Construction of prognostic signature of breast cancer based on N7-Methylguanosine-Related LncRNAs and prediction of immune response.

Background: Long non-coding RNA (LncRNA) is a prognostic factor for malignancies, and N7-Methylguanosine (m7G) is crucial in the occurrence and progression of tumors. However, it has not been documented how well m7G-related LncRNAs predict the development of breast cancer (BC). This study aims to develop a predictive signature based on long non-coding RNAs (LncRNAs) associated with m7G to predict the prognosis of breast cancer patients. Methods: The Cancer Genome Atlas (TCGA) database provided us with the RNA-seq data and matching clinical information of individuals with breast cancer. To identify the signature of N7-Methylguanosine-Related LncRNAs and create a prognostic model, we employed co-expression network analysis, least absolute shrinkage selection operator (LASSO) regression analysis, univariate Cox regression analysis, and multivariate Cox regression analysis. The signature was assessed using the Kaplan-Meier analysis and Receiver Operating Characteristic (ROC) curve. A nomogram and principal component analysis (PCA) were employed to confirm the predictive signature's usefulness. Then, we examined the drug sensitivity between the two risk groups and utilized single-sample gene set enrichment analysis (ssGSEA) to investigate the association between predictive factors and the tumor immune microenvironment in high-risk and low-risk groups. Results: Nine m7G-related LncRNAs (LINC01871, AP003469.4, Z68871.1, AC245297.3, EGOT, TFAP2A-AS1, AL136531.1, SEMA3B-AS1, AL606834.2) that are independently associated with the overall survival time (OS) of BC patients make up the signature we developed. For predicting 1-, 3-, and 5-year survival rates, the areas under the ROC curve (AUC) were 0.715, 0.724, and 0.726, respectively. The Kaplan-Meier analysis revealed that the prognosis of BC patients in the high-risk group was worse than that of those in the low-risk group. When compared to clinicopathological variables, multiple regression analysis demonstrated that risk score was a significant independent predictive factor for BC patients. The results of the ssGSEA study revealed a substantial correlation between the predictive traits and the BC patients' immunological status, low-risk BC patients had more active immune systems, and they responded better to PD1/L1 immunotherapy. Conclusion: The prognostic signature, which is based on m7G-related LncRNAs, can be utilized to inform patients' customized treatment plans by independently predicting their prognosis and how well they would respond to immunotherapy.

Regional variation in multiple paternity in the brown smooth-hound shark Mustelus henlei from the northeastern Pacific.

Multiple paternity (MP) in the brown smooth-hound shark (Mustelus henlei) was assessed in 15 litters (15 mothers and 97 embryos) collected in the northern Gulf of California of which 86.7% were sired by more than one male (i.e., from 2 to 4 sires). When taken together with results from previous studies, this record indicates that there is regional variation in MP in M. henlei in the northeastern Pacific. This pattern is associated with variations in the reproductive traits of each population (e.g., female size and litter size). In the Gulf of California, the results of a generalized linear model (GLZ) indicated that the litters of larger females had a higher probability of MP compared to those of smaller females.

Antecedentes, hábitos, características de género y escalas de riesgo cardiovascular en trabajadores hospitalarios / Medical history, habits, gender characteristics and cardiovascular risk scores in health care workers

Introducción: La enfermedad cardiovascular es la principal causa de morbilidad y mortalidad. Contribuye a la muerte de 1 por cada 3 mujeres. En los trabajadores hospitalarios no se encuentra información acerca de los factores de riesgo que influyen en eventos cardiovasculares. Material y Métodos: Se realizó un estudio de corte transversal. Se realizaron registros de aquellos trabajadores hospitalarios sometidos a tamizaje de riesgo cardiovascular. Se documentan 4 escalas de riesgo cardiovascular y se analiza su relación con variables sociodemográficas y laborales. Resultados: Se obtuvieron 179 registros de trabajadores hospitalarios. Los principales factores de riesgo cardiovascular fueron hipertensión arterial en 17% y diabetes mellitus en 5.6%, historia familiar de enfermedad cardiovascular en 27.4%. Al evaluar la estratificación del riesgo cardiovascular en la mujer el 8.5% tiene salud cardiovascular ideal, 82% en riesgo y el 7.7% en riesgo alto. Al comparar relaciones entre hipertensión arterial con otros factores de riesgo en las mujeres se encontró que las pacientes con diabetes mellitus tiene más proporción de hipertensión arterial (P = 0.028). Conclusiones: Los factores de riesgo cardiovascular son altamente prevalentes en la población, incluso en trabajadores hospitalarios y pacientes jóvenes. La población femenina se ve más afectada comparado con la población masculina. La identificación temprana de estos factores es clave para la prevención de eventos cardiovasculares. (AU)

Introduction: cardiovascular disease is the principal cause of Mortality in the world. It causes 1 in 3 women´s death. In health workers, there is no information about the risk factors that can affect cardiovascular events. Material and Methods: a cross-sectional study was performed. Medical history, habits, gender characteristics, and cardiovascular risk scores were screened out in health workers and then analysed their cardiovascular health relationship. Results: a total of 179 records of health workers were obtained. The main cardiovascular risk factors were hypertension in 17%, and diabetes mellitus in 5.6%, family history of cardiovascular disease were in 27.4% of patients. In women, cardiovascular disease was classified in ideal cardiovascular health in 8.5%, at risk in 82%, and high risk in 7.7%. We found women with diabetes have higher proportion of hypertension (P = 0.028). Conclusions: cardiovascular risk factors are highly prevalent in people, even in health workers and young patients. Women are more affected compared with men. Early recognition of cardiovascular risk factors is a fundamental factor to cardiovascular disease prevention. (AU)

Sugiura modificado: una alternativa para pacientes no cirróticos con trombosis de la vena porta extrahepática y sangrado variceal recurrente / Modified sugiura procedure: an alternative for non-cirrhotic patients with extrahepatic portal vein thrombosis and recurrent variceal bleeding

Resumen Una de las consecuencias más graves de la trombosis de la vena porta extrahepática es la hipertensión portal con sangrado variceal recurrente. Una vez falla la ligadura endoscópica de las várices y el eje esplenoportal no se encuentra permeable, la devascularización tipo Sugiura modificado puede ser la única alternativa. Se ha documentado su uso en pacientes con cirrosis, pero hay poca información en personas no cirróticas. En este artículo se describe una serie de 4 casos de pacientes no cirróticos, en los cuales se realizó dicho procedimiento. Los pacientes fueron seguidos durante 12 meses y ninguno presentó episodios de resangrado de las várices esofágicas, ni tampoco se requirió la ligadura de las várices residuales. Esta cirugía se perfila como una alternativa terapéutica para este tipo de pacientes.

Abstract One of the most serious consequences of extrahepatic portal vein thrombosis is portal hypertension with recurrent variceal bleeding. Once endoscopic variceal ligation fails and the spleno-portal axis is not permeable, modified Sugiura devascularization may be the only alternative. Its use in patients with cirrhosis has been reported, but there is little information on non-cirrhotic patients. This article presents a series of four cases of non-cirrhotic patients that underwent this procedure. Patients were followed for twelve months; none presented episodes of esophageal varices re-bleeding nor required ligation of residual varices. This surgery is outlined as a therapeutic alternative for this type of patients.

Cirugía laparoscópica con imagen 3D: indicaciones, resultados y evaluación subjetiva y objetiva de cirujanos participantes / Laparoscopic surgery with 3D image: indications, results and subjective and objective evaluation of participating surgeons

Resumen Introducción El uso del sistema de visión 3D en cirugía laparoscópica puede significar una mejor performance de los procedimientos quirúrgicos de mayor complejidad. Objetivo Reportar las indicaciones, los resultados y la valoración de un grupo de cirujanos de diferentes especialidades en el uso de visión 3D. Materiales y Método: Se analizan las indicaciones quirúrgicas y los resultados subjetivos y objetivos del uso del sistema óptico 3D (n = 155 pacientes) en cirugía laparoscópica compleja. Para evaluación subjetiva se aplicó a una encuesta de percepción cualitativa a los cirujanos participantes tipo Likert. Para la evaluación objetiva, se registran los tiempos quirúrgicos empleados en los diferentes procedimientos efectuados y las complicaciones postoperatorias y se comparan con los pacientes operados con sistema 2D (n = 783 pacientes) en el mismo periodo. Resultados el 70,6% concuerda tener mejor imagen con la técnica 3D, el 64,7% de los cirujanos refieren que se puede reducir el tiempo operatorio, el 58,8% considera que se puede reducir el error quirúrgico, el 92% y 100% respectivamente afirman que el confort del cirujano es mejor con el uso de óptica 3D y que esta técnica es recomendable para los procedimientos complejos. El tiempo operatorio se redujo en algunos procedimientos, especialmente urológicos. No se encontró diferencias sustanciales al comparar los resultados con el uso de sistema 3D versus 2D en cuanto a complicaciones postoperatorias. En la 3D no se encontró mortalidad postoperatoria, probablemente por el menor número de pacientes de ese grupo. Conclusión La laparoscopia 3D posee una buena valoración por los cirujanos que la emplearon, principalmente en calidad de imagen, reducción del tiempo operatorio y confort del cirujano en comparación con la laparoscopía 2D convencional. No se encontró diferencias sustanciales al comparar los resultados con el uso de sistema 3D versus 2D en cuanto a tiempo operatorio ni complicaciones postoperatorias.

Introduction The use of the 3D vision system in laparoscopic surgery can mean better performance in more complex surgical procedures. Aim Report the indications, results and assessment of a group of surgeons of different specialties in the use of 3D vision. Materials and Method Surgical indications and subjective and objective results of the use of 3D optical system in patients (n = 155) submitted to complex laparoscopic surgery are analyzed. Subjective evaluation based on a survey of qualitative perception (Likert) was applied to the participating surgeons. For objective evaluation, the operatory times and postoperative complications were recorded and compared with the results observed with the use of the 2D system (783 patients) in the same period. Results 70.6% agree to have a better image with the 3D technique, 64.7% of surgeons report that the operative time can be reduced, 58.8% consider that it can be reduced the surgical error, 92% and 100% respectively considered that the comfort of the surgeon is better with the use of 3D optics and that this technique is recommended for complex procedures. No substantial differences were found when comparing the results with the use of 3D versus 2D system by the same surgical teams in terms of operative times and postoperative complications. In 3D, postoperative mortality was probably not found due to the lower number of patients in this group. Conclusion 3D laparoscopy has a good evaluation by the surgeons who used it, mainly in image quality, reduction of operative time and comfort of the surgeon compared to conventional 2D laparoscopy. No substantial differences were found when comparing the results with the use of 3D versus 2D system in terms of operative times or postoperative complications.

PieloRM: una nueva herramienta en el estudio de pielonefritis aguda en pediatría / PyeloMR (PieloRM): a new tool in the study of acute pyelonephritis in children

Para determinar la existencia de compromiso parenquimatoso renal en infección del tracto urinario en niños, la tendencia actual es utilizar métodos de imágenes lo menos invasivos posibles, disminuyendo al máximo la exposición a radiación ionizante. La resonancia magnética ha demostrado utilidad en la pesquisa de pielonefritis aguda. Desarrollamos por esto un protocolo de resonancia magnética (PieloRM), que permite de manera rápida, segura y no invasiva detectar compromiso inflamatorio parenquimatoso renal, eventuales complicaciones y alteraciones anatómicas preexistentes. Se utilizan secuencias anatómicas potenciadas en T2 y difusión en los planos axial y coronal en el eje largo de los riñones, sin contraste endovenoso ni anestesia, con técnica de privación de sueño, abrigar y alimentar en lactantes y niños más pequeños. La duración total del examen no sobrepasa los 15 minutos.

Current trend to determine kidney involvement in urinary tract infection in children consider less invasive and lower radiation exposure. Magnetic resonance has been reported has a useful tool in acute pyelonephritis suspicion. We developed a fast, safety, non-contrast magnetic resonance protocol to detect renal parenchymal inflammatory changes in children. Complications and anatomical alterations were also possible to be evaluated. Axial and coronal T2-weighted images for anatomical characterization and diffusion weighted images were obtain for kidney representation. Feed and wrap technique and sleep deprivation, with non-additional sedation or anesthesia was used in a 15 minutes total examination protocol.

[Management of Rhinosinusitis in Primary Care]. / Manejo de las rinosinusitis en Atención Primaria.

Acute rhinosinusitis is an important health problem. Even though its frequency is not well documented in our country?, the economic burden it bears is not insignificant as it notably alters the quality of life of affected patients. Its diagnosis is generally clinical in nature, with further studies reserved only for the differential diagnoses of complications or tumour-like processes. The most frequent causes are viral infections, although Streptococcus pneumoniae and Haemophilus influenzae are the most commonly isolated bacterial agents. Although complications are uncommon nowadays, they can be serious when they occur, and commonly include orbital infections, closely followed in frequency by intracranial and bone infections. Treatment should consist of symptomatic measures, like saline rinses and antibiotics in cases of bacterial origin.

Babesiosis prevalence in malaria-endemic regions of Colombia.

BACKGROUND & OBJECTIVES: : The presence of Babesia spp in humans, bovine cattle and ticks (the transmitting vector) has not been well characterized in Colombia. Babesia infection in humans can be overlooked due to similarity of the disease symptoms with malaria specially in the regions where malaria is endemic. The aim of the present work was to study the frequency of Babesia infection in humans, bovines and ticks in a malaria endemic region of Colombia, and explore the possible relationship of infection with host and the environmental factors. METHODS: : A cross-sectional study was carried out between August 2014 and March 2015 to determine the frequency of B. bovis and B. bigemina infection in a sample of 300 humans involved in cattle raising, in 202 bovines; and in 515 ticks obtained from these subjects, using molecular (PCR), microscopic and serological methods. In addition, the demographic, ecological and zootechnical factors associated with the presence of Babesia, were explored. RESULTS: : In the bovine population, the prevalence of infection was 14.4% (29/202); the highest risk of infection was found in cattle under nine months of age (OR = 23.9, CI 8.10-94.30, p = 0.0). In humans, a prevalence of 2% (6/300) was found; four of these six cases were positive for B. bovis. Self-report of fever in the last seven days in the positive cases was found to be associated with Babesia infection (Incidence rate ratio = 9.08; CI 1.34-61.10, p = 0.02). The frequency of B. bigemina infection in the collected ticks was 18.5% (30/162). INTERPRETATION & CONCLUSION: : The study established the presence of Babesia spp in humans, bovines and ticks. The most prevalent species responsible for babesiosis in humans and bovines was B. bovis, while B. bigemina was the species most frequently found in the tick population. The results contribute to the knowledge of the epidemiology of babesiosis in the country and can provide guidelines for the epidemiological surveillance of this non-malarial febrile illness in humans as well as cattle.

A Meta-analysis on the relations between short-term exposure to PM(2.5) and both mortality and related emergency visits in China / 中华流行病学杂志

Objective: To carry out a quantitative estimate that related to the effects of short-term exposure to PM(2.5) on all-cause mortality and emergency visits in China by using the systematic review and Meta-analysis. Methods: We selected all the studies published before March 2018 from China National Knowledge Infrastructure, Wanfang database, PubMed and EMBASE and data on relative risk (RR), excess risk (ER) and their 95%CIs: appeared in these papers were extracted. According to the differences in the size or direction (heterogeneity) of the results, we computed summary estimates of the effect values using a random-effect or fixed effect model. We also conducted the subgroup analysis and Meta-analysis to have assessed the selected studies for the evidence of study bias. Results: A total of 33 original studies, indexed in databases, were identified. Among those studies, 39 sets of data on mortality and 4 sets of data on emergency were valid to show that within the daily concentration range from 47.7 to 176.7 μg/m(3), for 10 μg/m(3) increases in PM(2.5) concentrations, it would increase the daily numbers of deaths by 0.49% (95%CI: 0.39%-0.59%) and 0.30% (95%CI: 0.10%-0.51%) for all-cause deaths and all-cause emergency-room visits, respectively. For subgroup analysis, the combined effect of PM(2.5) in causing short-term all-cause deaths in the northern areas (ER=0.42%, 95%CI: 0.30%-0.54%) seemed lower than that in the southern areas (ER=0.63%, 95%CI: 0.44%-0.82%). The combined effect of PM(2.5) concentration below 75 μg/m(3) (ER=0.50%, 95%CI: 0.37%-0.62%) was higher than that of PM(2.5) concentration ≥75 μg/m(3) (ER=0.39%, 95%CI: 0.26%-0.52%). Conclusion: Within the concentration range from 47.7 to 176.7 μg/m(3), short-term exposure to current level of PM(2.5) might increase both the all-cause daily mortality and daily emergency visits in China.

Caracterización del acto homicida según los informes de autopsias realizados por el servicio médico legal de Concepción, periodo 2011-2015 / Characterization of the homicidal act according to the autopsy reports released by the Legal Medical Service of Concepción, 2011-2015

Introducción: Más de la tercera parte de los homicidios reportados a nivel mundial tienen lugar en el continente Americano, siendo Chile uno de los países con las tasas más bajas de Latinoamérica. Actualmente, son escasos los estudios que caracterizan el acto homicida en nuestro país. Se caracterizó el acto homicida según las autopsias realizadas por el Servicio Médico Legal (SML) de Concepción, durante el periodo 2011-2015. Materiales y método: Se realizó un estudio transversal de informes de autopsia con causa homicidio durante los años 2011 a 2015, realizadas por el SML de Concepción, utilizándose las variables: género, edad, procedencia, lugar de ocurrencia del homicidio, estado civil, ocupación, patologías asociadas, causa de muerte, tipo de arma utilizada, alcoholemia, examen toxicológico y atención en centro asistencial. El estudio fue aprobado por comité de ética. Resultados: Del total de autopsias en el periodo 2011-2015; 5.92% (241) correspondieron a homicidios, de los cuales un 89.6% fueron víctimas de sexo masculino. Del total de homicidios estudiados la edad promedio fue de 33 años, un 58.3% del total ocurrieron en vía pública y 42.1% fallecieron por trauma torácico complicado. Finalmente del total de homicidios, un 49,2% poseían alcoholemia negativa y 49.2% examen toxicológico negativo. Discusión: En Chile, el homicidio afecta a una pequeña porción de la población, acercándose a las bajas tasas que presentan diversos países de Europa. En su mayoría, los homicidios reportados fueron hombres entre los 18 y 29 años de edad, resultado similar a lo descrito a nivel mundial.

Introduction: More than a third part of the worldwide reported homicides takes place in the whole american continent, and Chile is one the countries with the lowest rates in latin america. Only a few are the studies that characterize the homicidal act in our country. Characterize the homicide act according to the autopsies reports performed by the Legal Medical Service (SML) of Concepción, during the period 2011-2015. Materials and methods: We made a transversal study with the autopsies reports classified as homicide, performed by the SML Concepción, between the years 2011 and 2015 using variables such as: gender, age, place of residence, place of homicidal act, marital state, occupation, comorbidities, death cause, weapon, blood alcohol concentration, toxicological results and medical assistance. An ethic committee approved the study. Results: From the total autopsies between 2011 and 2015; 5.92% (241) were homicides, of which 89.4% were men. The average age of homicides victims was 33 years old, 58.3% occurred on public areas and 42.1% were died because a complicated thoracic traumatism. And finally from the total homicides, 49.2% had none alcohol in blood such as the 49.2% as well had negative toxicological test. Discussion: In Chile, homicide affects a few number of its population, approaching the low rates that some european countries have. The most of the homicides reported were men between 18 to 29 years old, similar results comparing with the worldwide statistics.

Opciones terapéuticas actuales en el manejo de la coledocolitiasis asociada a colecistolitiasis / Current therapeutic options in the management of choledocholithiasis associated with cholecyllithiasis

The term Choledocholithiasis refers to the presence of biliary stones in the extrahepatic bile ducts, which are found in 5 to 10% of patients undergoing cholecystectomy for gallstones. Nowadays, with the adoption of the laparoscopic cholecystectomy(LC) as a standard, multiple minimally invasive treatment options for bile duct stones are feasible, with no consensus to date on the procedure of choice. The two stage endoscopic techniques involve the use of Endoscopic Retrograde Cholangiopancreatography(ERCP) before or after performing a LC, which has the main advantage of separating the bile duct procedure from the LC. However, the need for two separate anesthesia times, the possibility of blank or failed ERCP, and the chance for calculi migration between procedures increase the length of hospital stay and associated costs. The single stage procedures include the Laparoscopic Bile Duct Exploration (LBDE), and more recently, the performance of a laparoscopy guided intraoperative ERCP(Rendez Vous). The LBDE, when performed by an experienced surgical team, is an effective and safe technique. Nonetheless, it is considered a technically demanding procedure, whose results cannot be extrapolated to the general surgical community. Recently, the Rendez Vous has become a treatment alternative that simplifies both the surgical and the endoscopic procedures, decreases morbidity, and requires a single anesthesia time. On the downside, Rendez Vous technique involves complex operating room (OR) logistics, requiring both a trained surgical and endoscopic team at the same time. (AU)

Caracterización molecular de caso fatal por Streptococcus pyogenes

Streptococcus pyogenes es ampliamente conocido como uno de los patógenos bacterianos más importantes en seres humanos. Este caso reporta a una paciente femenina de 3 años de edad, procedente de Lambaré, sin patología de base conocida, consultó en el Servicio de Urgencias del Instituto de Medicina Tropical por una lesión en cara externa de pierna derecha de 3 días de evolución que se extendió progresivamente, agregándose tumefacción y flictenas violáceas. Además vómitos 24 hs antes del ingreso en varias ocasiones. La paciente presentó cultivo de lesión por punción infiltrativa de zona afecta del miembro inferior derecho positivo a Streptococcus pyogenes multisensible que fue derivado al Departamento de Biología Molecular y Biotecnología del Instituto de Investigaciones en Ciencias de la Salud para caracterización molecular en el que se detectó la portación de los factores de virulencia speA, speB y speC.

Abstract Streptococcus pyogenes is widely known as one of the most important bacterial pathogens in humans. This case report of a female patient age 3, from Lambaré, no known pathology base, consulted in the emergency department of the Institute of Tropical Medicine with an injured right leg outer face of 3 days of evolution that progressively expanded, adding purple swelling and blisters. In addition vomiting 24 hours before admission several times. The patient developed culture of lesion infiltration puncture affected area of the right leg positive for Streptococcus pyogenes multisusceptible which was referred to the Department of Molecular Biology and Biotechnology Research Institute in Health Sciences for molecular characterization in which the bearing was detected virulence factors speA, speB and speC.

Analgesic effect and side effects of celecoxib and meloxicam in canine hip osteoarthritis / Efectos analgésicos y secundarios de celecoxib y meloxicam en osteoartritis de cadera canina

Objective. To evaluate the pharmacological, clinical and toxicological effects of celecoxib and meloxicam for analgesia for 30 days in dogs with hip osteoarthritis. Materials and methods. Twenty-four patients were evaluated, 75% were females with an average age of 7.16 ± 2.06 years and twenty five percent were males with an average age of 7.83 ± 2.22 years. All patients had hip osteoarthritis and they were randomized into two groups; one group received oral celecoxib 5 mg/kg every 12 hours during one month and the second group received oral meloxicam 0.2 mg/kg every 24 hours during 1 month. The patients were evaluated for analgesia, and hematological, renal, liver, and coagulation tests on days 0, 10th and 30th after treatment initiation, and a gastric endoscopy on day 30. Statistical analysis was performed using a HSD Tukey test and c² with a 5% level of statistical significance. Results. Both drugs reduced articular pain according to the Melbourne scale during the 30 days of treatment (p≤0.05). Hematological, renal, hepatic and coagulation tests were normal in both treatment groups. All patients presented chronic gastritis on endoscopy on day 30th. Conclusions. Both drugs decreased pain at day 30th without causing alterations in hematological, renal, hepatic or coagulation tests after 30 days of treatment. However, both drugs induced chronic gastritis.

Objetivos. Evaluar el efecto farmacológico, clínico y toxicológico de celecoxib y meloxicam utilizados como analgésicos durante 30 días en caninos con osteoartritis de cadera. Materiales y métodos. Fueron evaluados 24 pacientes, 75% hembras, con edad de 7.16 ± 2.06 años, y el 25% machos; con edad de 7.83 ± 2.22 años, todos tenían osteoartritis de cadera, se asignaron aleatoriamente a dos grupos; un grupo recibió celecoxib 5 mg/kg oral cada 12 horas durante 1 mes y el segundo grupo recibió 0.2 mg/kg de meloxicam, oral cada 24 horas durante 1 mes. Todos fueron evaluados por grado de analgesia y pruebas renales, hepáticas y de coagulación al día 0, 10 y 30. Se realizó una endoscopía gástrica al día 30. Para el análisis estadístico se utilizó el test HSD Tukey y c², con nivel significancia del 5%. Resultados. Ambos tratamientos redujeron el dolor articular durante los 30 días, según la escala Melbourne (p≤0.05). Las variables hemáticas, renales, hepáticas y de coagulación estuvieron dentro de los valores normales sin diferencia. Todos presentaron gastritis crónica por endoscopia a los 30 días. Conclusiones. Ambos fármacos redujeron el dolor, ninguno tuvo efectos sobre la hematología, función renal, hepática y de coagulación a los 30 días; sin embargo, hubo gastritis crónica a los 30 días.

Cáncer temprano de la vesícula biliar: tratamiento y sobrevida a largo plazo / Survival of patients with early gallbladder cancer

Background: Advanced gallbladder cancer has a high mortality. Therefore, this tumor should be diagnosed and treated in early stages. Aim: To analyze the survival rates of patients with an early gallbladder cancer. Material and Methods: Retrospective analysis of medical records of patients with early gallbladder cancer diagnosed until 2003. From that date, all patients with gastrointestinal cancer were registered in a prospective record. Patients with early gallbladder cancer defined as Tis (Carcinoma in situ), T1A (Tumor invades lamina propia) and T1B (Tumor invades muscular layer), were included in this analysis. Results: Eighty patients aged 31 to 87 years (74 percent women) were analyzed. The diagnosis was made during surgery in two patients and during the pathological study in the rest. All 24 patients with Tis tumors were alive after 96 months of follow up. Only one of 16 patients with T1A tumors died of unknown causes. Among the 40 patients with T1B tumors, 24 were re-operated and survival was over 90 percent. Conclusions: This group of patients with early gallbladder cancer had a five years survival over 90 percent. In patients with muscle involvement does not seem necessary to extend the surgery.

Introducción: Dada la elevada mortalidad del cáncer vesicular en etapas avanzadas, lo ideal es diagnosticarlo y tratarlo en una etapa temprana de la enfermedad. Objetivo: Analizar la sobrevida de pacientes con carcinoma temprano de la vesícula biliar y el impacto de una eventual re-operación. Material y Método: Se incluyen en el estudio 80 pacientes con cáncer temprano, siendo la mayoría (65 pacientes) parte de un estudio prospectivo desde mayo de 2004 hasta febrero de 2013. Fueron divididos en 3 grupos: a) carcinoma in situ T1s; b) carcinoma mucoso T1a; c) carcinoma muscular I1b. Seguimiento en el 100 por ciento de los casos. Resultados: El diagnóstico de carcinoma temprano se hizo en 2 pacientes durante la cirugía, en el resto fue un hallazgo del estudio histo-patológico. Los 24 pacientes con carcinoma in situ estaban vivos a los 96 meses de seguimiento. De los 16 pacientes con carcinoma mucoso, sólo 1 (6 por ciento) falleció sin conocerse la causa. Entre los 40 pacientes con cáncer muscular, hubo 24 que no se reoperaron y 16 reoperados. Los resultados anatomo patológicos fueron similares y la sobrevida de ambos grupos fue superior al 90 por ciento. Conclusión: En pacientes con carcinoma de la vesícula biliar in situ y hasta la mucosa, la colecistectomía logra sobrevida mayor del 95 por ciento a largo plazo. En pacientes con carcinoma muscular, ésta se acompaña de una sobrevida mayor a 90 por ciento a 5 años y no parece justificarse ampliar la cirugía.

Signo radiológico: "nariz del oso hormiguero" / Radiological sign: the anteater nose

The tarsal coalition corresponds to the abnormal osseous, cartilaginous or fibrous joining between two or more bones in the midfoot or hindfoot. The anteater nose sign is caused by a tubular elongation of the anterior process of the calcaneus that approaches or overlaps the tarsal scaphoid (navicular) and resembles the nose of an anteater on a lateral foot or ankle radiograph.

La coalición tarsal corresponde a la unión anormal, ya sea ósea, cartilaginosa o fibrosa, entre dos o más huesos del retro o medio pie. El signo de la nariz del oso hormiguero es causada por un alargamiento tubular del proceso anterior del calcáneo que se acerca o se superpone con el escafoides tarsiano y se asemeja a la nariz de un oso hormiguero en una radiografía lateral del pie o tobillo.

Resección de metástasis hepáticas en cáncer gástrico: experiencia preliminar / Excision of liver metastases in gastric cancer: preliminary experience

Introduction: The benefits of liver metastasis excision in gastric cancer are not clearly demonstrated. Aim: To communicate preliminary experience concerning excision of hepatic metastasis and simultaneously performing gastrectomy in patients with gastric cancer. Material and Methods: In a prospective study, 3 of 397 patients treated for gastric cancer that met certain criteria, underwent hepatic metastasis excision. Results: Three patients with gastric cancer and liver metastases. A 58 years old male in whom one liver metastasis was excised and two were treated with radiofrequency ablation, who is alive after 40 months of follow up. A 26 years old female subjected to the excision of one liver metastasis. Eight months later, the lesion relapsed and a right hepatectomy was carried out. The patient died after 19 months of follow up. A 56 years old female subjected to the excision of one liver metastasis, who died 9 months later...

Introducción: En pacientes con cáncer gástrico y metástasis hepáticas sincrónicas, la posibilidad de tener sólo 1 a 3 metástasis es cerca de 2 por ciento, ya que, en la inmensa mayoría, corresponde a una enfermedad sistémica. Objetivos: Comunicar una experiencia preliminar que se refiere a realizar metastasectomía hepática simultánea a la gastrectomía en pacientes con cáncer gástrico. Material y Método: En estudio prospectivo, 3 de 397 pacientes tratados por cáncer gástrico que cumplían algunos criterios, fueron sometidos además a metatasectomía hepática. Resultados: Se incluye a 3 pacientes, 2 con sólo metástasis hepáticas y 1 paciente con metástasis hepáticas y peritoneales, en los que se realizó metastasectomía. La evolución postoperatoria en los 3 fue sin incidentes. En 2 pacientes la metástasis era única y en otro se realizó además radiofrecuencia de 3 pequeñas metástasis, siendo el único paciente vivo a 40 meses; los otros fallecen a los 19 y 9 meses...

Asimetría de extremidades inferiores: evaluación por imágenes en la edad pediátrica / Lower limb asymmetry: imaging evaluation in children

Limb length discrepancy or anisomelia has long been objectified with imaging.The biomechanical implications for patients with a developing skeleton are more relevant than the cosmetic aspects, both in treatment and in follow-up. The aim of this publication is to review the most common causes of lower limb asymmetry in children, with emphasis on imaging findings, which are of great importance for clinical management. A retrospective review was performed on patients younger than 15 years, who required evaluation at our center for lower limb asymmetry, using simple X-ray, CT scan and /or MRI. The anatomical findings and morphometric analysis were recorded for each case. The causes of limb length discrepancy are many, including congenital and sequelae conditions. A knowledge and proper assessment of the imaging findings helps to improve and standardize the radiology report.

La asimetría de extremidades inferiores o anisomelia ha sido largamente objetivada con imágenes y posee implicancias biomecánicas para los pacientes con esqueleto en desarrollo que son más relevantes que los aspectos cosméticos, tanto en su tratamiento como en el seguimiento. El objetivo de esta publicación es revisar las causas más frecuentes de asimetría de extremidades inferiores en la edad pediátrica con énfasis en los hallazgos imaginológicos, que son de gran importancia para el manejo clínico. Se realizó una revisión retrospectiva de pacientes menores de 15 años que requirieron evaluación en nuestro centro por asimetría de extremidades inferiores mediante radiografía simple, tomografía computarizada y/o resonancia magnética, consignando los hallazgos anatómicos y el análisis morfométrico para cada caso. Las causas de anisomelia son múltiples, incluyendo trastornos congênitos y secuelares. Su conocimiento y la adecuada valoración de los hallazgos en imágenes permiten enriquecer y estandarizar el informe radiológico.

Tortícolis en la edad pediátrica: revisión pictográfica / Torticollis in children: a pictographic review

La tortícolis describe el hallazgo clínico de una posición anómala de la cabeza respecto del eje corporal, con rotación cervical e inclinación contralateral de la cabeza, que habitualmente es secundaria a una contracción involuntaria de la musculatura cervical con compromiso predominante del músculo es-ternocleidomastoídeo (ECM). Como signo clínico su diagnóstico diferencial es muy amplio, pudiendo ser secundario a múltiples causas. En la edad pediátrica el espectro es particular y difiere de la forma reconocida en adultos. El objetivo de esta revisión pictográfica es evaluar algunas de las causas de torticolis en la edad pediátrica y analizar los principales hallazgos imaginológicos y su aporte al diagnóstico clínico.

Torticollis describes the clinical finding of an abnormal positioning of the head related with the body axis, with cervical rotation and contralateral tilt of the head, which is usually secondary to an involuntary contraction of the cervical musculature been sternocleidomastoideus muscle (ECM) the most important component. As a clinical sign, differential diagnosis is very broad, and may be secondary to multiple causes. Pediatric population has a particular spectrum of diseases which differs from adults. The aim of this pictorial review is to evaluate some torticollis causes in the pediatric setting recording main imaging findings and their contribution to the clinical diagnosis.

Causas de mortalidad por colecistectomía tradicional y laparoscópica 1991-2010 / Mortality associated with open and laparoscopic cholecystectomy

Background: Laparoscopic cholecystectomy is nowadays the standard surgical treatment for cholelithiasis. Aim: To determine surgical mortality of laparoscopic cholecystectomy as compared with the open procedure. Material and Methods: Review of medical records of all patients subjected to open or laparosco-pic surgery in a surgical service of a clinical hospital, in a period of 20 years. Results: The records of 26.441 patients were reviewed. The figures for overall, open and laparoscopic surgery mortality were 0.16, 0.39 and 0.07 percent respectively. Only two of the 43 deceased patients, died as a direct complication of the surgical procedure. In the rest, the causes of mortality were underlying severe medical conditions. Conclusions: La-paroscopic cholecystectomy has a very low mortality that depends mostly on underlying medical conditions and advanced age.

Introducción: La colecistectomía laparoscópica se ha convertido en el gold standard de la cirugía biliar y se emplea masivamente en todo Chile. Objetivos: Determinar la mortalidad operatoria en 4 períodos de 5 años de la colecistectomía laparoscópica comparada con la colecistectomía tradicional. Material y Método: Se incluyó a todos los pacientes sometidos a colecistectomía, ya sea laparotómica o laparoscópica, entre enero de 1991 y diciembre de 2010 (20 años). Se analizó las causas de mortalidad, el grupo etario en que ocurrió y el tipo de abordaje quirúrgico. Resultados: Se operaron un total de 26.441 pacientes, con un promedio de 1.322 operados por año. La mortalidad global de la colecistectomía laparotómica fue de 0,39 por ciento y de la laparoscópica de 0,07 por ciento, con un promedio general de 0,16 por ciento. Las principales causas de mortalidad fueron patologías médica severas. Sólo 2 pacientes de los 43 fallecidos (5 por ciento) tuvieron una complicación directamente derivada de la cirugía como causa de la mortalidad. Conclusiones: La colecistectomía laparoscópica es una operación de muy baja mortalidad (7 de 10.000 operados). Esta complicación se presenta principalmente en pacientes con grave patología biliar, de edad avanzada y con múltiples complicaciones médicas.