¿Anestesia halogenada o anestesia total endovenosa en neurocirugía? / Volatile or total intravenous anesthesia for neurosurgery?

Total intravenous anesthesia (TIVA) with propofol/remifentanil appears in the literatura as a good option for neurosurgical patients who have increased intracranial pressure (ICP),risk of postoperative nausea and vomiting (PONV), need for neuromonitoring, and in those with impaired brain self-regulation. On the other hand, in patients with normal neurological status, normal ICP, a technique with volatile (halogenated) agents plus an opiiid can be used. This review describes two anesthetic techniques available for use in neurosurgery, highlighting the neurophysiological changes, advantages and disadvantages of each technique. MATERIAL AND METHOD: PubMed search engine was used for bibliographic search. DISCUSSION: The search for an ideal anesthetic in neurosurgery is still a matter of debate. There are numerous investigations aimed at finding an optimal agent that ensure the coupling between cerebral flow (CBF) and metabolism, keeping self-regulation intact without increasing the CBF and intracerebral pressure (ICP). CONCLUSIONS: Both anesthetic techniques, TIVA and volatile agents (halogenated), can be used in neurosurgical procedures and should provide neuroprotection, brain relaxation and a rapid awakening.

La anestesia total endovenosa (TIVA) con propofol/remifentanilo aparece en la literatura como una buena opción para pacientes neuroquirúrgicos que tienen aumento de la presión intracraneana (PIC), riesgo de náuseas y vómitos posoperatorios (NVPO), necesidad de neuromonitoreo, y en aquellos con alteración de la autorregulación cerebral. Por otra parte, en pacientes con estado neurológico normal, PIC normal puede usarse una técnica con agentes volátiles (halogenados) más un opioide. Esta revisión describe dos técnicas anestésicas disponibles para su uso en neurocirugía, destaca los cambios neurofisiológicos, ventajas y desventajas de cada técnica. MATERIAL Y MÉTODO: Para búsqueda bibliográfica se usó buscador PubMed. DISCUSIÓN: La búsqueda de un anestésico ideal en neurocirugía sigue siendo tema de debate. Existen numerosas investigaciones destinadas a buscar un agente óptimo que asegure el acoplamiento entre flujo sanguíneo cerebral (FSC) y metabolismo, manteniendo la autorregulación intacta sin aumentar el FSC y presión intracerebral (PIC). CONCLUSIONES: Ambas técnicas anestésicas, TIVA y agentes volátiles (halogenados), pueden ser usadas en procedimientos neuroquirúrgicos y deben brindar neuroprotección, relajación cerebral y un despertar rápido.

Cambio de imagen facial en base a rinoseptoplastía y cirugía ortognática: resultados preliminares / Facial makeover based in rhinoplasty and orthognathic surgery. preliminary results

RESUMEN Introducción: La cirugía ortognática y la rinoplastia son procedimientos consolidados con altas tasas de éxito. La sinergia entre ambos procedimientos ha sido presentada en diferentes investigaciones pero aún no es un procedimiento estándar para pacientes con deformidades faciales. Objetivo: Analizar una serie de casos tratados con cirugía ortognática y rinoplastia y discutir las opciones y fundamentos de la técnica combinada. Material y método: 14 pacientes operados de forma consecutiva fueron incluidos en el estudio. Se identificaron sujetos según el tipo de deformidad facial, el tipo de deformidad nasal y los tipos de cirugías realizadas. El seguimiento mínimo de cada sujeto fue de 12 meses. Resultados: El 50% de los sujetos presentaba deformidad facial de clase III, seguido de deformidades de clase II y I. Las deformidades nasales, de la punta y del puente nasal fueron más prevalentes, siendo el ancho nasal también una deformidad común. En la etapa intraoperatoria, después de realizar la cirugia ortognática, fue necesario realizar un análisis nuevo respecto de la morfologia nasal debido a los cambios que generaba el movimiento maxilar en la condición nasal. Conclusión: La cirugía combinada es sinérgica y viable de ser realizada con bajo número de complicaciones; protocolos y nuevos criterios de análisis son necesarios para obtener mayor predictibilidad en los resultados estéticos.

ABSTRACT Introduction: Orthognathic surgery and rhinoplasty are procedures with high success rate. The synergy between both surgeries has been showed in the past by researches but still they are not standardized procedures for the treatment of patients with facial deformities. Aim: To analyze a case series treated with orthognathic surgery and rinoplasty in the same surgical time, discussing surgical options and techniques in the combined procedure. Material and method: 14 patients were treated consecutively and were included in this research. Subjects were selected by facial deformity, nasal deformity and type of surgery. Minimal follow up was for 12 months to observe results. Results: 50% of subjects showed class III facial deformity, follow by class II and class I facial deformity. In nasal deformities, tip and nasal bridge were more prevalent, being the nasal width a common deformity; in the intraoperative time, after orthognathic surgery, it was necessary to make a new analysis and approach to nasal morphology because the new conditions related to movement of the maxilla. Conclusion: Orthognathic and nasal surgery are good complement and it is possible to do with few complications; surgical protocol and criteria for the analysis are necessaries to obtain more predictability in the esthetic results.

Descompresión orbitaria endoscópica transnasal en orbitopatía tiroidea severa / Transnasal endoscopic orbital decompression in severe thyroid orbitopathy

RESUMEN La orbitopatía tiroidea es una enfermedad autoinmune, en la que una reacción inflamatoria genera aumento de la presión orbitaria con protrusión de su contenido. A menudo es autolimitada y sus síntomas más frecuentes son retracción palpebral, exoftalmo y diplopía. Existen casos severos con compromiso de la agudeza visual por compresión del nervio óptico. El diagnóstico es clínico, pero debe complementarse con una tomografía computarizada. Su tratamiento depende de la gravedad y actividad de la enfermedad, siendo los procedimientos quirúrgicos, como la descompresión orbitaria, de elección en exoftalmo y neuropatía óptica compresiva. El pilar de tratamiento en la orbitopatía tiroidea severa es la cirugía descompresiva. Se han descrito múltiples técnicas, pero con limitaciones. La descompresión endoscópica transnasal, es considerada actualmente el procedimiento de elección, ya que permite una buena visualización de la pared medial, con resultados comparables y menores complicaciones, respecto a métodos tradicionales. Describimos un caso de oftalmopatía tiroidea severa, con exoftalmo, diplopía y disminución de la agudeza visual, en la que se realizó una descompresión endoscópica con muy buenos resultados.

ABSTRACT Thyroid orbitopathy is an autoimmune disease in which an inflammatory reaction generates increased orbital pressure with protrusion of its contents. It is often self-limiting and its most frequent symptoms are eyelid retraction, exophthalmos and diplopia. There are severe cases with compromised visual acuity due to compression of the optic nerve. The diagnosis is clinical, but must be complemented with a computed tomography scan. Its treatment depends on the severity and activity of the disease and the surgicals procedures such as orbital decompression is the best choice in exophthalmos and compressive optic neuropathy. The treatment in severe thyroid orbitopathy is decompressive surgery. Multiple techniques have been described, but with limitations. The transnasal endoscopic decompression is currently considered the gold standard, since it allows a good visualization of the medial wall with comparable results and less complications, compared to traditional methods. We present a case of severe thyroid ophthalmopathy, with exophthalmos, diplopia and decreased visual acuity, in which a transnasal endoscopic decompression was performed with very good outcomes.

Cirugía hipofisiaria endoscópica transesfenoidal, con realización de colgajo nasoseptal: evaluación del impacto de la técnica en la olfación:. serie de casos / Endoscopic pitituary surgery transsphenoidal, with nasoseptal flap: assessment of the impact of the technique in the olfaction: cases series

Introducción: La cirugía endoscópica transesfenoidal en la exéresis de patología hipofisaria ha sido ratificada dentro de la mejores opciones para conseguir abordajes exitosos. Para cerrar la brecha ósea, se puede utilizar el colgajo nasoseptal, el cual lograría un cierre adecuado y seguro, evitando complicaciones como persistencia de fístulas de líquido cefalorraquídeo. Dentro de los probables efectos secundarios de este colgajo se señala la presencia de anosmia o hiposmia. Objetivo: Nuestro objetivo es mostrar los resultados obtenidos empleando la técnica del colgajo nasoseptal y la evaluación del olfato posoperatorio. Material y método: Incluimos 14 pacientes con diagnóstico de adenoma hipofisiario intervenidos en nuestro servicio entre diciembre 2014 a diciembre 2015. Se evaluaron diversos parámetros entre otros, olfatometría pre y posoperatorias. A todos se les realizó la técnica endoscópica transesfenoidal. Efectuando la disección del colgajo con la técnica tipo Hadad. La exéresis tumoral fue realizada por neurocirujano, se cubrió la osteotomía con este colgajo. Resultados: De los 14 pacientes, 13 llegaron al estado olfativo preoperatorio. 1 paciente se mantuvo hipósmico mantenidamente. En nuestro estudio, no hemos encontrado deterioro significativo en la calidad del sentido del olfato. Así como tampoco observamos otras complicaciones. Conclusiones: Esta experiencia aún inicial, estimamos que podría ya esbozar una tendencia de mantención de la función olfativa en este tipo de cirugía.

Introduction: Transsphenoidal endoscopic surgery resection of pituitary pathology has been ratified within the best options for successful approaches. To close the gap bone, you can use the nasoseptal flap, which achieved an adequate and secure closure, preventing complications such as persistent cerebrospinal fluid leaks. Among possible side effects of this flap anosmia-hyposmia noted. Aim: Our goal is to show the results obtained using the technique of nasoseptal flap and postoperative evaluation of smell. Material and method: We included 14 patients with a diagnosis of pituitary adenoma surgery in our department between December 2014 to December 2015. Various parameters were evaluated pre and post operative, specially olfactory function. All underwent transsphenoidal endoscopic technique. Performing dissection flap with the technical type Hadad. The tumor resection was performed by neurosurgeon, osteotomy covered with this flap. Results: Of the 14 patients, 13 reached the olfactory preoperative state. 1 patient remained with hyposmia. In our study, we found no significant deterioration in the quality of the sense of smell. Not other complications were found. Conclusions: This is an initial experience, and we estimate that could outline a trend of maintaining olfactory function in this surgery approach.

Atorvastatina y concentraciones de proteína C reactiva en mujeres con síndrome de ovarios poliquísticos y sobrepeso / Atorvastatin and c-reactive protein concentrations in overweight women with Polycystic ovary syndrome

Objetivo: Determinar los efectos de la atorvastatina sobre las concentraciones de proteína C reactiva (PCR) en mujeres con síndrome de ovarios poliquísticos (SOPQ) con sobrepeso. Método: Se seleccionaron 45 mujeres con diagnóstico de SOPQ. Se analizaron las concentraciones séricas de PCR, colesterol, triglicéridos, colesterol unido a lipoproteínas de alta densidad (HDL) y colesterol unido a lipoproteínas de baja densidad (LDL) antes y después de 6 meses de tratamiento con 20 mg/día de atorvastatina. Resultados: La edad promedio de las mujeres fue de 23,2 ± 2,8 años. El valor promedio del índice de masa corporal fue de 29,4 ± 4,8 kg/m2 y de la relación cintura cadera fue de 0,87 ± 0,07. Al comparar las concentraciones de lípidos plasmáticos se observó una disminución de 19,1% en las concentraciones de colesterol, 11% en las concentraciones de triglicéridos y 8,5% en las concentraciones de LDL (p < 0,05). Las concentraciones de PCR iniciales fueron de 24,2 ± 6,9 mg/dl. Posterior al tratamiento con atorvastatina, las concentraciones promedios de PCR fueron de 17,4 ± 5,8 mg/dl. Esta diferencia fue considerada estadísticamente significativa y superior al 39% (p < 0,05). No se reportaron efectos adversos severos.Conclusión: La atorvastatina produce disminución de las concentraciones de PCR en mujeres con SOPQ y sobrepeso

Objective: To determine the effects of atorvastatin on C-reactive protein (CRP) concentrations in overweight women with polycystic ovary syndrome (PCOS). Methods: Forty-five women with a diagnosis of PCOS were included. Serum concentrations of CRP, cholesterol, triglycerides, high-density lipoprotein cholesterol (HDL-c) and low-density lipoprotein cholesterol (LDL-c) were recorded before and after 6 months of atorvastatin therapy (20 mg/d). Results: The mean age of the women was 23.2 ± 2.8 years. The mean body mass index was 29.4 ± 4.8 Kg/m2and the mean waist/hip ratio was 0.87 ± 0.07. When lipid concentrations were compared, there were reductions of 19.1% in cholesterol concentrations, 11% in triglyceride concentrations and 8.5% in LDL-C concentrations (p < 0.05). The initial CRP value was 24.2 ± 6.9 mg/dl. After atorvastatin therapy, the CRP value was 17.4 ± 5.8 mg/dl. This difference was statistically significant and over 39% (p < 0.05). There were no severe side effects. Conclusion: Atorvastatin lowers CRP concentrations in overweight women with PCOS

THE FIRST TWENTY YEARS (1994-2014) OF OZONE SOUNDINGS FROM RAPA NUI (27°S, 109°W, 51 M A.S.L.).

Ozone (O3) soundings have been performed on Easter Island or Rapa Nui (27°S, 23 109°W, 51 m a.s.l.) since 1994 as part of the Global Atmospheric Watch (GAW) Programme of the World Meteorological Organization (WMO). In this work, we analyze 260 soundings compiled over the period 1994-2014, and make the data available for the international community. We characterize O3 profiles over this remote area of the Pacific by means of statistical analyses that consider, on the one hand, a traditional climatology that describes the data in terms of seasonal cycles based on monthly averages and, on the other hand, a process oriented analysis based on self-organizing maps. Our analyses show the influence of both tropical and subtropical/mid-latitude air masses at Rapa Nui. The former occurs in summer and fall when convective conditions prevail, and the latter in late winter and spring when subsiding conditions are recurrent. The occurrence of stratospheric intrusions in late winter and spring in connection with deep troughs and the presence of the subtropical jet stream is also apparent in the data set. The tropospheric ozone column is in good agreement with the corresponding data derived from satellites but with a systematic overestimate of summer and fall values. We show evidence of an upward trend in ozone near the surface, which suggests the impact of local pollution. We look forward to an enhancement of the Rapa Nui observing site, given its location that offers a privileged position to observe climate change over the sparsely sampled and vast South Pacific Ocean.

[Acute gastroenteritis caused by a Vibrio cholerae non-O1, non-O139 strain harboring a genetic region homologous to the VpaI-7 pathogenicity island]. / Gastroenteritis aguda causada por Vibrio cholerae no-O1, no-O139 que porta una región homologa a la isla de patogenicidad VpaI-7.

Pathogenic Vibrio cholerae isolates, the etiologic agents of cholera, generally express one of two O antigens (O1 or O139). Most environmental isolates are nonpathogenic and are referred to as "non-O1, non-O139". However some V. cholerae non-O1, non-O139 strains are clearly pathogenic and have caused outbreaks or sporadic cases of gastroenteritis and extraintestinal infections in humans. We report a case of acute gastroenteritis by a V. cholerae non-O1, non-O139 harboring a genetic region homologous to a segment of the VpaI-7 V. parahaemolyticus pathogenicity island.

Gastroenteritis aguda causada por Vibrio cholerae no-O1, no-O139 que porta una región homologa a la isla de patogenicidad VpaI-7 / Acute gastroenteritis caused by a Vibrio cholerae non-O1, non-O139 strain harboring a genetic region homologous to the VpaI-7 pathogenicity island

Pathogenic Vibrio cholerae isolates, the etiologic agents of cholera, generally express one of two O antigens (O1 or O139). Most environmental isolates are nonpathogenic and are referred to as "non-O1, non-O139". However some V. cholerae non-O1, non-O139 strains are clearly pathogenic and have caused outbreaks or sporadic cases of gastroenteritis and extraintestinal infections in humans. We report a case of acute gastroenteritis by a V. cholerae non-O1, non-O139 harboring a genetic region homologous to a segment of the VpaI-7 V. parahaemolyticus pathogenicity island.

Cepas patogénicas de Vibrio cholerae, el agente causal del cólera, expresan generalmente uno de dos antígenos O (denominados O1 u O139). La mayoría de las cepas ambientales son no patogénicas y corresponden al tipo denominado "no-O1, no-O139". Sin embargo, algunas cepas de este tipo son claramente patogénas y han causado brotes de gastroenteritis e infecciones extra-intestinales en humanos. Se reporta un caso clínico de gastroenteritis aguda causado por una cepa de V. cholerae no-O1, no-O139 que contiene en su genoma una región homóloga a un segmento de la isla de patogenicidad VpaI-7 descrita previamente en V. parahaemolyticus.

[Allergic sensitization profile in the immigrant population living in the central region of Spain]. / Perfil de sensibilización alérgica en inmigrantes residentes en la zona centro de España.

INTRODUCTION: The prevalence of allergic diseases has increased worldwide in the last two decades, particularly in developed countries. Respiratory allergy is determined by genetic heredity, influenced by environmental factors. Migration is a good epidemiological model for assessing the influence of the environment. We present the clinical characteristics of respiratory allergy in immigrants in the central region of Spain. METHODS: We prospectively collected data on all immigrants referred to the allergy units of 7 different hospitals in Madrid, Cuenca and Ciudad Real in March 2010. Respiratory Allergy was diagnosed using a standard study for allergic diseases. Results in immigrants were compared with data from a similar Spanish population. RESULTS: Sixty-two immigrants and 32 Spanish patients were evaluated (63% female, mean age 28.4 years). Their countries of origin were uniformly distributed among 3 macroareas (North of Africa, Latin America, and Eastern Europe). More than 96% presented rhinitis, although persistent rhinitis was more prevalent amongst Latin Americans (76.9%) than in the Spanish population (48%). No differences were observed in asthma prevalence, although immigrants had higher rates of non-controlled and partially controlled asthma. The mean time of onset of symptoms after immigration was 43 months. Grass pollen was the most relevant allergen with the exception of Arab patients. Sensitization to polcalcin was rare. Otherwise, 44.1% of the Spanish population was sensitized to profilin (only 4.88% among immigrants) although this sensitization did not associate allergy to fruits or other vegetables. CONCLUSIONS: In summary, a multicentric study is presented where significant differences have been observed in the sensitization pattern and clinical evolution of respiratory allergy in immigrants and the Spanish population.

Perfil de sensibilización alérgica en inmigrantes residentes en la zona centro de España / Allergic sensitization profile in the immigrant population living in the central region of Spain

Introducción. La prevalencia de las enfermedades alérgicas ha aumentado últimamente, especialmente en países industrializados. Puesto que la alergia está influenciada por factores genéticos y ambientales, la población inmigrante constituye un buen modelo epidemiológico para valorar influencia del ambiente. Presentamos las características clínicas de alergia respiratoria en población inmigrante del centro de España. Métodos. Se recogieron datos prospectivamente de 62 pacientes inmigrantes y 33 españoles que acudieron en marzo de 2010 a 7 hospitales de Madrid, Cuenca y Ciudad Real, diagnosticados de alergia respiratoria mediante un estudio alergológico estándar. Resultados. El 63% eran mujeres, edad media 28,4 años. Sus países de origen se distribuyeron en 3 grupos (Norte de África, Latinoamérica, Europa del Este). El 96% presentaban rinitis, aunque sólo el 48% de españoles frente al 76,9% de hispanos sufrían rinitis persistente. La prevalencia de asma fue similar, aunque entre hispanos el porcentaje de asma controlada fue menor. El tiempo de evolución fue menor en pacientes inmigrantes. El polen de gramíneas resultó el alérgeno más relevante salvo en pacientes árabes. La incidencia de sensibilización a polcalcina fue muy baja. Por el contrario, el 44,1% de españoles presentaban sensibilización aprofilina, frente al 4,88 de hispanos, aunque no implicaba sintomatología al tomar vegetales en la mayoría de casos. Conclusiones. Este estudio multicéntrico muestra diferencias significativas en tiempo de evolución y perfiles de sensibilización entre pacientes españoles e inmigrantes con alergia respiratoria. Además, diferencias en la expresión clínica de la rinitis y peor control del asma, pueden condicionar peor evolución clínica en el colectivo inmigrante(AU)

Introduction. The prevalence of allergic diseases has increased worldwide in the last two decades, particularly in developed countries. Respiratory allergy is determined by genetic heredity, influenced by environmental factors. Migration is a good epidemiological model for assessing the influence of the environment. We present the clinical characteristics of respiratory allergy in immigrants in the central region of Spain. Methods. We prospectively collected data on all immigrants referred to the allergy units of 7 different hospitals in Madrid, Cuenca and Ciudad Real in March 2010. Respiratory Allergy was diagnosed using a standard study for allergic diseases. Results in immigrants were compared with data from a similar Spanish population. Results. Sixty-two immigrants and 32 Spanish patients were evaluated (63% female, mean age 28.4 years). Their countries of origin were uniformly distributed among 3 macro areas (North of Africa, Latin America, and Eastern Europe). More than 96% presented rhinitis, although persistent rhinitis was more prevalent amongst Latin Americans (76.9%) than in the Spanish population (48%). No differences were observed in asthma prevalence, although immigrants had higher rates of non-controlled and partially controlled asthma. The meantime of onset of symptoms after immigration was 43 months. Grass pollen was the most relevant allergen with the exception of Arab patients. Sensitization to polcalcin was rare. Otherwise, 44.1% of the Spanish population was sensitized to profilin (only 4.88% among immigrants) although this sensitization did not associate allergy to fruits or other vegetables. Conclusions. In summary, a multicentric study is presented where significant differences have been observed in the sensitization pattern and clinical evolution of respiratory allergy in immigrants and the Spanish population(AU)

Inversed Y cardioplasty plus a truncal vagotomy-antrectomy and a Roux-en-Y gastrojejunostomy performed in patients with stricture of the esophagogastric junction after a failed cardiomyotomy or endoscopic procedure in patients with achalasia of the esophagus.

Laparoscopic anterior cardiomyotomy in addition to anterior Dor's fundoplication is the procedure of choice for achalasia of the esophagus with approximately 95% success rate. Redo cardiomyotomy is complicated and associated with rerecurrence of dysphagia. Twelve patients with failed redo myotomy were clinically evaluated with radiology, endoscopy, and manometry in whom achalasia type III or IV was confirmed. We propose as treatment for these selected cases an inversed Y cardioplasty + truncal vagotomy, a partial distal gastrectomy and Roux-en-Y gastrojejunostomy in order to facilitate esophageal emptying and avoid the appearance of postoperative gastroesophageal reflux as a side effect of this procedure. One patient was reoperated on in order to enlarge the cardioplasty. Disappearance of dysphagia was confirmed in all patients. Three patients presented reflux symptoms and were treated with 20 mg of Omeprazole 20 twice/day. No food retention, erosive esophagitis, or Barrett's esophagus were observed. The mean resting pressure decreased from 24.9 +/- 8.5 mm Hg to 7.5 +/- 2.5 mm Hg (P = 0.0001). Furthermore, esophageal diameter decreased significantly after a 5-year follow-up. This procedure could be an option for treating patients in which repeated Heller operations have failed.

[Probiotic properties of Lactobacillus spp isolated from gastric biopsies of Helicobacter pylori infected and non-infected individuals]. / Propiedades probióticas de Lactobacillus spp aislados de biopsias gástricas de pacientes con y sin infección por Helicobacter pylori.

BACKGROUND: Gastric microbiota is a complex ecosystem, composed by diverse microorganisms, where H pylori and Lactobacillus are relevant species. AIM: To study the probiotic properties of Lactobacillus spp isolated from gastric biopsies of subjects bearing or not H pylori. MATERIALS AND METHODS: Gastric biopsies from 197 individuals that consulted for gastrointestinal disorders were cultivated in media specific for H pylori and Lactobacillus spp. Probiotic properties of lactobacilli isolates and histological diagnosis of H pylori colonized patients were performed. RESULTS: Among 197 individuals evaluated, Hpylori was detected in 43%, Lactobacillus spp in 24%, while 8% presented both bacteria simultaneously. Forty one percent of the Lactobacillus spp strains produced hydrogen peroxide, S'3% presented a highly hydrophobic surface and 32% had an inhibitory effect upon Hpylori ATCC 43504, even greater than Lactobacillus LGG or LAL reference strains. The main pathological diagnosis of patients ivas chronic non-atrophic gastritis (73%) followed by intestinal metaplasia (19%). A similar proportion of both conditions were observed in patients colonized by Lactobacillus spp, while not colonized individuals developed preferentially chronic non-atrophic gastritis (p =0.002). CONCLUSIONS: Lactobacillus spp and H pylori were mutually excluded, suggesting a competitive colonization model between probiotic bacteria and pathogens .

Propiedades probióticas de Lactobacillus spp aislados de biopsias gástricas de pacientes con y sin infección por Helicobacter pylori / Probiotic properties of Lactobacillus spp isolated from gastric biopsies of Helicobacter pylori infected and non-infected individuals

Background: Gastric microbiota is a complex ecosystem, composed by diverse microorganisms, where H pylori and Lactobacillus are relevant species. Aim: To study the probiotic properties of Lactobacillus spp isolated from gastric biopsies of subjects bearing or not H pylori. Materials and Methods: Gastric biopsies from 197 individuals that consulted for gastrointestinal disorders were cultivated in media specific for H pylori and Lactobacillus spp. Probiotic properties of lactobacilli isolates and histological diagnosis of H pylori colonized patients were performed. Results: Among 197 individuals evaluated, Hpylori was detected in 43 percent, Lactobacillus spp in 24 percent, while 8 percent presented both bacteria simultaneously. Forty one percent of the Lactobacillus spp strains produced hydrogen peroxide, S'3 percent presented a highly hydrophobic surface and 32 percent had an inhibitory effect upon Hpylori ATCC 43504, even greater than Lactobacillus LGG or LAL reference strains. The main pathological diagnosis of patients ivas chronic non-atrophic gastritis (73 percent) followed by intestinal metaplasia (19 percent). A similar proportion of both conditions were observed in patients colonized by Lactobacillus spp, while not colonized individuals developed preferentially chronic non-atrophic gastritis (p =0.002). Conclusions: Lactobacillus spp and H pylori were mutually excluded, suggesting a competitive colonization model between probiotic bacteria and pathogens.

Conflicto decisional en salud en mujeres cuidadoras / Health decisional conflict in female care givers

Objetivos: la población de mujeres cuidadoras es un grupo que por sus características necesita especialmente ser estudiada respecto a las variables que están involucradas en los conflictos decisionales de salud a los que se enfrentan. Para ello se plantearon dos objetivos: captar la esencia de variables latentes de conflicto decisional en salud en mujeres cuidadoras informales. Construir tipologías de mujeres que experimentan este conflicto en salud, en una muestra de 50 mujeres de la Comuna de Concepción, Chile. Métodos: se realizó un estudio exploratorio, utilizando la técnica de análisis factorial para variables categóricas, seguido por un análisis de clasificación. Resultados: los resultados arrojaron 2 dimensiones, una que se interpretó como conocimientos para enfrentar el conflicto y la segunda como recursos personales que favorecen la toma de decisión. Conclusiones: el análisis de clasificación permitió identificar 4 grupos distintos de mujeres cuidadoras que enfrentan conflictos decisionales(AU)

Objetives: the population of female care givers is a group that due to their characteristics need to be specially studied as regards the variables involved in the health decisional conflicts they have to face. Two goals were established to this end: to capture the essence of latent variables of health decisional conflict in informal care givers, and to construct typologies of women experimenting this conflict in health, in a sample of 50 females from Comuna de la Concepción, Chile. Methods: an exploratory study was conducted by using the technique of factorial analysis for categorical variables, followed by a classification analysis. Results: the results showed 2 dimensions, one that was interpreted as knowledge to face the conflict and the second as personal resources that favor the decision-making. Conclusions: the classification analysis allowed to identify 4 different groups of female care givers that face decisional conflicts(AU)

Treatment of chronic anal fissure by gonyautoxin.

OBJECTIVE: The use of gonyautoxin has been reported to be safe and effective in healing acute and chronic anal fissures. This study was designed to show better efficacy in healing patients with chronic anal fissure by increasing the frequency of toxin injection. METHOD: Twenty-three chronic anal fissure patients were treated with doses of 100 units of gonyautoxin, which was intrasphincteric, infiltrated. The frequency of injection was every 4 days. Anorectal manometries were performed before and 4 min after infiltration. RESULTS: Total remissions were achieved within 7-14 days. The patients healed with a mean time of 8.2 +/- 2.4 days. No relapsed were observed during the 10-month follow up. Neither faecal incontinence nor other side effects were observed. All patients showed immediate sphincter relaxation detected by clinical examination. The maximum anal resting pressures, recorded 4 min after injections decreased to 62.9 +/- 27.7 mmHg, being 65.3 +/- 29.6% of baseline. Immediately after infiltration, patients reported anaesthetic effect with a fall down of the postdefecatory pain. CONCLUSION: Although, gonyautoxin anal fissures treatment recently published proved to be safe and effective, this study shows a better protocol for anal fissure treatment, showing better efficacy by shorting the healing time with better perception of healing by patients. Gonyautoxin anal sphincter infiltration proves to be safe and effective, reducing discomfort and healing time, advantageously comparing with alternative therapeutic approaches for chronic anal fissure.

Incontinencia urinaria de esfuerzo en la mujer. Comparación de la técnica de Raz y de la técnica de Bologna / Comparison of Raz bladder neck suspension and the Bologna procedure for the treatment of urinary stress incontinence

Nuestra situación es la de comparar las complicaciones y los resultados sobre la incontinencia de esfuerzo de 2 técnicas de suspensión cervicouretral: la técnica de Raz y la técnica de Bologna. Se ha evaluado retrospectivamente a 199 pacientes que se han beneficiado de un tratamiento de incontinencia urinaria de esfuerzo, bien mediante la técnica de Bologna (grupo 1, 99 pacientes), bien por la técnica de Raz (grupo 2, 100 pacientes). Los datos clínicos preoperatorios, los parámetros urodinámicos y las complicaciones postoperatorias se han comparado en cada uno de los 2 grupos. El margen entre el tratamiento de la incontinencia urinaria y la recidiva se ha comparado con los 2 grupos por un test logarítmico. Se fabricó un modelo multivariante con la ayuda de un modelo de Cox, a fin de exponer los parámetros explicativos del fracaso quirúrgico. La duración de la curación en el grupo 1 es significativamente más larga que en el grupo 2 (p = 0,00001). La mediana de duración del intervalo libre sin incontinencia (éxito) es de 51 meses en el grupo 1 y de 21 meses en el 2 (p = 0,00001). La frecuencia de las complicaciones operatorias (lesión vesical y hemorragia) y postoperatorias (hemorrágicas, infecciosas y embólicas) no difieren en los 2 grupos. El análisis multivariante según el modelo de Cox muestra que la única variable preoperatoria explicativa de las recidivas es la técnica de colposuspensión realizada: Raz y Bologna. Después de este estudio comparativo, la técnica de Bologna debe preferirse a la de Raz para tratar los pacientes con IUE por el hecho de la presencia de suficiente pared vaginal anterior para confeccionar las cinchas vaginales. Si tal no es el caso, la técnica de Raz, tal y como nosotros la habíamos practicado, se debe abandonar en beneficio de otros métodos de colposuspensión (AU)

The aim of this study was to evaluate and compare perioperative morbidity and the long-term results of Raz colposuspension and the Bologna procedure in the treatment of urinary stress incontinence in women. Data from 199 women who underwent either the Bologna procedure (group 1; n = 99) or Raz colposuspension (group 2; n =100) for urinary stress incontinence were retrospectively analyzed. Preoperative clinical data, urodynamic parameters and postoperative complications were compared between the two groups. Logarithmic analysis was used to compare time to recurrence of stress incontinence between the two groups. Multivariate analysis using a Cox proportional hazards regression model was performed to identify possible outcome predictors. The success rate was significantly higher in group 1 than in group 2 (p = 0.00001). The median incontinence- free interval was 51 months in group 1 and was 21 months in group 2 (p = 0.00001). No differences were found between the two groups in the frequency of intraoperative complications (inadvertent cystotomy, hemorrhage) and postoperative complications (hemorrhagic, infectious and embolic complications). Multivariate analysis using the Cox regression model showed that the only variable correlated with the surgical cure rate was the type of surgical anti-incontinence procedure adopted: Bologna or Raz (p = 0.00001). The results of this study indicate that the Bologna procedure should be preferred over Raz colposuspension in the treatment of urinary stress incontinence when sufficient anterior vaginal tissue is available to create vaginal bands. When this is not the case, Raz colposuspension, as performed in the present study, should be abandoned in favor of other colposuspension methods (AU)

Enfermedad severa de inclusiones citomegálicas en un feto de una mujer inmunizada antes de la gestación / Severe cytomegalic inclusion disease in the fetus of a woman with preconceptional immunity

El descubrimiento de una microfelalia durante la gestación nos ha incitado a practicar una punción de líquido amniótico para análisis cromosómico y la búsqueda viral por reacción en cadena de la polimerasa (PCR). El análisis realizado ha confirmado una infección fetal por citomegalovirus (CMV) en una madre inmunizada antes de la concepción. El feto presentaba una clásica enfermedad de inclusiones citomegálicas. Se han publicado observaciones similares. Publicaciones recientes explican tales observaciones por la variabilidad de las cepas virales. Estos hechos incitan a estar atentos con los signos ecográficos evocadores de una infección viral en una mujer encinta ya inmunizada: se puede tratar de una reinfección por CMV

Due to detection of fetal microcephaly at 24 weeks' gestation, we performed an amniocentesis at 29 weeks with chromosomal analysis and polymerase chain reaction (PCR) to investigate the presence of viral contamination. Cytomegalovirus (CMV) infection was confirmed by PCR, although the mother had preconceptional CMV immunity. The fetus showed classical CMV inclusion disease. Recent publications explain similar observations by the variability of viral strains. These findings highlight the importance of being alert to ultrasonographic signs of CMV reinfection in pregnant women with preconceptual immunity

Intoxicación aguda por monóxido de carbono durante la gestación / Acute carbon monoxide poisoning during pregnancy

Documentamos dos intoxicaciones agudasmoderadas al monóxido de carbono en el cursodel tercer trimestre de la gestación. Las dos pacientesse beneficiaron de una oxigenación hiperbáricaa 2.5 atmósferas durante 90 minutosy han parido a término. Uno de los niños hapresentado una lesión cerebral de origen isquémicode constitución antenatal, posiblementedebida a la hipoxia secundaria a la intoxicaciónpor monóxido de carbono. La fisiopatología y eltratamiento de este tipo de accidente son discutidos

We report two cases of moderate maternalpoisining during the third trimester. They underwentoxygen therapy at 2.5 atmospheres for90 minutes and werw delivered at term. In onecase the newborn presented an antenatal ischemiccerebral lesion probably due to monoxidepoisoning. Pathophysiology and treatment ofsuch accidents are discussed

Leptina, embarazo y reproducción / Leptin, pregnancy and reproduction

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