ramas de la carótida externa. El diagnóstico temprano es de suma importancia y es la imagenología el procedimiento que facilita esta condición ya que proporciona diagnósticos más sensibles y específicos, que permite la detección del tumor incluso antes de ser palpable. El tratamiento definitivo fue quirúrgico con buenos resultados(AU)

International literature describes the paranganglioma of the carotid body as a very rare neoplasia that originates in type I cells of the normal carotid glomus present in the bifurcation of the common carotid. It affects both sexes at a ratio of 3 to 1, being predominant in females with low malignancy potential. It has also been related to living in high places. Carotid ganglionic tumors are infrequent, so their presentation is significant. This is a 52 years-old Caucasian male patient, who noticed swellings at both sides of the neck. On the physical examination, pulsating tumors were detected in both sides of the neck with positive Fontaine's sign. The color Doppler ultrasound revealed the existence of hypervascularized masses at both sides of the neck, being the largest those located on the left side, which received afferents through the external carotid branches. Early diagnosis is of utmost importance and imaging is the method that makes it easier to detect this condition and that provides the most sensitive and specific diagnosis, thus leading to the detection of a tumor even before it becoming palpable. Surgical treatment is the therapy of choice with good results(AU)

Utilidad de la ecografía abdominal en el diagnóstico del aneurisma de la aorta abdominal y sus complicaciones / Advantages of the abdominal echocardiography in the diagnosis of abdominal aortic aneurysm and its complications

Introducción: la ecografía de la aorta abdominal tiene un lugar relevante en el diagnóstico y seguimiento de los aneurismas abdominales y de sus complicaciones, por lo que el empleo de las técnicas de diagnóstico por imágenes ha cambiado el enfoque sobre el manejo de muchas afecciones en angiología. Objetivo: demostrar la utilidad de la ecografía en la confirmación del diagnóstico clínico de aneurisma de la aorta abdominal y sus complicaciones. Métodos: se realizó un estudio descriptivo longitudinal en 56 pacientes atendidos en el Instituto Nacional de Angiología y Cirugía Vascular, con el diagnóstico ultrasonográfico de aneurisma de la aorta abdominal. Se tuvo en cuenta las siguientes variables: el sexo, el diámetro anteroposterior, la distancia de la mesentérica, la localización, la toma de las renales, de las iliacas, si hubo ruptura, líquido libre o hematoma.Resultados: los aneurismas grandes de más de 5 cm fueron los que predominaron con 42,86 por ciento, su localización fue infrarrenal en el 94,64 por ciento de los casos. La luz excéntrica se observó en el 60,71 por ciento sobre todo en los aneurismas grandes (30,36 por ciento); a menos de 20 mm de la mesentérica superior hubo cuatro casos con toma renal, nueve casos (16,07 por ciento) con toma de las iliacas, cuatro casos con toma bilateral. Un caso con aneurisma grande presentó complicaciones. Conclusiones: los estudios ultrasonográficos de la aorta abdominal confirmaron la presencia de aneurisma aórtico, sus características y complicaciones asociadas; lo que determinó la conducta terapéutica(AU)

Introduction: echocardiography of the abdominal aorta has a relevant place in the diagnosis and tracking of the abdominal aneurysms; and its complications; hence the use of the diagnostic imaging techniques has changed the approach to the management of many illnesses in Angiology. Objective: to show the advantages of echocardiograpy in confirming the clinical diagnosis of the abdominal aortic aneurysm and its complications in patients seen at the National Institute of Angiology and Vascular Surgery. Methods: longitudinal descriptive study of 56 patients, with ultrasonographic diagnosis of abdominal aortic aneurysm. following variables were used: sex, anteroposterior diameter, distance of the mesenteric, location, the renal overtaking, iliac overtaking, if there was rupture, liquid free in abdominal cavity or hematoma.Results: big aneurysms measuring over 5 cm predominated in 42.86 percent of cases and their infrarenal location was found in 94.64 percent of the cases. The eccentric light observed in the 60.71 percent in them big aneurysms itself most of all (30.36 percent); To there was less than the superior mesenteric 20 mm four cases with renal take, nine cases (16.07 percent) with take of iliac artery, four cases with bilateral take. A case with big aneurysm presented complications. Conclusions: the ultrasonographic studies of the abdominal aorta confirmed the presence of aortic aneurysm, its characteristics and correlated complications, all of which determined the therapy to be followed(AU)

Aspectos clínicos y epidemiológicos de los aneurismas de la aorta abdominal / Epidemiologic and clinical aspects of the abdominal aortic aneurysms

Introducción: el aneurisma de la aorta abdominal es una afección frecuente e importante en angiología , de ahí su valor clínico. Objetivo: describir algunos aspectos clínicos y epidemiológicos de los aneurismas de la aorta abdominal según sexo y tamaño del aneurisma. Métodos: estudio descriptivo longitudinal en 56 pacientes, mayores de 55 años, con el diagnóstico clínico y ultrasonográfico de aneurisma de la aorta abdominal. Se analizaron algunos aspectos clínicos y epidemiológicos. Se trabajó con las siguientes variables: edad, sexo, localización y tamaño del aneurisma, y factores de riesgo cardiovasculares. Resultados: se apreció una mayor frecuencia de aneurismas después de los 60 años en el sexo masculino, sobre todo en el grupo de edades entre 70 y 79 años (35,71 por ciento). Se encontró que el 32,14 por ciento de los pacientes eran asintomáticos, mientras que el tumor palpable (37,5 por ciento) y el dolor abdominal (19,64 por ciento) fueron los hallazgos clínicos más frecuentes. Se observó un predominio de hipertensión arterial (64,29 por ciento) y de tabaquismo (67,86 por ciento). El 56,5 por ciento de los pacientes con aneurismas grandes tenía dos factores de riesgo, pero aquellos con aneurismas muy pequeños (45,8 por ciento) presentaban un solo factor. Se encontró un predominio de los aneurismas de localización infrarrenal en 53 casos.Conclusiones: los aneurismas de la aorta abdominal predominaron en pacientes mayores de 60 años, sobre todo si son hipertensos y fumadores, factores importantes a tener en cuenta aunque el paciente sea asintomático(AU)

Introduction: the abdominal aortic aneurysm is a frequent and important illness of clinical value in angiology.Objective: to describe some clinical and epidemiological aspects of the abdominal aortic aneurysms according to sex and size of the aneurysm. Methods: longitudinal descriptive study of 56 patients aged over 55 years, with clinical and ultrasonographic diagnosis of abdominal aortic aneurysm. Some clinical and epidemiological aspects were analyzed. The following variables were used such as age, sex, location and size of aneurysm, and cardiovascular risk factors.Results: aneurysms were more frequent in males aged over 60 years, mainly in 70-79 years (n= 26, 35.71 percent). It was found that 32.14 percent of patients were asymptomatic, whereas the palpable tumor (37.5 percent) and abdominal pain (19.64 percent) were the most common findings. Hypertension (64.29 percent) and smoking (67.86 percent) predominated. The 56.5 percent of patients with big aneurysms presented with two factors, but those with very small aneurysms (45.8 percent) presented just one. It was observed that infrarenal aneurysms were predominant, with 53 cases.Conclusion: the abdominal aortic aneurysm predominated in patient older than 60 years, mainly if they are hypertensive and smoker, which are important factors to bear in mind in asymptomatic patients(AU)

Colonic duplication: another suspected diagnosis in a prenatal ultrasound with double bubble sign.

Alimentary tract duplication is a rare congenital malformation that usually presents with gastrointestinal obstruction. Colonic duplication is associated with other anomalies as duplication of the anus and genitourinary tract. It is uncommon and very few cases have been reported were a colonic duplication is associated with intestinal malrotation. We present a case of a newborn that presented with a double bubble sign in a prenatal ultrasound that resulted to be the colonic duplication and not the typical duodenal obstruction.

Carotid endarterectomy in the era of endovascular therapy: still the gold standard.

BACKGROUND: Carotid stenosis is the most common cause of ischemic stroke and is managed by carotid endarterectomy. We report our ten-year results of carotid surgery for stenosis and kinking of the internal carotid artery (ICA). METHODS: Four hundred sixty nine patients underwent surgery: 306 localized carotid endarterectomy, 107 extensive endarterectomy, 18 shortening of the ICA plus endarterectomy, 42 endarterectomy plus coronary artery bypass, 11 endarterectomy plus bypass to another cervical artery, and 1 endarterectomy with aortic valve replacement. RESULTS: Three patients had an ipsilateral stroke, 2 due to technical reasons and one for a stroke in evolution. Six had transient facial nerve dysfunction, 2 division of the hypoglossal nerve and one vocal cord paralysis. Thirty-one patients died, 16 during the hospital stay and 15 during the follow up. CONCLUSIONS: The short and long-term results of carotid endarterectomy are excellent. Carotid endarterectomy remains the "gold standard" for the treatment of carotid stenosis.

Species identification of Crassostrea and Ostrea oysters by polymerase chain reaction amplification of the 5S rRNA gene.

A specific multiplex polymerase chain reaction (PCR) was developed for the identification of Crassostrea angulata, C. gigas, Ostrea edulis, and O. stentina oyster species. Universal primers were used for the amplification of complete repetition units of 5S rDNA in each of the 4 species. The alignment of the obtained sequences was the basis for the specific design of species-specific primers (ED1, ED2, ST1, ST2, CR1, and CR2) located in the nontranscribed spacer regions. The different sizes of the species-specific amplicons, separated by agarose gel electrophoresis, allowed identification of Crassostrea and Ostrea species. A multiplex PCR with a set of the 6 designed primers showed that they did not interfere with each other and bound specifically to the DNA target. This genetic marker can be very useful for traceability of the species, application in the management of oyster cultures, and conservation of the genetic resources of the species.