Landmarks for the hypoglossal nerve within the anterior cervical triangle / Topografía del nervio hipogloso en el triángulo cervical anterior

SUMMARY: Cranial nerve injury is one of the neurologic complications following carotid endarterectomy. The hypoglossal nerve is one of the most frequently injured nerves during carotid endarterectomy. Guidelines suggest that proper anatomic knowledge is crucial to avoid cranial nerve injury. The aim of the present study is to provide landmarks for the localization of the hypoglossal nerve during carotid endarterectomy. 33 anterior cervical triangles of formalin-fixed adult cadavers were dissected. The "carotid axis" was defined and measured, the level of the carotid bifurcation within the carotid axis was registered. "High carotid bifurcation" was considered for those carotid bifurcation found in the upper 25 mm of the carotid axis. The distance between the hypoglossal nerve and the carotid bifurcation was measured (length 1). The relationship between the hypoglossal nerve and the posterior belly of the digastric muscle was registered. For caudal positions, the distance between hypoglossal nerve and posterior belly of the digastric muscle was determined (length 2). Carotid axis range 88.3 mm-155.4 mm, average 125.8 mm. Level of the carotid bifurcation within the carotid axis range 75.3 mm-126.5 mm, mean 102.5 mm. High carotid bifurcation was found in 19 cases (57 %). Length 1 ranged from 1.6 mm to 38.1, mean 17.5. Finally, in 29 specimens (87.8 %) the hypoglossal nerve was caudal to posterior belly of the digastric muscle, whereas in 4 cases (12.2 %) it was posterior. Length 2 ranged from 1 mm to 17.0 mm, mean 6.9 mm. Distances between the hypoglossal nerve and nearby structures were determined. These findings may aid the surgeon in identifying the hypoglossal nerve during carotid endarterectomy and thus prevent its injury.

RESUMEN: La lesión de pares craneales es una de las complicaciones neurológicas posteriores a la endarterectomía carotídea. El nervio hipogloso es uno de los nervios lesionados más frecuentemente durante la endarterectomía carotídea. Las guías de actuación clínica sugieren que el conocimiento anatómico adecuado es crucial para evitar lesiones de los nervios craneales. El objetivo del presente estudio fue proporcionar puntos de referencia para la ubicación del nervio hipogloso durante la endarterectomía carotídea. Se disecaron 33 triángulos cervicales anteriores de cadáveres adultos fijados en solución a base de formaldehído. Se definió y midió el "eje carotídeo", se registró el nivel de la bifurcación carotídea dentro del eje carotídeo. Se consideró una "bifurcación carotídea alta" para aquellas bifurcaciones carotídeas encontradas en los 25 mm superiores del eje carotídeo. Se midió la distancia entre el nervio hipogloso y la bifurcación carotídea (longitud 1). Se registró la relación entre el nervio hipogloso y el vientre posterior del músculo digástrico. Para las posiciones caudales, se determinó la distancia entre el nervio hipogloso y el vientre posterior del músculo digástrico (longitud 2). Rango del eje carotídeo 88,3 mm-155,4 mm, media 125,8 mm. Rango del nivel de la bifurcación carotídea dentro del eje carotídeo 75,3 mm-126,5 mm, media 102,5 mm. Se encontró una bifurcación carotídea alta en 19 casos (57 %). La longitud 1 osciló entre 1,6 mm y 38,1, con una media de 17,5. Finalmente, en 29 muestras (87,8 %) el nervio hipogloso fue caudal al vientre posterior del músculo digástrico, mientras que en 4 casos (12,2 %) fue posterior. La longitud 2 osciló entre 1 mm y 17,0 mm, con una media de 6,9 mm. Se determinaron las distancias entre el nervio hipogloso y las estructuras cercanas. Estos hallazgos pueden ayudar al cirujano a identificar el nervio hipogloso durante la endarterectomía carotídea y así prevenir su lesión.

Does elevated atmospheric CO2affect soil carbon burial and soil weathering in a forest ecosystem?

Most experimental studies measuring the effects of climate change on terrestrial C cycling have focused on processes that occur at relatively short time scales (up to a few years). However, climate-soil C interactions are influenced over much longer time scales by bioturbation and soil weathering affecting soil fertility, ecosystem productivity, and C storage. Elevated CO2can increase belowground C inputs and stimulate soil biota, potentially affecting bioturbation, and can decrease soil pH which could accelerate soil weathering rates. To determine whether we could resolve any changes in bioturbation or C storage, we investigated soil profiles collected from ambient and elevated-CO2plots at the Free-Air Carbon-Dioxide Enrichment (FACE) forest site at Oak Ridge National Laboratory after 11 years of 13C-depleted CO2 release. Profiles of organic carbon concentration, δ13C values, and activities of 137Cs, 210Pb, and 226Ra were measured to ∼30 cm depth in replicated soil cores to evaluate the effects of elevated CO2 on these parameters. Bioturbation models based on fitting advection-diffusion equations to 137Cs and 210Pb profiles showed that ambient and elevated-CO2 plots had indistinguishable ranges of apparent biodiffusion constants, advection rates, and soil mixing times, although apparent biodiffusion constants and advection rates were larger for 137Cs than for 210Pb as is generally observed in soils. Temporal changes in profiles of δ13C values of soil organic carbon (SOC) suggest that addition of new SOC at depth was occurring at a faster rate than that implied by the net advection term of the bioturbation model. Ratios of (210Pb/226Ra) may indicate apparent soil mixing cells that are consistent with biological mechanisms, possibly earthworms and root proliferation, driving C addition and the mixing of soil between ∼4 cm and ∼18 cm depth. Burial of SOC by soil mixing processes could substantially increase the net long-term storage of soil C and should be incorporated in soil-atmosphere interaction models.

[Multifocal basaloid squamous carcinoma of the esophagus]. / Carcinoma basaloide escamoso multifocal de esófago.

Basaloid-squamous carcinoma is a poorly-differentiated variety of squamous cell carcinoma. The most common location is the upper aerodigestive tract and the incidence of this entity in the esophagus is low. Despite advances in knowledge of the biology of these tumors, their recent description and their low frequency has hampered consensus on the therapeutic approach. We present a case of basaloid-squamous cell of the esophagus a 54 year-old man who underwent an esophagectomy with lymphadenectomy and has been followed-up for 5 years with no evidence of disease recurrence. We also provide a literature review of this entity.

Carcinoma basaloide escamoso multifocal de esófago / Multifocal basaloid squamous carcinoma of the esophagus

El carcinoma basaloide escamoso es una variedad pobremente diferenciada del carcinoma escamoso. Se localiza predominantemente en el tracto aerodigestivo superior, y es poco frecuente en el esófago. Si bien ha habido avances en los últimos años en la comprensión de la biología de estos tumores, su descripción reciente y su escasa frecuencia justifican que aún no haya una conducta terapéutica consensuada en el cáncer basaloide escamoso de esófago. Presentamos un caso de cáncer basaloide escamoso multifocal de esófago en un varón de 54 años, al que se realizó una esofagectomía con linfadenectomía y que tras un seguimiento de más de 5 años no hay evidencias de recurrencia de la enfermedad. Se realiza una revisión de la bibliografía sobre el tema

Basaloid-squamous carcinoma is a poorly-differentiated variety of squamous cell carcinoma. The most common location is the upper aerodigestive tract and the incidence of this entity in the esophagus is low. Despite advances in knowledge of the biology of these tumors, their recent description and their low frequency has hampered consensus on the therapeutic approach. We present a case of basaloid-squamous cell of the esophagus a 54 year-old man who underwent an esophagectomy with lymphadenectomy and has been followed-up for 5 years with no evidence of disease recurrence. We also provide a literature review of this entity

Indoor climbing elicits plasma oxidative stress.

PURPOSE: Indoor climbing is a worldwide sport with particular physiological and physical demands. The purpose of this study was to analyze the effect of sustained indoor climbing until exhaustion on plasma oxidative stress markers, and to relate it to whole-body dynamic exercise performed at the same percentage of maximal oxygen uptake (VO2max). METHODS: Fourteen male indoor climbers continuously climbed a competition-style route until exhaustion. Oxygen consumption and heart rate were continuously monitored during the climbing exercise. One week later, subjects performed a treadmill running protocol with the same duration and percentage of VO2max as that of climbing exercise. Blood samples were collected at rest, immediately after, and 1 h after both exercise protocols to analyze plasma levels of reduced (GSH) and oxidized (GSSG) glutathione, malondialdehyde (MDA), protein sulfhydryl (-SH) and carbonyl (CG) groups, total antioxidant status (TAS) and uric acid (UA), and total blood leukocytes, neutrophil, and lymphocyte counts. RESULTS: Compared with running, climbing significantly increased the %GSSG, MDA, CG, TAS, and UA and decreased the GSH and -SH content. Blood counts of total leukocytes and neutrophils increased immediately after and 1 h after both running and climbing (P<0.05), although counts were higher in climbing than in running (P<0.05). Lymphocytes significantly increased from baseline to 0 h, although they decreased below baseline 1 h after climbing (P<0.05). CONCLUSION: Data demonstrate that indoor climbing induces plasma oxidative stress. Moreover, results suggest that an ischemia-reperfusion prooxidant-based mechanism related to climbers' sustained and intermittent isometric forearm muscle contractions might have significantly contributed to observed plasma oxidative stress.

[Results of laparoscopic fundoplication in gastroesophageal reflux disease with atypical manifestations]. / Resultados de la fundoplicatura laparoscópica en la enfermedad por reflujo gastroesofágico con síntomas atípicos.

INTRODUCTION: Gastroesophageal reflux disease (GERD) may present with typical (heartburn and regurgitation) and atypical symptoms (cough, asthma, non-cardiac chest pain). Laparoscopic fundoplication has been performed for approximately 10 years, with results similar to or better than those obtained with open antireflux procedures. The aim of this study was to evaluate the clinical and functional results of laparoscopic fundoplication in patients with GERD and atypical symptoms. PATIENTS AND METHOD: There were 158 consecutive patients with GERD who underwent a 360 degrees laparoscopic fundoplication (January 1999 to March 2006) and 27 patients had atypical symptoms. All patients underwent preoperative manometry and 24 hour pH-metry and 78% underwent the same tests postoperatively (at 6 months). Data from hospital records were analyzed and a clinical telephone survey was conducted. RESULTS: There was no mortality and no conversions were required. The median length of follow-up was 21 months. All atypical symptoms (cough, chest pain, asthma, dysphonia and hoarseness) were significantly reduced (p < 0.05). There was no relationship between symptom persistence in five patients and pathologic acid reflux, except in one patient. Eighty-nine percent of the patients responded to the telephone survey; of these, 79% had no symptoms. The median satisfaction score was 9 (from 0 to 10). CONCLUSIONS: Laparoscopic fundoplication for GERD with atypical symptoms is a safe procedure with good results (clinical and functional) in trained groups patients. Moreover a high satisfaction rate is obtained.

Resultados de la fundoplicatura laparoscópica en la enfermedad por reflujo gastroesofágico con síntomas atípicos / Results of laparoscopic fundoplication in gastroesophageal reflux disease with atypical manifestations

Introducción. La enfermedad por reflujo gastroesofágico (ERGE) se presenta clínicamente con síntomas típicos (pirosis y regurgitaciones) y atípicos (tos, asma, dolor torácico no cardíaco). La fundoplicatura laparoscópica (FPL) se realiza desde hace más de 10 años para el tratamiento de esta enfermedad con resultados similares o mejores que con cirugía abierta. El objetivo de este trabajo es evaluar los resultados clínicos y funcionales de la FPL en la ERGE con síntomas atípicos. Pacientes y método. De 158 pacientes consecutivos con ERGE que fueron sometidos a FPL tipo Nissen (enero de 1999 a marzo de 2006), se identificó a 27 pacientes con síntomas atípicos. A todos se les realizó manometría y pH-metría preoperatoria y al 78% de ellos, en el postoperatorio (sexto mes). Se analizaron los datos de la historia clínica y se realizó una encuesta clínica telefónica. Resultados. No hubo mortalidad ni conversiones. La mediana del seguimiento fue de 21 meses. Todos los síntomas atípicos (tos, dolor torácico, asma, afonía y carraspera) disminuyeron significativamente (p < 0,05). La persistencia de síntomas en 5 pacientes no se relacionó, salvo en 1 de ellos, con reflujo ácido patológico. Respondieron a la encuesta telefónica un 89% de los pacientes, y el 79% no tenía síntomas. La mediana de satisfacción de los pacientes por la cirugía fue de 9 en una escala del 0 al 10. Conclusiones. La FPL en la ERGE con síntomas atípicos es un procedimiento seguro y tiene buenos resultados (clínica y funcionalmente) en grupos especializados; se obtiene, además, una alta aceptación por parte de los pacientes (AU)

Introduction. Gastroesophageal reflux disease (GERD) may present with typical (heartburn and regurgitation) and atypical symptoms (cough, asthma, non-cardiac chest pain). Laparoscopic fundoplication has been performed for approximately 10 years, with results similar to or better than those obtained with open antireflux procedures. The aim of this study was to evaluate the clinical and functional results of laparoscopic fundoplication in patients with GERD and atypical symptoms. Patients and method. There were 158 consecutive patients with GERD who underwent a 360° laparoscopic fundoplication (January 1999 to March 2006) and 27 patients had atypical symptoms. All patients underwent preoperative manometry and 24 hour pH-metry and 78% underwent the same tests postoperatively (at 6 months). Data from hospital records were analyzed and a clinical telephone survey was conducted. Results. There was no mortality and no conversions were required. The median length of follow-up was 21 months. All atypical symptoms (cough, chest pain, asthma, dysphonia and hoarseness) were significantly reduced (p < 0.05). There was no relationship between symptom persistence in five patients and pathologic acid reflux, except in one patient. Eighty-nine percent of the patients responded to the telephone survey; of these, 79% had no symptoms. The median satisfaction score was 9 (from 0 to 10). Conclusions. Laparoscopic fundoplication for GERD with atypical symptoms is a safe procedure with good results (clinical and functional) in trained groups patients. Moreover a high satisfaction rate is obtained (AU)

Enfermedad de Chagas crónica en Chile. Experiencia de intervención educativa / Chronic Chagas disease in Chile: educational intervention

Las diversas inquietudes planteadas por pacientes chagásicos crónicos en relación a su condición clínica, motivaron a un grupo de parasitólogos a diseñar un programa de intervención educativa. Participaron en forma voluntaria 72 pacientes, 32 hombres y 40 mujeres, procedentes de zona de alta y baja endemia chagásica de Chile. La metodología docente consistió fundamentalmente en: aplicación de test diagnóstico y de conocimientos adquiridos; sesiones teóricas que abordaron seis temáticas relacionadas; actividades prácticas tutoriales; utilización de material audiovisual e impreso; atención personalizada por médico parasitólogo (posterior a la intervención educativa y con los antecedentes serológicos, electrocardiográficos y parasitológicos previamente determinados) y evaluación de la actividad educativa por parte de los pacientes. Un mayor conocimiento previo y adquirido se observó en chagásicos crónicos procedentes de zonas endémicas. Todos demos-traron un alto grado de interés y participaron activamente de las actividades programadas. La metodología utilizada, el trabajo tutorial de pequeño grupo y la atención-orientación individual por parte del médico parasitólogo, facilitaron el proceso de enseñanza-aprendizaje. Se concluye que la intervención educativa responde a muchas de las interrogantes respecto de la afección, permite al paciente reconocer el rol que le cabe como protagonista de su propio bienestar y lo transforma en un eficaz agente en el control de la enfermedad de Chagas.

Ecografía intraoperatoria hepática: bases anatómicas de las imágenes / Intraoperative hepatic echography: anatomical basis of images

Se presenta un trabajo descriptivo en el que se comparan las imágenes obtenidas por la ecografía intraoperatoria hepática realizada con ecógrafo Modo B con aquellas de la disposición anatómica normal estudiada en hígados cadavéricos fetales y adultos, inyectados con material elastomérico coloreado. Se concluye que el método reproduce con mucha fidelidad la disposición anatómica normal permitiendo determinar además las eventuales disposiciones anómalas

Correlación ecográfico-operatoria en la patología vesicular / Echographic-operative correlation in gall-bladder pathology

Este estudio prospectivo controlado con los hallazgos operatorios, valora la eficacia de la ecografía preoperatoria realizada en el Hospital de Clínicas, en el diagnóstico de la patología vesicular, en una serie de 40 pacientes. El análisis estadístico de la correlación de los hallazgos ecográficos y operatorios fue realizado para las dimensiones vesiculares, el espesor parietal y el contenido vesicular: bilis normal, barro ciliar y cálculos (presencia o ausencia, número y dimensiones). Los resultados muestran que la ecografía: -tiende a subestimar en forma estadísticamente significativa las dimensiones vesiculares, -tiene alta sensibilidad en el diagnóstico de litiasis vesicular (100//) y en la distinción entre litiasis única y múltiple (91//), -tiende a sobreestimar en forma estadísticamente no significativa el espesor parietal