Management of Grade IV Renal Graft Trauma Secondary to Oncological Surgery: A Case Report.

BACKGROUND: Renal graft injury is a challenging condition that can endanger function or become a life-threatening event. Although the most common cause of renal graft injury is trauma, some cases of injuries associated with surgical procedures have been described. Here, we present a case of a transplant patient who experienced a grade IV renal graft injury after an open oophorectomy. CLINICAL CASE: A 31-year-old woman received a renal transplant from a cadaveric donor. During her follow-up, a multilocular cyst with a solid mural nodule tumor of the left ovary was documented, with an 84% risk for malignancy as determined by the International Ovarian Tumour Analysis score. Therefore, an open unilateral (left) oophorectomy was scheduled. RESULTS: The patient was readmitted 2 days after surgery and was hemodynamically stable despite intense pain in the right iliac fossa, sudden creatinine elevation, and hematuria. Tomography revealed a peri-graft hematoma with a mass effect. An exploratory laparotomy was performed, and 2 lacerations with an exposed collecting system and without urinary leakage were identified. These were repaired with absorbable barbed sutures reinforced with Teflon patches on the edges, with cellulose hemostatic mesh and fibrin adhesive on top of these patches. In the postoperative period, creatinine decreased to its baseline levels, but a urinary leak was noted, which was corrected by ureteral stent placement. CONCLUSION: The management of renal graft trauma requires closer monitoring and stricter criteria for reaching a definitive therapeutic decision to prevent the deterioration of the graft and the patient.

Evaluation of IL-6, FoxP3 Treg lymphocytes, intestinal barrier biomarkers and the use of synbiotics in obese adolescents: a pilot study.

Aim: This prospective pilot study evaluated inflammatory and intestinal barrier biomarkers and the effects of a synbiotic in obese adolescents. Methods: Eighteen obese and 20 eutrophic adolescents were evaluated for body composition using bioimpedance analysis (BIA), body mass index (BMI), IL-6 and lipopolysaccharide (LPS) serum levels, CD4 and FoxP3 Treg lymphocytes and monocytes. Synbiotic supplementation for 60 days was also evaluated for these parameters only in obese adolescents. Results: We observed an increase in CD4 lymphocyte (18.0 ± 12.4 vs. 8.9 ± 7.5; p < 0.01), IL-6 (0.30 ± 0.06 vs. 0.20 ± 0.06; p = 0.02) and LPS (0.18 ± 0.15 vs. 0.08 ± 0.05; p < 0.01) levels in obese compared to eutrophic adolescents. After synbiotic supplementation, FoxP3 Treg lymphocytes increased (14.0 ± 6.7 vs. 9.9 ± 5.4; p = 0.02) in obese adolescents. Conclusions: Obese adolescents presented a state of microinflammation and intestinal barrier breakdown, and synbiotic supplementation increased the expression of FoxP3 Treg lymphocytes, an anti-inflammatory regulator. Whether the increase in FoxP3 Treg lymphocytes may have an impact on inflammation and outcomes in obese adolescents deserves further evaluation.

Prospective effects of cholecalciferol supplementation on irisin levels in sedentary postmenopausal women: A pilot study.

Introduction: In postmenopausal women, vitamin D deficiency has been associated with disability, low muscle mass and fractures. Irisin is an important myokine that may contribute to the maintenance of muscle and bone density. Vitamin D is associated with the growth and function of muscle tissue through interactions between the vitamin D receptor and PGC-1α and activation of p38/MAPK (mitogen-activated protein kinase) in muscle, a mechanism similar to irisin action. The aim of this pilot study was to evaluate the effects of cholecalciferol supplementation on serum irisin levels in sedentary postmenopausal women with hypovitaminosis D (25(OH)D < 20 ng/mL). Material and methods: 80 sedentary postmenopausal women with hypovitaminosis D and low sun exposure were supplemented with cholecalciferol (30,000 IU/month) for 12 months. Calcium, parathyroid hormone, alkaline phosphatase (AP) and irisin levels were measured before and after supplementation. Results: 25(OH) vitamin D increased in all participants. Serum levels of irisin increased (from 0.52 ± 0.27 to 0.80 ± 0.53; p < 0.003), accompanied by a decrease in AP (from 80 ± 24 to 66 ± 23; p < 0.001). Conclusions: Restoration of vitamin D status increased serum irisin levels in sedentary postmenopausal women. Whether increased serum irisin levels may have an impact on clinical outcomes deserves further evaluation.

Uretroplasty with oral mucosal graft in patients with anterior urethral stenosis. Comparative study with conventional treatment.

ANTECEDENTES: El manejo con uretroplastía de la estenosis uretral es una opción quirúrgica fundamental, y comparar la uretroplastía con injerto de mucosa oral con la uretroplastía término-terminal tiene trascendencia para conocer la diferencia entre ambas técnicas. OBJETIVO: Comparar la uretroplastía con injerto de mucosa oral con la uretroplastía término-terminal en pacientes con estenosis uretral tipo Jordan C, D y E. MÉTODO: Cuasiexperimento realizado en pacientes con estenosis uretral anterior operados de uretroplastía con anastomosis término-terminal o con injerto de mucosa bucal. RESULTADOS: Veintinueve pacientes con una media de edad de 50.7 años, 6 diabéticos, 9 hipertensos, longitud media de la estenosis de 3.6 cm, 19 operados con uretroplastía termino-terminal (grupo 1) y uretroplastía con mucosa bucal (grupo 2). El Índice Internacional de Síntomas Prostáticos promedio preoperatorio fue grave en la mayoría de los pacientes (93%). Hubo mejoría significativa en el posoperatorio en ambos grupos (p = 0.0001 y p = 0.0011), así como en los resultados uroflujométricos (p = 0.0046 y p = 0.00062). CONCLUSIONES: Ambos procedimientos lograron mejorías significativas en la sintomatología urinaria a los 6 meses en comparación con los valores preoperatorios. BACKGROUND: Urethroplasty management of urethral stricture is a fundamental surgical option, and comparing urethroplasty with oral mucosal graft with end-to-end urethroplasty is important to know the difference between both techniques. OBJECTIVE: To compare urethroplasty with oral mucosal graft with end-to-end urethroplasty in patients with urethral stricture type Jordan C, D and E. METHOD: Quasi-experiment performed in patients with anterior urethral stricture operated with urethroplasty with end-to-end anastomosis or with oral mucosal graft. RESULTS: Twenty-nine patients with a mean age of 50.7 years, 6 diabetic, 9 hypertensive, mean stenosis length of 3.6 cm, 10 with end-to-end urethroplasty (group 1) and 19 operated with urethroplasty with buccal mucosa (group 2). The average preoperative International Prostatic Symptom Index was severe in most patients (93%). There was significant improvement postoperatively in both groups (p = 0.0001 and p = 0.0011), as well as in uroflowmetric results (p = 0.0046 and p = 0.00062). CONCLUSIONS: Both procedures achieved significant improvements in urinary symptomatology at 6 months compared to preoperative values.

25-vitamin D reduces inflammation in uremic environment.

Chronic kidney disease (CKD) is characterized by loss of renal function and a consequent increase of serum uremic toxins, which contribute to inflammation status. Deficiency of 25-vitamin D, often found in patients with CKD, has been included as an inflammatory factor since it might modulate the immune system. The aim of this study was to investigate the role of 25-vitamin D on inflammatory pathways in healthy and uremic environment. Toll-like receptor 4 (TLR4), oxidative stress (ROS), vitamin D receptor (VDR), 1-α hydroxylase (CYP27), 24 hydroxylase, cathelicidin, and MCP-1 were evaluated in monocytes exposed to a uremic serum pool compared with healthy pool. The human monocytes lineage (U937) was incubated with or without 25-vitamin D (50 ng/ml for 24 hours). TRL4, VDR, CYP27, CYP24, and ROS were evaluated by flow cytometry. We used ELISA to measure IL-6, TNF-α, IL-10, cathelicidin, and MCP-1 in the cell culture supernatant. We observed a higher expression of TRL-4, IL-6, TNF-α, IL-10, cathelicidin and MCP-1 in monocytes incubated with uremic serum when compared with serum from healthy individuals. Supplementation of 25-vitamin D was able to reduce the expression of TRL4, cathelicidin, and MCP-1 in the uremic environment. There was no difference in the expression of VDR, CYP27 and CYP24 intracellular enzymes. This in vitro study showed that the uremic pool activates inflammatory response in monocytes, which was reversed by 25-vitamin D supplementation; this finding suggests that 25-vitamin D has an anti-inflammatory role in the uremic environment.

Sequential Neuroimaging of the Fetus and Newborn With In Utero Zika Virus Exposure.

Importance: The evolution of fetal brain injury by Zika virus (ZIKV) infection is not well described. Objectives: To perform longitudinal neuroimaging of fetuses and infants exposed to in utero maternal ZIKV infection using concomitant magnetic resonance imaging (MRI) and ultrasonography (US), as well as to determine the duration of viremia in pregnant women with ZIKV infection and whether the duration of viremia correlated with fetal and/or infant brain abnormalities. Design, Setting, and Participants: A cohort of 82 pregnant women with clinical criteria for probable ZIKV infection in Barranquilla, Colombia, and Washington, DC, were enrolled from June 15, 2016, through June 27, 2017, with Colombian women identified by community recruitment and physician referral and travel-related cases of American women recruited from a Congenital Zika Program. Interventions and Exposures: Women received 1 or more MRI and US examinations during the second and/or third trimesters. Postnatally, infants underwent brain MRI and cranial US. Blood samples were tested for ZIKV. Main Outcomes and Measures: The neuroimaging studies were evaluated for brain injury and cerebral biometry. Results: Of the 82 women, 80 were from Colombia and 2 were from the United States. In 3 of 82 cases (4%), fetal MRI demonstrated abnormalities consistent with congenital ZIKV infection. Two cases had heterotopias and malformations in cortical development and 1 case had a parietal encephalocele, Chiari II malformation, and microcephaly. In 1 case, US results remained normal despite fetal abnormalities detected on MRI. Prolonged maternal polymerase chain reaction positivity was present in 1 case. Of the remaining 79 cases with normal results of prenatal imaging, postnatal brain MRI was acquired in 53 infants and demonstrated mild abnormalities in 7 (13%). Fifty-seven infants underwent postnatal cranial US, which detected changes of lenticulostriate vasculopathy, choroid plexus cysts, germinolytic/subependymal cysts, and/or calcification in 21 infants (37%). Conclusions and Relevance: In a cohort of pregnant women with ZIKV infection, prenatal US examination appeared to detect all but 1 abnormal fetal case. Postnatal neuroimaging in infants who had normal prenatal imaging revealed new mild abnormalities. For most patients, prenatal and postnatal US may identify ZIKV-related brain injury.

Infección por Strongyloides stercoralis simulando un tumor intestinal: presentación de un caso / Infection Strongyloides Stercoralis Mimicking a Malignant Intestinal Tumor: Case Report

Las enfermedades infecciosas pueden tener una presentación inicial similar a la de malignidad. Por ejemplo, la infección con la bacteria de la especie Actinomyces causa crecimiento de tejido infiltrativo similar a la observada en el cáncer de pulmón, tumores pélvicos o cáncer de colon; las enfermedades por protozoos, por ejemplo la Entamoeba histolytica, causa ulceración de la mucosa colónica con hallazgos similares al carcinoma; la infección viral por virus de Epstein-Barr puede causar proliferación de linfocitos que imita la leucemia, y la infección por hongos del tipo Cryptococcus gattii puede producir lesiones similares a las de cáncer de pulmón y cerebro. La familiaridad del radiólogo con las infecciones que se presentan con características similares a la malignidad es útil porque las infecciones inicialmente diagnosticadas como cáncer, manejadas y tratadas como tal, pueden llevar a intervenciones innecesarias, incluyendo procedimientos invasivos. El diagnóstico adecuado y precoz de las infecciones bacterianas o parasitarias que se presentan con imágenes similares a la malignidad será beneficioso para el paciente.

Infectious diseases can have an initial presentation similar to that of malignancy. For example, an infection with Actinomyces species bacteria causes infiltrative tissue growth similar to growth seen in lung cancer, pelvic tumor, or colon cancer; protozoal disease, e.g. with Entamoeba histolytica, can cause ulceration of the colonic mucosa similar in a manner similar to carcinoma. Viral infection with Epstein -Barr virus can cause proliferation of lymphocytes in a manner similar to leukemia, and fungal infection with Cryptococcus gattii can cause lesions similar to those present in lung and brain cancer. It is useful for the radiologist to be familiar with infections which present features similar to malignancy, because infections which are initially diagnosed as cancer, and are managed and treated as such, may lead to unnecessary interventions, including invasive procedures. Proper diagnosis and early bacterial or parasitic infections that occur with images similar to the malignancy will be beneficial to the patient.

Hemangiopericitoma meníngeo anaplásico: presentación de caso / Anaplastic meningeal hemangiopericytoma: case report

Se presenta el caso de una mujer joven que consultó por una masa en los tejidos blandos de la región frontal izquierda, la cual correspondió a un hemangiopericitoma meníngeo anaplásico. Debido a la baja frecuencia de este tumor y a las pocas descripciones existentes, revisamos los hallazgos clínicos e imaginológicos.

Malformación arteriovenosa pulmonar: reporte de caso / Pulmonary arteriovenous malformation: case report

Las malformaciones arteriovenosas pulmonares (MAVP ) son comunicaciones anormales entre los sistemas arterial y venoso pulmonar. Son infrecuentes, pero a su vez importantes, por la asociación con potenciales complicaciones fatales. Las formas más frecuentes (85) consisten en comunicaciones únicas entre una arteria aferente y una vena eferente. En ningún caso existe territorio capilar entre ambas estructuras. Más del 70 de las MAVP se presentan asociadas a malformaciones arteriovenosas de la piel, membranas mucosas y otros órganos, que configuran el síndrome de Rendu-Osler o telangiectasia hemorrágica hereditaria. En este artículo se presenta el caso de una mujer de 48 años de edad con un cuadro clínico de dolor pleurítico en quien se realizó diagnóstico de MAVP mediante hallazgos radiológicos.

Improving drug treatment services for Hispanics: research gaps and scientific opportunities.

Delivery of services to Hispanic drug users remains a great challenge, as shown by low service access and retention, and disproportionate negative consequences of drug abuse in the Hispanic population. This paper provides a critical analysis of current services research on Hispanics with drug abuse problems, identifies gaps in the knowledge, and offers recommendations for scientific opportunities to address these gaps, focusing on four central needs: (1) the need to understand the circumstances of Hispanics in their own communities (i.e., community context); (2) the need to develop and test service delivery models tailored to Hispanics' circumstances and special needs; (3) the need to remove client, provider, and system barriers to utilization; and (4) the need to establish links between drug abuse services, social services, and other service sectors to optimize treatment outcomes. The authors suggest an approach that begins with a focus on the local Hispanic community and builds understanding of the cultural context, inclusion of indigenous resources, recognition of barriers to enrollment and retention, and coordination of related services.

Meningoencefalitis Bacteriana su comportamiento en una Unidad de Cuidados Intensivos en África. Enero de 2000 a octubre de 2002

Se presentó la experiencia de un grupo de trabajo de una Unidad de Cuidados Intensivos en Luanda, Angola sobre Meningoencefalitis Bacteriana, ya que esta entidad constituye la segunda causa de ingreso en el servicio. La Neisseria Meningitidis (61,3 porciento), fue el agente etiológico que con mayor frecuencia se aisló. La mortalidad fue de un 12 porciento y se relacionó con la demora en la asistencia, la presencia de complicaciones y las enfermedades intercurrentes, presentes en un 60 porciento de los casos. De estas, la Malaria (32 porciento), la Tuberculosis Pulmonar (12 porciento) y el SIDA (10,7 porciento) fueron las más frecuentes. La Penicilina y el Cloranfenicol demostraron buena sensibilidad, tanto in Vitro como en vivo, lo que justifica aún su empleo en estas zonas geográficas(AU)

The experience of a Unit of Intensive Cares team work in Luanda presents a work about Bacterial Meningitis, which is, the second cause of admission in that service. The Neisseria Meningitidis (61,3 percent), was the aethiological agent more frequently isolated. The mortality was 12 percent and it was correlated with the delay in the attendance, as well as the presence of complications and the concomitant illnesses, that was presented in 60 percent of the cases. Malaria (32 percent), the Lung Tuberculosis (12 percent) and the AIDS (10,7 percent), were the most frequent diseases associated with mortality. Both the Penicillin and the Cloranfenicol, demonstrated good sensibility, not only in vitro but also in live, that why their employ in these geographical areas is justified(AU)

3D-MEDNEs: an alternative "in silico" technique for chemical research in toxicology. 1. prediction of chemically induced agranulocytosis.

A novel approach to molecular negentropy from the point of view of Markov models is introduced. Stochastic negentropies (MEDNEs) are used to develop a linear discriminant analysis. The discriminant analysis produced a set of two discriminant functions, which gave rise to a very good separation of 93.38% of 151 chemicals (training series) into two groups. The total predictability (86.67%, i.e., 52 compounds out of 60) was tested by means of an external validation set. Randic's orthogonalization procedures allowed interpretation of the model while avoiding collinearity descriptors. On the other hand, factor analysis was used to suggest the relation of MEDNEs with other molecular descriptors and properties into a property space. Three principal factors (related to three orthogonal MEDNEs) can be used to explain approximately 90% of the variance of different molecular parameters of halobenzenes including bulk, energetic, dipolar, molecular surface-related, and hydrophobic parameters. Finally, preliminary experimental results coincide with a theoretical prediction when agranulocytosis induction by G-1, a novel microcidal that presents Z/E isomerism, is not detected.

Alteraciones neurotológicas en la esclerosis múltiple / Neurotological distrurbances in multiples sclerosis

La esclerosis múltiple es una enfermedad desmielinizante del sistema nervioso, de etiología aún desconocida. La afección del VIII par craneal es frecuente, por ello se realizó una investigación en 20 pacientes con diagnóstico de certeza de esclerosis múltiple, con manifestaciones otoneurológicas, los cuales fueron sometidos a un examen neurológico, a determinación de inmunoglobulina G en el líquido cefalorraquídeo, audiometría tonal, electronistagmografía, potenciales evocados auditivos del tallo cerebral y resonancia magnética nuclear; con la finalidad de conocer la alteración otoneurológica mas frecuente y el impacto de los estudios paraclínicos en la esclerosis múltiple. El vértigo (90 por ciento) fue el dato mas importante. Los potenciales evocados como la resonancia magnética demostraron la evidencia de lesiones, pero no se pudo establecer una relación entre ambos estudios

Evaluación de la audición en lactantes con alto riesgo con potenciales evocados auditivos del tallo cerebral / Evaluation of hearing in the high-risk infant with brain-stem auditory evoked potentials

Se estudiaron cuarenta niños entre 1 y 6 meses de edad, 20 con factores de alto riesgo para desarrollar hipoacusia neurosensorial adquirida postnatalmente: prematurez, hipoxia, hiperbilirrubinemia, meningitis y la utilización de aminoglucósidos; y 20 lactantes sir riesgo, que conformaron el grupo control. En ambos grupos se valoró la audición mediante potenciales evocados auditivos del tallo cerebral, con la finalidad de conocer la repercusión de estos antecedentes en la capacidad auditiva. Se midió especificamente la latencia de la onda V para definir la integridad y la madurez de la vía auditiva. Se encontró una diferencia estadísticamente significativa de p<0.01 entre el grupo de alto riesgo (6.55 +/- 0.46 en el oído derecho y 6.63 +/- 0.43 en el oído izquierdo) y el grupo control (6.31 +/- 0.29 en el oído derecho y 6.35 +/- 0.08 en el oído izquierdo). Además la administración de aminoglucósidos (80 por ciento) se relacionó con mayor frecuencia con alteraciones en los potenciales evocados. Consideramos que los potenciales evocados auditivos del tallo cerebral son necesarios en la evaluación de los infantes con alto riesgo

Aneurisma cirsoideo: a propósito de un caso / Aneurysm cirsoid: a purpose of the a case

Se presenta el caso de un aneurisma cirsoideo postraumático, ubicado en la regíon occipital derecha. Se analiza la clinica, los estudios neuroradiológicos y el tratamiento de los aneurismas cirsoideos

Análisis de la cirugía contemporánea del cáncer gástrico en Venezuela / Surgical treatment of gastric cancer in Venezuela

El cancer gástrico en Venezuela es un problema de salud pública que ocupá el 1er. lugar como causa de muerte por enfermedad neoplásica. Se revisa la experiencia en el Hospital Universitario de Caracas durante el decenio 1976-1986. Encontramos que al igual que en la revisión de la literatura nacional, los resultados de la cirugía y la mortalidad operatoria son adecuados. La diferencia estriba en que nuestros pacientes consultan con lesiones avanzadas donde la terapéutica no logra una sobrevida aceptable a los cinco años. Cuando el diagnóstico es precoz y la lesión es resecable, la expectativa de sobrevida es similar a las mejores publicaciones, provenientes de otros centros. Es necesario propiciar exámenes de pesquisa masiva y campañas publicitarias, que asociado a un espíritu quirúrgico agresivo, mejorará el pronóstico de esta fatal enfermedad

Divertículo uretral femenino / Female urethral diverticulum

Se revisaron 23 casos de divertículo uretral en el servicio de Ginecología del Hospital Civil de Guadalajara y de la Clínica T-1 N§ 7 del IMSS. de Tijuana Baja California; la edad promedio fue de 31.2 años; los síntomas más comunes fueron: disuria (100%), tumor vaginal (100%), dispareuna (52%) y polaquiuria (43%). El diagnóstico se corroboró por uretrografía y radiografía simple (se encontraron cálculos en 4 pacientes). Se practicó diverticulectomía en 17 casos (73.9%) y diverticulectomía = uretrotomía en cinco casos (21.7%). En tres pacientes hubo lesión vesical transcirugía. No se encontró carcinoma asociado a los divertículos extirpados

Procedimientos audiológicos aplicables en la clínica / Audiological procedures aplied to clinical practice

Se describen las pruebas audiológicas más utilizadas en la práctica clínica. Se clasifican en: 1. Objetivas: impedanciometría; audiometría por reflejos neurovegetativos; potenciales evocados auditivos de tallo cerebral, independientes de la voluntad del sujeto. 2. Pruebas subjetivas: audiometría tonal clásica; logoaudiometría, audiometría supraliminal; audiometría por reflejos condicionados, dependientes de la voluntad del sujeto. Se menciona su utilidad clínica y las indicaciones para una valoración audiológica