Fotocoagulación láser guiada por ultrasonido para el tratamiento del secuestro broncopulmonar fetal. Reporte de dos casos exitosos en Venezuela / Ultrasound-guided laser photocoagulation for the treatment of fetal bronchopulmonary sequestration. Report of two successful cases in Venezuela

El secuestro broncopulmonar es una malformación del aparato respiratorio que consiste en tejido bronquial y pulmonar no funcionante, separado del árbol tráqueo-bronquial y alimentado por un vaso sanguíneo proveniente de la circulación sistémica. La incidencia es de 1 por cada 5000 nacimientos, comprende entre 0,15 % y 6,45 % de las patologías pulmonares. El pronóstico es, generalmente, favorable, reportándose regresión espontánea de la lesión en 50 % a 75 % de los pacientes. Puede ocasionar efecto de masa, comprimiendo el corazón y el pulmón hasta generar cambios hemodinámicos y falla cardíaca. Hay múltiples procedimientos para el tratamiento y manejo, principalmente en casos de gran tamaño y fetos hidrópicos, para mejorar el pronóstico perinatal. Se presentan los dos primeros casos de secuestro broncopulmonar tratados en Venezuela mediante fotocoagulación láser del vaso nutricio y su evolución perinatal, con sobrevida del 100 % y sin ninguna complicación registrada en el periodo perinatal(AU)

Bronchopulmonary sequestration is a malformation of the respiratory system consisting of non-functioning bronchial and pulmonary tissue, separated from the tracheo-bronchial tree and fed by a blood vessel from the systemic circulation. The incidence is 1 in 5000 births, ranging from 0.15% to 6.45% of pulmonary pathologies. The prognosis is generally favorable, with spontaneous regression of the lesion reported in 50% to 75% of patients. It can cause mass effect, compressing the heart and lung to the point of generating hemodynamic changes and heart failure. There are multiple procedures for treatment and management, mainly in large cases and hydropic fetuses, to improve perinatal prognosis. We present the first two cases of bronchopulmonary sequestration treated in Venezuela by laser photocoagulation of the nutrient vessel and their perinatal evolution, with 100% survival and without any complications recorded in the perinatal period(AU)

GEIS-SEHOP clinical practice guidelines for the treatment of rhabdomyosarcoma.

Rhabdomyosarcoma (RMS) is the most frequent soft tissue sarcoma (STS) in children and adolescents. In Spain the annual incidence is 4.4 cases per million children < 14 years. It is an uncommon neoplasm in adults, but 40% of RMS are diagnosed in patients over 20 years of age, representing 1% of all STS in this age group. RMS can appear anywhere in the body, with some sites more frequently affected including head and neck, genitourinary system and limbs. Assessment of a patient with suspicion of RMS includes imaging studies (MRI, CT, PET-CT) and biopsy. All patients with RMS should receive chemotherapy, either at diagnosis in advanced or metastatic stages, or after initial resection in early local stages. Local control includes surgery and/or radiotherapy depending on site, stage, histology and response to chemotherapy. This guide provides recommendations for diagnosis, staging and treatment of this neoplasm.

ECLIM-SEHOP, a new platform to set up and develop international academic clinical trials for childhood cancer and blood disorders in Spain.

INTRODUCTION: Cancer and blood disorders in children are rare. The progressive improvement in survival over the last decades largely relies on the development of international academic clinical trials that gather the sufficient number of patients globally to elaborate solid conclusions and drive changes in clinical practice. The participation of Spain into large international academic trials has traditionally lagged behind of other European countries, mainly due to the burden of administrative tasks to open new studies, lack of financial support and limited research infrastructure in our hospitals. METHODS: The objective of ECLIM-SEHOP platform (Ensayos Clínicos Internacionales Multicéntricos-SEHOP) is to overcome these difficulties and position Spain among the European countries leading the advances in cancer and blood disorders, facilitate the access of our patients to novel diagnostic and therapeutic approaches and, most importantly, continue to improve survival and reducing long-term sequelae. ECLIM-SEHOP provides to the Spanish clinical investigators with the necessary infrastructural support to open and implement academic clinical trials and registries. RESULTS: In less than 3 years from its inception, the platform has provided support to 20 clinical trials and 8 observational studies, including 8 trials and 4 observational studies where the platform performs all trial-related tasks (integral support: trial setup, monitoring, etc.) with more than 150 patients recruited since 2017 to these studies. In this manuscript, we provide baseline metrics for academic clinical trial performance that permit future comparisons. CONCLUSIONS: ECLIM-SEHOP facilitates Spanish children and adolescents diagnosed with cancer and blood disorders to access state-of-the-art diagnostic and therapeutic strategies.

Percepción del personal de salud sobre un programa de detección oportuna del cáncer cervical / Health personnel perceptions on a cervical cancer early detection program / Percepção do pessoal de saúde sobre um programa de detecção oportuna do câncer cervical

Objetivo: Conocer la percepción que el personal de salud del primer nivel de atención tiene respecto al programa Detección Oportuna del Cáncer Cervical en México. Método: Estudio cualitativo, se realizaron 15 entrevistas semi-estructuradas a médicos y enfermeras de tres centros de salud rurales del Estado de Morelos, México. La información se analizó siguiendo los planteamientos de la Teoría Fundamentada. Resultados: El personal de salud percibe el programa Detección Oportuna del Cáncer Cervical como un programa de salud con fines preventivos, identifica la prueba de citología cervical como el medio para prevenir el cáncer cervicouterino, considera que el objetivo del programa es la obtención de muestras citológicas. La percepción está definida por el cumplimiento de metas, las barreras que se presentan para su operación, la elevada demanda y la escasez de recursos materiales, así como por los sentimientos del personal y sus condiciones de trabajo. Conclusiones: Es necesario reforzar los planes y programas de estudio de las carreras de enfermería y medicina para que los estudiantes obtengan conocimientos, desarrollen habilidades y adquieran competencias con base en conocimientos científicos, generar el correcto uso de términos médicos, la lectura crítica, la búsqueda de información y el interés por la actualización y crecimiento profesional.

Objective: To identify the perceptions which first level of attention health personnel have on the Cervical Cancer Early Detection National Health Program in Mexico. Method: This is a qualitative study which included 15 semi-structured interviews on medicine and nursing personnel of three rural health centers in the State of Morelos, Mexico. Data were analyzed in line with the Grounded Theory. Results: The health personnel perceives the Cervical Cancer Early Detection Program as a preventive initiative which relies on the cervical cytology as a main procedure to prevent cervical cancer. These perceptions are modulated by issues on the achievement of goals, operation barriers, high demand of the tests, scarcity of resources, and working conditions feelings. Conclusions: It is important to keep strengthening the nursing and medicine study plans so that students keep developing their knowledge, competencies, and skills to support health initiatives such as the Cervical Cancer Early Detection Program while they develop their scientific interest and professional growth.

Objetivo: Conhecer a percepção que o pessoal de saúde do primeiro nível de atenção tem ao respeito do programa Detecção Oportuna do Câncer Cervical no México. Método: Estudo qualitativo, realizaram-se 15 entrevistas semiestruturadas a médicos e enfermeiras de três centros de saúde rurais do Estado de Morelos, México. A informação analisou-se seguindo as abordagens da Teoria Fundamentada. Resultados: O pessoal de saúde percebe o programa Detecção Oportuna do Câncer Cervical como um programa de saúde com fins preventivos, identifica a proba de citologia cervical como o médio para prevenir o câncer de colo do útero, considera que o objetivo do programa é a obtenção de amostras citológicas. A percepção está definida pela realização de metas, as barreiras que se apresentam para sua operação, a elevada demanda e a escassez de recursos materiais, assim como pelos sentimentos do pessoal e suas condições de trabalho. Conclusões: É necessário reforçar os planos e programas de estudo das carreiras de enfermagem e medicina para que os estudantes obtenham conhecimentos, desenvolvam habilidades e adquiram competências com base em conhecimentos científicos, gerar o correto uso de termos médicos, a leitura crítica, a busca de informação e o interesse pela atualização e crescimento profissional.

Prevalence of Sarcopenia in Community-Dwelling Chilean Elders According to an Adapted Version of the European Working Group on Sarcopenia in Older People (EWGSOP) Criteria.

BACKGROUND: Sarcopenia is the progressive loss of mass and skeletal muscle strength and has serious consequences on older people's health. The Chilean older population has a high life-expectancy, but the prevalence of functional dependence is also high. OBJECTIVE: To determine the prevalence of sarcopenia in Chilean older adults and its relationship with age, gender, and body mass index (BMI). DESIGN: Cross-sectional study. SETTING: Community. PARTICIPANTS: 1,006 non-disabled, community-dwelling subjects aged 60 years or older living in Santiago. MEASUREMENTS: Anthropometric measurements, handgrip strength, physical performance tests, and dual-energy-x-ray-absorptiometry (DXA) scan were performed. Sarcopenia was defined using the algorithm of the European Working Group on Sarcopenia in Older People (EWGSOP). Muscle mass was measured with DXA scan; skeletal muscle mass index (SMI) and hand dynamometry were defined with cut-off points obtained for the Chilean population. For a 3m walking speed we used the cut-off point of the EWGSOP definition. Nutritional status and obesity were defined according to World Health Organization standards. Association between sarcopenia and age, gender, BMI and lean/fat mass ratio was estimated by logistic regression models. RESULTS: The prevalence of sarcopenia was 19.1% (95%CI: 16.8%-21.8%), similar in men and women. There was an increasing trend of sarcopenia by age group and a decreasing trend with nutritional status. After logistic regression, sarcopenia was positively associated with age (OR=1.10; 95%CI:1.06-1.15) and falls (OR=1.83; 95%CI:1.07-3.15) and negatively associated with overweight (OR=0.31; 95%CI:0.16-0.59), obesity (OR=0.02; 95%CI:0.004-0.11), lean mass/fat mass ratio (OR=0.69; 95%CI:0.48-0.9997), knee height (OR=0.78; 95%CI:0.68-0.89) and calf circumference (OR=0.87; 95%CI:0.77-0.97). CONCLUSIONS: The total prevalence of sarcopenia was 19.1% increasing with age reaching 39.6% in people of 80 or more years of age. A negative association of sarcopenia with overweight, obesity and lean/fat mass ratio was observed. Although the high prevalence of obesity (35.9%), only 2% of obese people were sarcopenic.

CRTAM is negatively regulated by ZEB1 in T cells.

T cell activation leads to the induction of genes that are required for appropriate immune responses. This includes CRTAM (Class-I MHC-restricted T cell associated molecule), a protein that plays a key role in T cell development, proliferation, and generating cell polarity during activation. We previously characterized the CRTAM promoter and described how AP-1 family members are important for inducing CRTAM expression upon antigenic activation. Here, we show that CRTAM is a molecular target for ZEB1 (zinc finger E-box-binding protein), a homeodomain/Zn finger transcription factor. Overexpression of ZEB1 repressed CRTAM promoter activity, as well as endogenous CRTAM levels in human T cells. ZEB1-mediated transcriptional repression was abolished when E-box-like elements in the CRTAM promoter are mutated. In summary, ZEB1 functions as a transcriptional repressor for the CRTAM gene in both non-stimulated and stimulated T cells, thereby modulating adaptive immune responses.

Listeria monocytogenes Infection in a Sugar Glider (Petaurus breviceps) - New Mexico, 2011.

Listeria monocytogenes is a Gram-positive, facultative anaerobic, rod-shaped bacterium that can infect and cause disease in many species. In this case report, we describe a case of L. monocytogenes infection causing sepsis in a sugar glider (Petaurus breviceps). The sugar glider consumed a varied diet consisting of human food items, including cantaloupe. A nationwide outbreak of L. monocytogenes foodborne illness associated with cantaloupes occurred simultaneously with this incident case. In this case, the bacterial strains from the outbreak and glider were genetically distinct. Although rare, veterinarians should be aware of the emergence of foodborne pathogens' ability to infect exotic animals residing in domestic environments.

Emergence of KPC-producing Klebsiella pneumoniae in Uruguay: infection control and molecular characterization.

We describe the first outbreak of Klebsiella pneumoniae carbapenemase-producing K. pneumoniae (KPC-KP), the infection control measures adopted and the shift in resistance patterns of isolates during antibiotic treatment. The ST258 KPC-KP strain exhibited a multiresistant antibiotic phenotype including co-resistance to gentamycin, colistin and tigecycline intermediate susceptibility. Isolates before and after treatment had different behaviour concerning their antibiotic susceptibility and the population analysis profile study. A progressive increase in the aminoglycosides (acquiring amicacin resistance) and ß-lactam MICs, and a decreased susceptibility to fosfomycin was observed throughout the administration of combined antimicrobial regimens including meropenem. A high meropenem resistance KPC-KP homogeneous population (MIC 256 Jg/mL), could arise from the meropenem heterogeneous low-level resistance KPC-KP population (MIC 8 Jg/mL), by the selective pressure of the prolonged meropenem therapy. The kpc gene was inserted in a Tn4401 isoform a, and no transconjugants were detected. The core measures adopted were successful to prevent evolution towards resistance dissemination.

Retrospective study assessing the role of MRI in the diagnostic procedures for early breast carcinoma: a correlation of new foci in the MRI with tumor pathological features.

BACKGROUND: Use of breast magnetic resonance imaging (MRI) to detect breast cancer has generated significant debate. We analyze the role of breast MRI in the detection of additional disease and the need to perform additional biopsies in early breast carcinoma patients. In addition, we correlate the detection of new foci with tumor pathological features. METHODS: Early breast carcinoma patients that had undergone an MRI as well as a mammography as diagnostic procedures were included in the study. The following pathologic features were studied: carcinoma type, histological grade, estrogen receptors (ER), progesterone receptors (PR), HER2 and Ki67. Univariate analysis was conducted to ascertain significant correlation among detection of new foci and each of the tumor pathological features. RESULTS: Data from 98 patients have been analyzed: median age 49 years (range 35-79); carcinoma type: (a) infiltrative ductal carcinoma (n = 73, 74 %), (b) infiltrative lobular cancer (n = 12, 12 %), (c) ductal carcinoma in situ (n = 6, 6 %); amplified HER2 (n = 18, 18 %); grade III (n = 33, 33 %); Ki67 ≥ 25 % (n = 33, 33.67 %); positive ER and PR (n = 79, 80 %); triple negative tumors (n = 8, 8 %). MRI detected additional disease in 38 cases (39.58 %), and 20 led to an additional biopsy (20.4 %). Thirty-eight patients (39 %) underwent mastectomy. We found a statistically significant correlation between new foci in MRI and high Ki67 ≥ 25 % (p < 0.005). No other statistically significant correlation was established. CONCLUSION: MRI detected additional disease in 39 % cases, requiring an additional biopsy 20 %. Tumors with high proliferative index were significantly correlated with the detection of new foci in MRI.

Compuestos volátiles de la guanábana colombiana (Annona muricata L. Cv. Elita) durante su maduración / Volatile compounds during the ripening of colombian soursop (Annona muricata L. Cv. Elita)

Los frutos de guanábana (Annona muricata L. cv. Elita) en diferentes estados de madurez se evaluaron para determinar las características fisico-químicas: sólidos solubles totales, porcentaje de acidez, pH e índice demadurez. Los cambios en la composición de los compuestos volátiles se determinaron mediante la técnica de Espacio de Cabeza-Microextracción en Fase Sólida y el posterior análisis por Cromatografía de gasesa coplada a espectrometría de masas. Los compuestos volátiles se identificaron por comparación de sus propiedades cromatográficas y espectrales con sustancias de referencia. Los factores de calidad sensorial mostraron valores que variaron con el estado de madurez. Además, se estableció que la cantidad de ésteres, especialmente los provenientes de los ácidos C6, C4 y C8, saturados e insaturados, se incrementaroncon la maduración. Los compuestos alifáticos C6, como el (Z)-3-hexenol y el (Z)-3- hexenal, fueronlos volátiles mayoritarios en la fruta verde; en tanto que el hexanoato de metilo y el (E)-2- hexenoato demetilo, fueron los más abundantes en las frutas maduras, sobremaduras y de madurez intermedia. En la sobremaduración aumentó la concentración de acetato de etilo, butanoato de metilo y butanoato de etilo; y aparecieron los ácidos alifáticos butanoico y hexanoico, los cuales pueden ser indicadores del inicio de la etapa fermentativa y de la pérdida de la calidad sensorial de la fruta.

Fine-needle aspiration cytopathology in the diagnosis of Wilms tumor.

BACKGROUND/PURPOSE The International Society of Paediatric Oncology (SIOP) protocol for Wilms tumor (WT) includes preoperative chemotherapy as the initial approach. However, an inadequate treatment may be performed in case of histological misdiagnosis. We evaluated the impact of fine-needle aspiration cytopathology (FNAC) in the diagnosis of unilateral WT in our group of patients. MATERIALS AND METHODS A retrospective descriptive study of patients with diagnosis of unilateral WT who underwent FNAC prior to neoadjuvant chemotherapy between 1993 and 2009 was performed. We reviewed the cytological diagnosis obtained by ultrasound-guided FNAC and the histological correlation with the resected specimens. RESULTS FNAC was performed in 66 patients with unilateral WT. In 57 of the 58 patients with positive FNAC for WT, the final diagnosis was correct (PPV: 98.2%). In 8 cases with negative FNAC for WT, the final diagnosis was positive for WT in 3 patients (NPV: 62.5%). Sensitivity was 95% and specificity was 83.3%. No complications were found associated with the procedure, except for an episode of haematuria, which resolved spontaneously. CONCLUSIONS FNAC is a useful and feasible technique in children that may confirm the suspected diagnosis of unilateral WT, avoiding inadequate preoperative chemotherapy in case of a non-Wilms renal tumor.

Embarazo postrasplante hepático: reporte de un caso y revisión de la evidencia actual / Pregnancy after liver transplantation: a case report and literature review

Se estima que en Chile, hasta marzo de 2008 se han efectuado 637 trasplantes hepáticos ortotópicos (THO), siendo la principal causa la cirrosis hepática. Según estadísticas norteamericanas, en el año 2006 existían 3000 mujeres con THO en edad reproductiva. Presentamos el caso de una paciente de 25 años, trasplantada hepática hace 6 años, en terapia inmunosupresora, con buen resultado materno-perinatal.

Until March 2008, Chile had 637 orthotopic liver transplantation (OLT), the main cause was liver cirrhosis. According to US statistics, in 2006 there were 3000 women of reproductive age with OLT. We report a 25-year-old, liver transplant six years ago in immunosuppressive therapy, with good maternal and perinatal outcome.

Tn7::In2-8 dispersion in multidrug resistant isolates of Acinetobacter baumannii from Chile.

Acinetobacter baumannii is considered an important pathogen in our hospital environment having a well-known capacity to acquire different mechanisms of antibiotic resistance. Previous studies in our laboratory had exposed the high dispersion of class 2 integrons in this species. In the present study, we analyzed 7 multiresistant intI2 positive A. baumannii isolates, 6 of which were found to harbour the Tn7::In2-8 element. Our results demonstrate the unusually high distribution of Tn7::In2-8 among different A. baumannii clones from Chile, suggesting a particular behavior of these elements at geographical level.

Efecto de recubrimientos comestibles sobre la calidad en poscocecha del níspero japonés (Eriobotrya japonica T) / Effect of edible coatings on japanese loquat (Eriobotrya japonica T) postharvest quality

Se estudia el efecto de dos recubrimientos comestibles sobre la calidad de frutos de níspero (Eriobotrya japonica T.) procedentes de Callosa d’En Sarriá (España). Los recubrimientos se preparan a partir de soluciones comerciales de quitosano (0,6%) y sucroéster de ácidos grasos (1%) que se aplican a frutos cosechados en madurez de consumo, los cuales se almacenan durante 16 días a 20°C y 90% de HR. La cromatografía gaseosa se usa para encontrar la tasa de respiración y la producción de etileno, la firmeza se precisa con una máquina universal Instron Machine-Modelo 4302, Canton Mass, USA®, la pérdida fisiológica de peso se determina gravimétricamente y la calidad sensorial la establece un panel de jueces entrenados. Los resultados muestran que el quitosano es más eficiente en reducir la pérdida fisiológica de peso, la tasa de respiración y la producción de etileno. Ambas sustancias contribuyen a mantener la firmeza de la pulpa, las características organolépticas y la presentación de los frutos.

Evaluación físico-quimica y sensorial de frutos de uchuva (Physalis peruviana L) / Physico-chemical and sensory evaluation of cape gooseberry fruits (Physalis peruviana L)

Se cosechan frutos de uchuva en grado de madurez de consumo en tres tiempos diferentes, se caracterizanfísico-química y sensorialmente. Se realizan análisis de medidas repetidas con estructura de varianzascovarianzasautoregresiva heterogénea de primer orden, estableciendo diferencias estadísticamente significativas (p<0,05) para las variables sólidos solubles totales, acidez y pH, pero no para el índice de color ni para la firmeza, expresada como fuerza de fractura. Con un panel de jueces seleccionados se realiza la evaluación sensorial, la cual no muestra diferencias estadísticamente significativas (p>0,05) para las variables aroma, textura bucal y sabor. Para el programa de fitomejoramiento las características físico-químicas y organolépticas de las accesiones estudiadas son similares al testigo comercial; por lo tanto, se espera que los cruzamientos entre ellas no demeriten estos aspectos.

Cambios fisiológicos, texturales, fisicoquímicos y microestructurales del tomate de árbol (Cyphomandra betacea S. ) en poscosecha / Changes physiological, textural, physicochemical and microestructural of the tree tomato (cyphomandra betacea S. ) at postharvest

Son evaluados diariamente tomates de árbol en grado de madurez de cosecha con el fin de determinar la evolución de diferentes características poscosecha. El comportamiento de la tasa respiratoria permite confirmar al fruto como un producto no climatérico, con un tiempo óptimo de maduración y consumo alrededor de los 10 días de poscosecha, alcanzando en este estado pérdidas de peso por transpiración entre el 8 y 10 por ciento. Las características físicas y químicas presentan un incremento de los sólidos solubles totales, disminución en el porcentaje de acidez y en la firmeza. El color de la epidermis y la pulpa presentan un incremento de la cromaticidad amarilla y roja, resultando una tonalidad anaranjada del fruto, que se hizo más acentuada con la maduración.

[Hepatic-splenic micobacteriosis, unusual form of probable extrapulmonary tuberculosis. Case report and review]. / Micobacteriosis hepato-esplénica, forma inusual de probable tuberculosis extrapulmonar. Caso clínico y revisión bibliográfica.

We report a 42 years old HIV negative male admitted for fever of unknown origin. Initial laboratory evaluation showed elevated hepatic transaminases and alkaline phosphatase and an hipodense hepatic imagen was visualized in the CT scan. Hepatic biopsy demonstrated tuberculous granulomas and alcohol fast acid rods with Ziehl Neelsen stain. Anti-tuberculous treatment resulted in resolution of fever, improvement of general condition and normalization of laboratory parameters.

Micobacteriosis hepato-esplénica, forma inusual de probable tuberculosis extrapulmonar: Caso clínico y revisión bibliográfica / Hepatic-splenic micobacteriosis, unusual form of probable extrapulmonary tuberculosis: Case report and review

Reportamos el caso de un hombre de 42 años, seronegativo para VIH, con fiebre de origen desconocido (FOD), asociada a elevación de transaminasas y fosfatasas alcalinas con patrón colestásico e imágenes hepáticas hipodensas en la tomografía axial computada. La biopsia hepática demostró la presencia de granulomas tuberculosos con visualización de un bacilo con alcohol-ácido resistencia. El cuadro respondió al tratamiento con fármacos antituberculosos presentando caída de curva febril, mejoría del estado general y normalización de parámetros de laboratorio.

We report a 42 years old HIV negative male admitted for fever of unknown origin. Initial laboratory evaluation showed elevated hepatic transaminases and alkaline phosphatase and an hipodense hepatic imagen was visualized in the CT scan. Hepatic biopsy demonstrated tuberculous granulomas and alcohol fast acid rods with Ziehl Neelsen stain. Anti-tuberculous treatment resulted in resolution of fever, improvement of general condition and normalization of laboratory parameters.

[Comparison of the use of local anaesthetic versus lidocaine injection under ultrasound guide for the pain control in patients undergoing prostate biopsy]. / Comparación del uso de anestésico local versus inyección de lidocaína bajo guía ecográfica para el control del dolor en pacientes sometidos a biopsia de próstata.

OBJECTIVE: To evaluate the lidocaine gel's application effect versus the periprostatic placement of lidocaine to manage the pain in patients who go through a prostate biopsy. MATERIALS AND METHOD: We took the patients who entered the FCI-IC to effectuate a prostate biopsy with an echographic guideline. The patients were split in two groups of 22 people with each one bearing similar characteristics. One of these groups experimented the previous prostate biopsy with 10cc of intrarectal lidocaine gel and the other group experimented 10 cc of lidocaine to 1% in the vesic-prostatic through echographic guidelines. To evaluate the pain, we used the visual analogue scale to gauge the pain during and after the procedure in both groups. The daily procedure to do biopsies by octants and their subsequent preparation remained the same and never changed. RESULTS: The average scale of pain during the procedure was 2.0 for the group with injected anaesthesia and 4.77 for the group who used gel. After the procedure the average of pain was 0.77 and 3.14 respectively. Some complications as bacteremy were present in 3 patients (6.8%) of the total, who were in the gel group and none were found in the group of injected anestesia. No significant relation was found with respect to other variables. CONCLUSIONS: the application of periprostatic lidocaine is efficient to control the pain in patients who go through a prostate biopsy. Besides, it is a safe procedure which can be easily reproduce in our environment.

Education and career development.

The main objective of this paper is to briefly analyse the different factors and circumstances that a person with haemophilia should take into account before undertaking the challenge of going to university and, in turn, choosing a profession or career. Although education systems in different countries or regions present fundamental differences, some characteristics remain the same, and these will be the focus of our study. The child with haemophilia will most likely encounter three challenges: (1) the challenge of choosing a career; (2) the challenge of choosing a college or university; and (3) the challenge of adjusting to college or university life. The young haemophiliac should be taught to exploit their strengths, and to feel that their only limit is their intellectual development. They should feel that they are only competing against themselves and that any adversities they might face due to haemophilia should not disfavour them; instead they should learn how to live with them and allow these to make them into stronger people.