Mining data from legacy taxonomic literature and application for sampling spiders of the Teutamus group (Araneae; Liocranidae) in Southeast Asia.

Taxonomic literature contains information about virtually ever known species on Earth. In many cases, all that is known about a taxon is contained in this kind of literature, particularly for the most diverse and understudied groups. Taxonomic publications in the aggregate have documented a vast amount of specimen data. Among other things, these data constitute evidence of the existence of a particular taxon within a spatial and temporal context. When knowledge about a particular taxonomic group is rudimentary, investigators motivated to contribute new knowledge can use legacy records to guide them in their search for new specimens in the field. However, these legacy data are in the form of unstructured text, making it difficult to extract and analyze without a human interpreter. Here, we used a combination of semi-automatic tools to extract and categorize specimen data from taxonomic literature of one family of ground spiders (Liocranidae). We tested the application of these data on fieldwork optimization, using the relative abundance of adult specimens reported in literature as a proxy to find the best times and places for collecting the species (Teutamus politus) and its relatives (Teutamus group, TG) within Southeast Asia. Based on these analyses we decided to collect in three provinces in Thailand during the months of June and August. With our approach, we were able to collect more specimens of T. politus (188 specimens, 95 adults) than all the previous records in literature combined (102 specimens). Our approach was also effective for sampling other representatives of the TG, yielding at least one representative of every TG genus previously reported for Thailand. In total, our samples contributed 231 specimens (134 adults) to the 351 specimens previously reported in the literature for this country. Our results exemplify one application of mined literature data that allows investigators to more efficiently allocate effort and resources for the study of neglected, endangered, or interesting taxa and geographic areas. Furthermore, the integrative workflow demonstrated here shares specimen data with global online resources like Plazi and GBIF, meaning that others can freely reuse these data and contribute to them in the future. The contributions of the present study represent an increase of more than 35% on the taxonomic coverage of the TG in GBIF based on the number of species. Also, our extracted data represents 72% of the occurrences now available through GBIF for the TG and more than 85% of occurrences of T. politus. Taxonomic literature is a key source of undigitized biodiversity data for taxonomic groups that are underrepresented in the current biodiversity data sphere. Mobilizing these data is key to understanding and protecting some of the less well-known domains of biodiversity.

Unveiling the genetic basis of Sclerotinia head rot resistance in sunflower.

BACKGROUND: Sclerotinia sclerotiorum is a necrotrophic fungus that causes Sclerotinia head rot (SHR) in sunflower, with epidemics leading to severe yield losses. In this work, we present an association mapping (AM) approach to investigate the genetic basis of natural resistance to SHR in cultivated sunflower, the fourth most widely grown oilseed crop in the world. RESULTS: Our association mapping population (AMP), which comprises 135 inbred breeding lines (ILs), was genotyped using 27 candidate genes, a panel of 9 Simple Sequence Repeat (SSR) markers previously associated with SHR resistance via bi-parental mapping, and a set of 384 SNPs located in genes with molecular functions related to stress responses. Moreover, given the complexity of the trait, we evaluated four disease descriptors (i.e, disease incidence, disease severity, area under the disease progress curve for disease incidence, and incubation period). As a result, this work constitutes the most exhaustive AM study of disease resistance in sunflower performed to date. Mixed linear models accounting for population structure and kinship relatedness were used for the statistical analysis of phenotype-genotype associations, allowing the identification of 13 markers associated with disease reduction. The number of favourable alleles was negatively correlated to disease incidence, disease severity and area under the disease progress curve for disease incidence, whereas it was positevily correlated to the incubation period. CONCLUSIONS: Four of the markers identified here as associated with SHR resistance (HA1848, HaCOI_1, G33 and G34) validate previous research, while other four novel markers (SNP117, SNP136, SNP44, SNP128) were consistently associated with SHR resistance, emerging as promising candidates for marker-assisted breeding. From the germplasm point of view, the five ILs carrying the largest combination of resistance alleles provide a valuable resource for sunflower breeding programs worldwide.

Reparación de una disección de aurícula izquierda: presentación de un caso / Repair of left auricular dissection: case report

Resumen Introducción: La disección de la aurícula izquierda es una complicación infrecuente, pero potencialmente fatal de la cirugía cardíaca. Es frecuentemente asociada a cirugías de la válvula mitral, tanto su reparación el reemplazo, con una incidencia de 0,16%. Sin embargo, otros procedimientos como intervenciones percutáneas también presentan este riesgo. Objetivos: Presentar la resolución quirúrgica de un caso de disección de aurícula izquierda y aportar a la casuística nacional. Materiales y Método: Registro clínico, imagenológico y fotográfico del episodio clínico. Resultados: Una paciente que fue sometida a ablación por radiofrecuencia por vía retrógrada, y cursa durante el periodo postintervencional con insuficiencia cardíaca y su estudio identifica una disección auricular. Se realiza reparación del anillo mitral, plastía del aparato subvalvular y parche de pericardio, la paciente presenta evolución clínica y ecográfica favorable. Discusión: El tratamiento de esta entidad debe analizarse caso a caso, ya que la etiología relacionada a procedimientos percutáneos es diferente a la causada por cirugía valvular mitral. Conclusión: La reparación de una disección auricular con parche es una buena alternativa de tratamiento en estos casos.

Introduction: Left atrial dissection is an infrequent but potentially fatal complication of cardiac surgery. It is frequently associated with mitral valve surgery, both its repair and replacement, with an incidence of 0.16%. However, other procedures such as percutaneous interventions can also be predisposing factors. Objectives: To report the surgical resolution of a left atrial dissection case and contribute to the national casuistry. Materials and Method: Clinical, imaging and photographic record of the clinical episode. Results: A patient who underwent retrograde radiofrequency ablation during the post-interventional period with heart failure and whose study identifies an atrial dissection. Mitral ring repair, subvalvular apparatus repair and pericardial patch was performed, the patient evolves with favorable clinical and sonographic evolution. Discussion: The treatment of this entity should be analyzed case by case, the etiology related to percutaneous procedures is different to that caused by mitral valve surgery and this should be considered when choosing a therapeutic option. Conclusion: Repairing an atrial dissection with a patch is a good alternative in these cases.

In Saccharomyces cerevisiae, withdrawal of the carbon source results in detachment of glycolytic enzymes from the cytoskeleton and in actin reorganization.

Metabolons are dynamic associations of enzymes catalyzing consecutive reactions within a given pathway. Association results in enzyme stabilization and increased metabolic efficiency. Metabolons may use cytoskeletal elements, membranes and membrane proteins as scaffolds. The effects of glucose withdrawal on a putative glycolytic metabolon/F-actin system were evaluated in three Saccharomyces cerevisiae strains: a WT and two different obligate fermentative (OxPhos-deficient) strains, which obtained most ATP from glycolysis. Carbon source withdrawal led to inhibition of fermentation, decrease in ATP concentration and dissociation of glycolytic enzymes from F-actin. Depending on the strain, inactivation/reactivation transitions of fermentation took place in seconds. In addition, when ATP was very low, green fluorescent protein-labeled F-actin reorganized from highly dynamic patches to large, non-motile actin bodies containing proteins and enzymes. Glucose addition restored fermentation and cytoskeleton dynamics, suggesting that in addition to ATP concentration, at least in one of the tested strains, metabolon assembly/disassembly is a factor in the control of the rate of fermentation.

Tratamiento de la estenosis traqueobronquial con prótesis: factores de buena respuesta / Treatment of tracheobronchial stenosis with stents: good response factors

OBJETIVO: Determinar predictores de buena respuesta con el uso de prótesis en la estenosis traqueobronquial. MATERIALES Y MÉTODO: Estudio retrospectivo descriptivo de una serie de casos entre junio de 2014 y junio de 2016. Se revisaron registros clínicos, protocolos operatorios, estudios histopatológicos y de imagen. Se consignaron antecedentes demográficos y clínicos al ingreso y luego del procedimiento, etiología de la estenosis traqueal, necesidad de oxígeno en litros, estadía hospitalaria, morbilidad asociada al procedimiento, indicación de terapia complementaria posterior y sobrevida. Se analizaron los datos con estadística descriptiva y analítica. RESULTADOS: Se realizaron 68 procedimientos, en 44 pacientes, 24 mujeres, el diagnóstico principal fue estenosis traqueal con 40 casos. La etiología neoplásica fue el 88% de los casos. El Performance status (PS) de ingreso fue mayor o igual a 2 en el 68% y posterior al procedimiento disminuyó a 22% p < 0,05. En 36 casos los pacientes requerían al menos 1 L de oxígeno lo que disminuyó en 13 casos posterior a la intervención p < 0,05. El tiempo de hospitalización promedio fue 6,2 días (1-60). En 13 pacientes con patología neoplásica se indicó terapia paliativa complementaria. La morbilidad asociada al procedimiento fue de 2,9% dado por prótesis desplazada y lesión iatrogénica. La sobrevida fue de 27% a un año. CONCLUSIONES: La etiología benigna, el PS previo a la intervención menor o igual a 3, requerimiento de oxígeno de 1 litro y obstrucción tumoral menor al 70% del lumen fueron elementos de buena respuesta.

AIM: Determine good response predictors in use of stent in benign and malignant tracheobronchial stenosis. MATERIAL AND METHODS: We retrospectively reviewed medical records of patients submitted to the procedure in the period 2014 to 2016. Clinical records, operative protocols, and histopathological and imaging studies were reviewed. Demographic and clinical data, performance status (PS) at admission and after the procedure, etiology of tracheal stenosis, need for oxygen in liters (L) Post-intervention, hospital stay, procedure-related morbidity, indication of therapy (Chemotherapy and/or Radiotherapy) and survival. Data were analyzed with descriptive and analytics statistics. RESULTS: A total of 68 procedures were performed in 44 patients, 24 women. Tracheal stenosis 40 cases were diagnosed. The malignant etiology was 88%. The admission PS was greater than or equal to 2 in 68% and 22% after the procedure. The oxygen requirements prior to the procedure were at least 1 L in 36 cases and decreased in 13 cases after the procedure. The average hospitalization period was 6.2 days (1-60). Complementary therapy was indicated in 13 patients; the morbidity associated with the procedure was 2.9%, displaced installation and iatrogenic injury. The one year survival was 27%. CONCLUSIONS: Benign etiology, el PS minor than or equal to 3, oxygen requirements prior to the procedure of 1 L and tumoral obstruction less than 75% were good response predictors in our study.

Description of five new Wulfila (Araneae, Anyphaenidae) species from Mexico with comments on the taxonomy of the genus.

The genus Wulfila O. Pickard-Cambridge 1895 belongs to the family Anyphaenidae Bertkau, 1878, commonly called ghost spiders. Wulfila is endemic to the Americas and currently has 43 valid species; here we describe five new: Wulfila conchamonile spec. nov., W. xilitlensis spec. nov., W. luisi spec. nov., W. unguis spec. nov. and W. phantasma spec. nov. Specimens were collected in Mexico as part of three biological inventories developed in Xilitla, San Luis Potosí, and Atotonilco and Xamaticpac, Veracruz, between 2011 and 2014. In addition, we provide an overview of Wulfila taxonomic literature with a discussion on the genus taxonomy, diagnostic characters, species placement, and novel genital characters.

Cuidado especializado a neonato prematuro fundamentado en la teoría general del autocuidado / Premature neonate specialized care based on the general theory of self-care / Cuidado especializado a neonato prematuro fundamentado na teoria general do autocuidado

Introducción: Los nacimientos prematuros permanecen como un problema perinatal, afectan entre 5 y 12% de los nacimientos, la principal condición clínica asociada a estos es el Síndrome de Dificultad Respiratoria (SDR), inicia inmediatamente al nacimiento con dificultad respiratoria progresiva que requiere asistencia ventilatoria e ingreso a Unidades de Cuidados Intensivos Neonatales (UCIN). Se presenta el abordaje de manera integral a una recién nacida de 32 SDG con SDR, en un hospital de segundo nivel de atención, en este se aplicó el proceso enfermero. Objetivo: Brindar atención integral e individualizada con cuidados específicos al neonato prematuro, con base en la Teoría General del Autocuidado. Método Selección de paciente a conveniencia en UCIN, aplicación de la metodología del proceso enfermero, valoración basada en los requisitos universales de autocuidado. La información obtenida fue a través del expediente clínico, entrevista a la madre y valoración de la recién nacida. Se analizaron los datos, se emitieron diagnósticos enfermeros, se ejecutó plan de cuidados fundamentados por artículos científicos y guías de práctica clínica. Resultados: Se realizaron 12 diagnósticos de enfermería, 10 reales y 2 de riesgo de acuerdo con los requisitos de autocuidado universal, se identificaron los más alterados: mantenimiento de un aporte suficiente de aire, agua y alimentos, y provisión de cuidados asociados con los procesos de excreción. Conclusiones: Se lograron intervenciones independientes e interdependientes; sin embargo, el neonato permaneció en UCIN debido a que su atención es compleja y requiere personal capacitado con conocimientos y habilidades fundamentadas para el cuidado. La asistencia al prematuro debe ser inmediata para la detección precoz y manejo de patologías frecuentes.

Introduction: Premature births remain a perinatal problem affecting between 5% and 12% of cases. The main clinical condition associated is the Neonatal Respiratory Distress Syndrome (NRDS), which onsets right after birth, and which is characterized by a progressive respiratory difficulty which requires ventilation assistance at the Neonatal Intensive Care Units (NICU). This study presents the integral handling of the case of a newly born with 32 gestational weeks and NRDS at a second level of attention hospital. The Nursing Process was applied. Objective: To provide integral and individualized attention with specific care to this premature neonate, based on the General Theory of Self-Care. Method The patient was selected by convenience from the NICU applying the methodology of the nursing process, and with an assessment based on the universal requirements of self-care. The related information was obtained through the clinical record, an interview to the mother, and the assessment of the patient. Data were analyzed and nursing diagnoses were generated. The care plan was executed with the support of scientific articles and clinical practice guides. Results: 12 nursing diagnoses were emitted, 10 real and 2 of risk, including: maintenance of enough air, water, and feeding supply, and excretion related associated care. Conclusions: Independent and inter-dependent interventions were achieved, however, the premature neonate remained at the NICU because of the complexity of the needed care, which requires constant supervision from experienced and skillful personnel. The attention to these cases must be immediate in order to handle the frequent associated pathologies.

Introdução: Os nascimentos prematuros permanecem como um problema perinatal, afeitam entre 5 e 12% dos nascimentos, a principal condição clínica associada a estresse é a Síndrome de Dificuldade Respiratória (SDR), inicia imediatamente no nascimento com dificuldade respiratória progressiva que requer assistência ventilatória e ingresso a Unidades de Cuidados Intensivos Neonatal (UCIN). Apresenta-se a abordagem de maneira integral a uma recém-nascida de 32 SDG com SDR, em um hospital de segundo nível de atenção, neste aplicou-se o processo enfermeiro. Objetivo: Proporcionar atenção integral e individualizada com cuidados específicos no neonato prematuro, com base na Teoria General do Autocuidado. Método Seleção de paciente a conveniência em UCIN, aplicação da metodologia do processo enfermeiro, valoração baseada nos requerimentos universais de autocuidado. A informação obtida foi a través do expediente clínico, entrevista à mãe e valoração da recém-nascida. Analisaram-se os dados, emitiram-se diagnósticos enfermeiros, executou-se o plano de cuidados fundamentados por artigos científicos e guias de prática clínica. Resultados: Realizaram-se 12 diagnósticos de enfermagem, 10 reais e 2 de risco conforme com os requerimentos de autocuidado universal, identificaram-se os mais alterados: mantimento de um aporte suficiente de ar, água e alimentos, e provisão de cuidados associados com os processos de excreção. Conclusões: Conseguiram-se intervenções independentes e interdependentes; porém, o neonato permaneceu em UCIN devido a que sua atenção é complexa e requer pessoal capacitado com conhecimentos e habilidades fundamentadas para o cuidado. A assistência no prematuro deve ser imediata para a detecção precoce e manejo de patologias frequentes.

Reactividad vascular in vitro y estudio morfométrico de venas safenas utilizadas como bypass coronario: técnica "no-touch" versus convencional / In vitro vascular reactivity and morphometric study of saphenous veins graft used as coronary bypass: "no-touch" versus conventional technique

Resumen Introducción: Prolongar la permeabilidad de los injertos utilizados en bypass coronario es un desafío constante. Objetivo: Comparar anatomofuncionalmente venas safenas humanas (VSH) extraídas con técnica convencional (TC) vs técnica "no-touch" (NT). Material y Método: Estudio experimental. Se diseccionó VSH con TC y NT en el pabellón de cirugía cardiaca del Hospital Regional de Antofagasta. Las muestras de VSH fueron seccionadas en anillos de 3 mm y conservados en cámaras de órganos aislados con solución Ringer-Krebs. Para evaluar la vasomotilidad se administró norepinefrina (10-6M), papaverina (10-4M), acetilcolina (10-6M) y nitroprusiato de sodio (10-5M). Un segmento de las muestras fue fijado en formalina al 10%, procesado con técnica histológica y analizado bajo microscopía óptica. Las muestras fueron teñidas con hematoxilina-eosina, Verhoeff y orceína. El análisis estadístico fue realizado mediante el software Prism Graphad. Resultados: Reactividad vascular: La vasoconstricción inducida por noradrenalina fue significativamente superior en anillos del grupo NT vs TC (p < 0,0001). La vasodilatación producida por papaverina y acetilcolina fue superior en el grupo NT (p < 0,004) y (p < 0,0003), respectivamente. Estudio morfométrico: El grupo NT presentó túnica muscular (0,755 vs 0,680 mm), adventicia (0,5600 vs 0,4663 mm) y pared total (1,344 vs 0,962 mm) más gruesa que el grupo TC. No hubo diferencias significativas respecto el número de vasa vasorum. Conclusión: El grupo NT responde significativamente mejor a estímulos vasoconstrictores y vasodilatadores. Los resultados se asocian con las diferencias morfométricas.

Introduction: Prolonging of the grafts permeability used in coronary bypass is a constant challenge. Objective: To compare anatomical and functional human saphenous veins (VSH) extracted "No touch" (NT) technique vs conventional technique (TC). Materials and Methods: Experimental study. VSH dissected with CT and NT in the Regional Hospital of Antofagasta cardiac surgery ward. VSH samples were sectioned into 3 mm rings and preserved in isolated organs chambers with Krebs-Ringer solution. To evaluate the vasomotor activity, norepinephrine (10-6M), papaverine (10-4M), acetylcholine (10-6M) and sodium nitroprusside (10-5M) was administered. A segment of samples was fixed in 10% formalin, processed and histological analyzed under light microscopy technique with hematoxylin-eosin, Verhoeff and orceína. Statistical analysis was performed using the Prism software Graphad. Results: Vascular Reactivity: norepinephrine-induced vasoconstriction was significantly higher in the group rings NT vs TC (p < 0.0001). Vasodilation was higher with papaverine and acetylcholine in the NT group (p < 0.004) and (p < 0.0003), respectively. Morphometric study: The NT group presented muscularis (0.755 vs 0.680 mm), adventitious (0.5600 vs 0.4663 mm), and total wall (1.344 vs 0.962 mm) thicker than the TC group. No significant differences in vasa vasorum number identified. Conclusion: The NT group vasoconstrictor and vasodilator responds significantly better. Results correlate with morphometric differences.

Phenotyping Sunflower Genetic Resources for Sclerotinia Head Rot Response: Assessing Variability for Disease Resistance Breeding.

Sclerotinia head rot (SHR) is one of the most serious constraints to sunflower (Helianthus annuus L. var. macrocarpus) production worldwide. Here, we evaluated the response to SHR in a sunflower inbred panel from a large INTA germplasm collection, consisting of 137 inbred lines (ILs). Field trials were performed over five consecutive seasons using a twice-replicated randomized complete-block design. Disease incidence, disease severity, incubation period, and area under disease progress curve for disease incidence and severity were determined after controlled inoculation with the pathogen. Statistical analysis using mixed-effect models detected significant differences among ILs for all variables (P < 0.001). In addition, principal component analysis (PCA) and distance-based methods were used to classify the ILs according to their response to SHR, with ILs ALB2/5261 and 5383 emerging as the most resistant. Broad-sense heritability estimates ranged from 20.64% for disease severity to 10.58% for incubation period. The ample phenotypic variability of our collection, along with the moderate heritability estimates, highlight the importance of molecular breeding approaches to gain new insights into the genetic basis of sunflower resistance to SHR. The exhaustive phenotypic characterization presented here provides a reliable set of variables to comprehensively evaluate the disease and identifies two new sources of resistance to SHR.

Three new species of the genus Trachelas (Araneae: Trachelidae) from an oak forest inside the Mesoamerican biodiversity hotspot in Mexico.

Three new species of the spider genus Trachelas L. Koch, 1872 are described and included in the speciosus group based on the following features: embolus as a separate sclerite from the tegulum with no basal coils, legs with a conspicuous fringe of long trichobothria and narrow copulatory ducts coiled irregularly. The new species described are: T. crassus sp. n., T. ductonuda sp. n. and T. odoreus sp. n. A total of 46 specimens were collected in an oak forest near Pico de Orizaba Volcano, Mexico. Most individuals were collected on low vegetation using beating trays and direct collecting at night. Additional images are available at www.unamfcaracnolab.com.

Neoplasias malignas primarias del apéndice cecal: estudio comparativo entre 2 hospitales regionales / Primary malignant tumors of appendix

Background: Primary malignant tumors of appendix are uncommon and usually found during the pathological examination of surgical pieces of appendectomies. Aim: To report the clinical and pathological features of appendiceal malignant tumors. Material and Methods: Review of medical and pathological reports of patients subjected to an appendectomy between 1998 and 2006 in two regional hospitals. Results: Fifteen appendiceal malignant tumors in 2,687 pathological studies were detected (0.55 percent of all studies) in one hospital. In the other 10 tumors were detected in 4,939 studies (0.2 percent). Nine bearers of tumors were male. In each hospital 93 and 80 percent of patients had an acute appendicitis, respectively. The pathology report informed a neuroendocrine tumor in 87 and 70 percent of patients of each hospital, respectively, followed by non-Hodgkin lymphoma and adenocarcinoma. In nine patients a staging study was performed. Four patients died during follow up, one of them due to tumor disseminations. Conclusions: Although appendiceal tumors appear in only 0.3 percent of all appendectomies, the pathological study of the excised appendix is fundamental for the diagnosis.

Introducción: Las neoplasias malignas primarias del apéndice cecal son infrecuentes, generando un gran problema diagnóstico, evidenciándose la mayoría de las veces de forma incidental en el estudio histopatológico (EH). Nuestro objetivo es analizar y comparar las características epidemiológicas, clínicas, quirúrgicas e histológicas de las neoplasias malignas primarias apendiculares en dos hospitales regionales de alta prevalencia en cáncer. Materiales y Métodos: Se realizó un estudio retrospectivo de serie de casos, se seleccionó pacientes con diagnóstico de neoplasia apendicular maligna en los Hospitales Regionales de Antofagasta (HRA) y Valdivia (HRV) entre 1998-2006, se excluyeron pacientes con neoplasias malignas secundarias. Los datos se analizaron mediante estadística descriptiva y χ2. Resultados: En HRA se pesquisaron 15 (0,55 por ciento) casos de tumores malignos primarios en 2.687 EH, en HRV se encontraron 10 (0,20 por ciento) casos en 4.939 EH. Siendo el universo muestral de 25 pacientes. En HRA, 8 fueron en hombres y 7 en mujeres, con edad media de 30 años. En HRV fueron 1 y 9 respectivamente, con edad media de 37,4 años. El 93 por ciento y el 80 por ciento se presentaron como cuadro apendicular agudo respectivamente. La histopatología evidenció Tumor Neuroendocrino (MET) en 87 por ciento y 70 por ciento respectivamente, seguido por Linfoma no Hodgkin y adenocarcinoma. Se realizó estudio de extensión en 4 y 5 pacientes respectivamente, cuatro pacientes fallecieron en el período de seguimiento, uno a causa de diseminación. Discusión: En ambos centros la presentación clínica fue similar, el NET fue el más frecuente. La incidencia fue significativamente mayor en HRA, p < 0,05. El estudio histopatológico rutinario es fundamental para el diagnóstico y tratamiento.

Absceso perirrenal recidivante con atrofia renal izquierda: reporte de un caso / Recurrence perrinephric abscess with left kidney atrophy: case report

El absceso perirrenal es una entidad infrecuente donde la presentación insidiosa y variable favorece el retraso del diagnóstico reportándose una mortalidad de 39-50 por ciento. Nuestro objetivo es presentar y analizar una paciente con absceso perirrenal que recidivó, con énfasis en el tratamiento y diagnóstico. PRESENTACIÓN DEL CASO: Mujer de 56 años consulta en Hospital Regional de Antofagasta por síntomas urinarios de un mes de evolución, reciente aparición de dolor en zona lumbar y fiebre. Se realiza tomografía computarizada: hipodensidad en espacio perirrenal e hiperdensidad en pelvis renal diagnosticándose cálculo coleriforme en pelvis renal y absceso perirrenal. Paciente evoluciona hipotensa: 72/40 mm Hg, posteriormente se realiza lumbotomía exploradora, drenaje e inicio de terapia antibiótica evolucionando favorablemente. Diez días después, vuelve a consultar por sensación febril, eritema y aumento de temperatura local en cicatriz operatoria. Se realiza drenaje percutáneo y tratamiento antibiótico no focalizado debido a urocultivos negativos. Paciente progresa asintomática, con clara reducción deabsceso. La función renal es evaluada con cintigrama informando exclusión funcional renal izquierda, indicándose nefrectomía izquierda. Paciente responde de forma adecuada a antibióticos y procedimientos quirúrgicos dándose de alta. DISCUSIÓN: El absceso perirrenal es una entidad poco sospechada, infrecuente y de difícil manejo donde el diagnóstico precoz adquiere vital importancia. A pesar de lo que recomienda la literatura en casos de abscesos de gran tamaño, el drenaje percutáneo fue efectivo sin recidiva. Como en nuestro caso, la recidiva de esta patología suele ser frecuente por tanto recomendamos evaluar con precisión el tratamiento y el alta del paciente...

The peritoneal abscess is an infrequent entity, the insidious and variant presentation favors delay on the reporting diagnosis with a mortality rate of 39-50 percent. CASE REPORT: A 56 years-old woman with a history of recurrent urinary tract infections asks for help due to urinary-related symptoms, fever and lower back pains. A computed tomography(CT) is performed: hypodensity in the perirenal space and hyperdensity in the renal pelvis. A coral shaped calculus in the renal pelvis along with perirenal abscess is diagnosed. The Patient evolves on a hypotensive way, this is followed the realization of a lumbotomy incision, drainage and antibiotic therapy. Evolving favorably, she is discharged. Ten days later, she consulted again due to a feverish sensation, erythema and increased local temperature on the operation scar. A percutaneous drainage is performed along with the initiation on a non-focal antibiotic treatment due to negative urine culture. The patient progressed asymptomatically with a clear reduction of the abscess. Renal function was evaluated with a reported scintigram process of the left kidney. Left nephrectomy is pointed out. The patient responds appropriately to the antibiotic therapy and surgical procedures. she was discharged being summoned to the urology clinic. DISCUSSION: The perirenal abscess is a rare and unwieldy entity, where an early diagnosis is imperative. Despite what the literature recommends in cases of large abscesses, percutaneous drainage was effective without recurrence. As in our case, the recurrence of this condition is usually prevalent therefore recommend to accurately assess treatment and patient discharge...

Absceso del psoas tuberculoso, debut en paciente inmunodeprimido: presentación de un caso / Tuberculous psoas abscess, debut in immunocompromised patient: case report

INTRODUCCIÓN: El absceso del psoas (AP) es una patología infrecuente de difícil diagnóstico. Se clasifica en primario o secundario teniendo como factor de riesgo común la inmunodeficiencia. PRESENTACIÓN DEL CASO: Paciente masculino de 40 años sin antecedentes mórbidos. Consulta por cuadro de un mes de evolución caracterizado por dolor lumbar derecho que aumenta al flexionar el muslo ipsilateral. Se asocia compromiso del estado general, dolor abdominal, sensación febril no cuantificada y bradipsiquia. La Tomografía computada (TC) de abdomen y pelvis mostró hipodensidad en relación al músculo psoas derecho diagnosticándose AP primario. El paciente evoluciona con shock séptico, siendo manejado con antibióticos de amplio espectro sin mejoría. Se realizan exámenes generales, Punción lumbar (PL) y Test de Elisa para VIH (TEVIH), resultando la PL compatible con Tuberculosis meníngea y el TE positivo. Se inició tratamiento empírico anti-tísico en espera del cultivo de Koch. Paciente evoluciona favorablemente. Se realiza una TC de control luego de dos semanas de tratamiento, que muestra imagen similar a la inicial, agregándose compromiso vertebral L4-L5, diagnosticándose Enfermedad de Pott (EP) y AP secundario. Se realiza punción y drenaje del absceso y se toma cultivo de Koch que resulta positivo. Paciente evoluciona asintomático, con buena respuesta al tratamiento. DISCUSIÓN: El AP secundario a EP es una entidad poco sospechada. Sin embargo, con métodos diagnósticos como la TC es posible realizar un diagnóstico precoz. Mycobacterium tuberculosis es una causa infrecuente de abscesos del psoas, pero debido al aumento de la población VIH positiva, es probable que aumente su incidencia.

INTRODUCTION: Psoas abscess is an uncommon disease with difficult diagnosis. It can be primary or secondary; immunodeficiency is among risk factors. CASE REPORT: 40 year-old male with no past medical history. He presented to the emergency department with right lumbar pain worsened with flexion of ipsilateral thigh. Involvement of general condition, abdominal pain, unquantified fever and bradypsychia were also present. Computed tomography (CT) scan of the abdomen and pelvis showed an hypodense lesion in the right psoas muscle. Primary psoas abscess was first diagnostic impression. Patient evolved to septic shock and was treated with broad spectrum antibiotics without improvement. General examinations were performed, lumbar puncture supported meningeal tuberculosis and HIV ELISA test was positive. Empirical quintuple therapy for tuberculosis was started before cerebrospinal fluid culture results, with favorable clinical evolution. Control CT scan was similar compared to first one but with L4 – L5 vertebrae involvement. Pott disease and secondary psoas abscess was diagnosed. Koch’s Bacillus culture from abscess puncture were positive. Patient had clinical improvement with antituberculous therapy. DISCUSSION: Psoas abscess is a rarely suspected patology, but with diagnostic methods as CT is possible to make an early diagnosis. Even though Mycobacterium tuberculosis is a rarer cause of psoas abscess, but more cases are expected due to the increased incidence of HIV – positive patients, more cases are expected eventually.

Abdominoplastia clásica con lipoaspiración de contorno versus lipoabdominoplastia: estudio aleatorio doble ciego / Classic abdominoplasty with liposuction contour versus lipoabdominoplasty: randomized double-blind

Con el advenimiento de la lipoaspiración en 1980, existió un gran progreso del abordaje de la pared abdominal, evolucionando a nuevos conceptos de remodelación del contorno corporal, como la lipoabominoplastia descrita por Saldanha en el año 2001. El objetivo del estudio es comparar los resultados de la abdominoplastia clásica con Lipoaspiración de contorno contra la lipoabdominoplastia. Analizando morbilidad postoperatoria y grado de satisfacción. Se estudiaron prospectivamente todos los pacientes intervenidos en la ciudad de Valdivia, excluyendo a los pacientes con IMC mayor de 35, hernias abdominales asociadas, cicatrices quirúrgicas extensas de la pared abdominal. Se designaron aleatoriamente mediante método de distribución de probabilidad uniforme. El paciente ni el encuestador supieron la técnica empleada. Los análisis estadísticos fueron realizados mediante estadística descriptiva y chi cuadrado. Hubo 30 pacientes por grupo. Ambos grupos fueron comparables según las variables demográficas. Hubo complicaciones en el 16,7 por ciento de las intervenciones. Siendo más frecuentes los seromas en el grupo de la abdominoplastia. El grado de satisfacción fue elevado en ambos grupos, sin embargo, los "retoques" solicitados por los pacientes fue mayor en el grupo de la abdominoplastia clásica. Nuestros resultados son comparables con otras series, creemos que el mayor porcentaje de seromas fue dado por el mayor tallaje del colgajo dermo graso. Sin duda que las técnicas de remodelación de la pared abdominal se deben analizar en forma particular, teniendo en consideración los distintos parámetros anatómicos de cada paciente.

With the advent of liposuction in 1980, there was a great progress in addressing the abdominal wall, evolving into new concepts of body contouring, as Lipoabdominoplasty described by Saldanha in 2001. The objective of the study is to compare the results of classical abdominoplasty contour liposuction against Lipoabdominoplasty. Analyzing postoperative, morbidity and satisfaction. All patients operated in the city of Valdivia, excluding patients with BMI greater than 35, associated abdominal hernias, extensive surgical scarring of the abdominal wall were prospectively studied. They were randomly designated using uniform probability distribution. Neither the patient nor the interviewer knew the technique. Statistical analyzes were performed using descriptive statistics and chi square. There were 30 patients per group. Both groups were comparable according to demographic variables. Complications occurred in 16.7 percent of the interventions. The most frequent was seroma in abdominoplasty group. The degree of satisfaction was high in both groups, however the "tweaks" requested by patients was higher in the classical abdominoplasty group. Our results are comparable with other series, we believe that the highest percentage of seromas was given by the largest sizing fatty dermal flap. Certainly the indication of technical remodeling of the abdominal wall should be analyzed on an individual basis taking into account the different anatomical parameters of each patient.

Implantes mamarios y cáncer / Breast implants and cancer

La asociación entre implantes mamarios y cáncer ha sido un tema controversial, dado la falta de evidencia suficiente sobre la seguridad de éstos a largo plazo. El aumento del número de pacientes que se han sometido a mamoplastía de aumento, así como la mayor incidencia del cáncer de mama a nivel mundial y la detección de elementos carcinogénicos derivados de los implantes mamarios encendieron el interés de la comunidad científica sobre su posible asociación con el cáncer. Consideramos por lo tanto, un tema de relevancia clínica la revisión sobre la literatura actual entre la asociación de implantes mamarios y cáncer. Algunos problemas que se han planteado sobre el uso de los implantes mamarios son las modificaciones que se establecen para la realización de un examen físico, además de la dificultad para analizar una mamografía, lo que hace suponer un retraso en la detección de patología maligna, así como un peor pronóstico y sobrevida. No obstante lo anterior, diversos estudios han demostrado que no existe asociación causal entre implantes mamarios y cáncer, a su vez la sospecha por examen físico se ha visto favorecida en la detección de masas sospechosas, la etapa y el tamaño tumoral no han presentado diferencias significativas, tendiendo en algunos casos a disminuir. La mamografía presenta disminución en su sensibilidad, pero es posible suplirla implementando proyecciones combinadas y otras técnicas de imagen ante la sospecha. La recurrencia y mortalidad se presentan sin modificaciones significativas respecto de la población general. Respecto a la relación entre implantes mamarios y cáncer extramamario, teniendo en consideración que el implante mamario es un cuerpo extraño susceptible de degenerar, capaz de producir una respuesta inmune y migración del contenido, se plantea un posible efecto carcinogénico en neoplasias a distancia. Se evidencian estudios disímiles describiendo relación con algunos tipos de cáncer...

The association between breast implants and cancer has been a controversial issue, due to the lack of evidence concerning the safety of these in the long term. The increase of the number of patients who have undergone augmentation mammoplasty and the detection of carcinogenic elements related to the mammary implants lit interest of the scientific community, on its possible association with the cancer. We consider to be very important, a review concerning the actual literature between breast implants and cancer. Some of the problems that have been raised about the use of breast implants are the modifications that are established for the execution of a physical exam, and also the difficulty to analyze a mammography, what makes us think of a delay in the detection of malignant pathology, and therefore a worse forecast and survival. Despite the stated above, several studies have demonstrated that there is no casual association between breast implants and cancer, and the suspicion by physical exam has been favored in the detection of suspicious masses; the stage and the size of the tumor have not presented major differences, in some cases tending to reduce its size. The mammography presents a reduction in its sensibility but it is possible to supplement by introducing combined projections and other image techniques in case of suspicion. The frequency and mortality do not face significant changes compared to the general population. Concerning the relationship between breast implants and extra mammary cancer, taking in consideration that the breast implant is a strange object susceptible to degeneration, capable of producing an immune response and migration of the content, a possible carcinogenic effect in neoplasms at distance is raised. Other studies can be witnessed describing a relation with some types of cancer, although by the existence of bias, these are not conclusive from a statistical point of view...

Critical issues and needs in management of primary immunodeficiency diseases in Latin America

Experts from six Latin American countries met to discuss critical issues and needs in the diagnosis and management of primary immunodeficiency diseases (PIDD). The diagnosis of PIDD is generally made following referral to an immunology centre located in a major city, but many paediatricians and general practitioners are not sufficiently trained to suspect PIDD in the first place. Access to laboratory testing is generally limited, and only some screening tests are typically covered by government health programmes. Specialised diagnostic tests are generally not reimbursed. Access to treatment varies by country reflecting differences in healthcare systems and reimbursement policies. An online PIDD Registry Programme for Latin America has been available since 2009, which will provide information about PIDD epidemiology in the region. Additional collaboration across countries appears feasible in at least two areas: a laboratory network to facilitate the diagnosis of PIDD, and educational programmes to improve PIDD awareness. In total, these collaborations should make it possible to advance the diagnosis and management of PIDD in Latin Americ(AU)

Critical issues and needs in management of primary immunodeficiency diseases in Latin America.

Experts from six Latin American countries met to discuss critical issues and needs in the diagnosis and management of primary immunodeficiency diseases (PIDD). The diagnosis of PIDD is generally made following referral to an immunology centre located in a major city, but many paediatricians and general practitioners are not sufficiently trained to suspect PIDD in the first place. Access to laboratory testing is generally limited, and only some screening tests are typically covered by government health programmes. Specialised diagnostic tests are generally not reimbursed. Access to treatment varies by country reflecting differences in healthcare systems and reimbursement policies. An online PIDD Registry Programme for Latin America has been available since 2009, which will provide information about PIDD epidemiology in the region. Additional collaboration across countries appears feasible in at least two areas: a laboratory network to facilitate the diagnosis of PIDD, and educational programmes to improve PIDD awareness. In total, these collaborations should make it possible to advance the diagnosis and management of PIDD in Latin America.

Hepatocellular carcinoma: multimodality management.

BACKGROUND: Hepatocellular carcinoma is one of the most common tumors worldwide. Surgical resection has been the standard treatment but can only be applied to a small percentage of patients. In recent years, several other treatment options, including ablative procedures and transplantation, have been used in patients with hepatocellular carcinoma. METHODS: For 6 years, 110 patients with hepatocellular carcinoma were managed at the Medical College of Wisconsin. Fifty-five patients received only chemotherapy (n = 5) or palliative treatment (n = 50) because of advanced cirrhosis (P <.03) or tumor. Thirty-one patients had tumor ablation with percutaneous ethanol injection, cryoablation, radiofrequency ablation, or arterial chemoembolization. Twenty-eight patients underwent surgical resection (n = 18) or hepatic transplantation (n = 10). Relatively more patients (38%; P <.001) were treated with ablation in the second period of the study (1998-2000). RESULTS: Thirty-day mortality was 3% with ablation and 0% with resection. Median survival was 6 months with no treatment, 27 months with ablation (P <.001), and 35 months with resection (P <.001). Patients who underwent liver transplantation had the longest median survival (53 months). A multivariate analysis suggested that treatment modality (ablation or resection; P <.001) and Child-Pugh classification (P <.01) were the most important factors predicting outcome. CONCLUSIONS: This study suggests that treatment of hepatocellular carcinoma requires multidisciplinary expertise and that ablation and operation can be performed safely. Outcome is influenced most by treatment modality and Child-Pugh classification. Patients in Child-Pugh classes A and B should be treated with ablation, surgical resection, or liver transplantation.

Ablation of liver metastasis: is preoperative imaging sufficiently accurate?

The recent introduction of cryotherapy and radiofrequency ablation of liver metastasis has expanded the indications for treatment. As technology has advanced, a percutaneous approach has been developed. Percutaneous treatment, however, requires accurate preoperative imaging. From 1993 to 1999, 179 patients underwent operative exploration for treatment of suspected hepatic metastases from colorectal carcinoma. One hundred seventy-seven patients were staged by preoperative CT, two patients were staged by MRI, and complete data were available in 176. Hepatic tumor count by preoperative imaging was compared to intraoperative tumor count obtained by inspection, palpation, ultrasonographic examination using a 3.5/7.5 MHz T probe, and careful gross sectioning of the resected specimen. Post hoc analysis was performed on 35 CT scans by two radiologists who specialize in abdominal CT. These radiologists were blinded to the intraoperative findings. Their interpretations were compared to the intraoperative counts and to each other. Thirty-four (19%) of 179 patients were deemed untreatable at operation because of unsuspected overwhelming liver involvement in 11 (6%) or extrahepatic metastases in 23 (13%). For the group, CT was accurate in 80 patients (45%), showed more lesions than were found in 16 (9%), and showed fewer metastases than were found in 80 (45%). When the preoperative scan predicted a solitary metastasis, it was correct in 45 (65%) of 69 patients and underestimated disease in 24 (35%). In the post hoc analysis, the mean numbers of lesions reported by the two radiologists did not differ from the mean number of tumors found; however, the radiologists' counts agreed on 16 (59%) and disagreed on 11 (41%) of the scans. The accuracy of CT decreased with increasing numbers of lesions. Regardless of the type of preoperative imaging, intraoperative findings altered the course of the operation in 96 (55%) of 176 patients. Preoperative imaging is not sufficiently accurate to permit adequate percutaneous treatment of hepatic metastases from colorectal carcinoma.