Physical and respiratory therapy in the critically ill patient with obesity: a narrative review.

Obesity has become increasingly prevalent in the intensive care unit, presenting a significant challenge for healthcare systems and professionals, including rehabilitation teams. Caring for critically ill patients with obesity involves addressing complex issues. Despite the well-established and safe practice of early mobilization during critical illness, in rehabilitation matters, the diverse clinical disturbances and scenarios within the obese patient population necessitate a comprehensive understanding. This includes recognizing the importance of metabolic support, both non-invasive and invasive ventilatory support, and their weaning processes as essential prerequisites. Physiotherapists, working collaboratively with a multidisciplinary team, play a crucial role in ensuring proper assessment and functional rehabilitation in the critical care setting. This review aims to provide critical insights into the key management and rehabilitation principles for obese patients in the intensive care unit.

Pólipo endometrial metaplásico: hallazgo histeroscópico de enfermedad premaligna en mujeres jóvenes. Reporte de tres casos / Endometrial metaplastic polyps: findings of premalignant disease on histeroscopy in young women, a report of 3 cases

ANTECEDENTES: Los pólipos endometriales son sobrecrecimientos de la mucosa endometrial, una de las causas más comunes de hemorragia uterina anormal, pueden estar asociados con lesiones premalignas y malignas del endometrio. Existen características histeroscópicas que ayudan a diferenciar una lesión benigna o maligna. El pólipo metaplásico es un hallazgo histeroscópico caracterizado por superficies laminares e hiperqueratosis, con zonas blancas e hiperrefringentes. CASOS CLÍNICOS: Tres casos clínicos de pacientes menores de 40 años, con hemorragia uterina anormal donde el hallazgo histeroscópico común fue el pólipo metaplásico, hallazgo premaligno que se confirmó mediante el análisis patológico y la positividad del marcador de inmunohistoquímica p63. Caso 1. Paciente de 28 años, nulípara, obesa, con antecedente de síndrome de ovario poliquístico, con engrosamiento endometrial e histeroscopia, con pólipo con superficie hiperqueratósica, a manera de láminas irregulares, con excrecencias y lesiones exofíticas. Caso 2. Paciente de 25 años, con endometrio irregular engrosado e histeroscopia con hallazgo de pólipos transparentes, con cambios vasculares leves y superficie con zonas hiperrefringentes blanquecinas. Caso 3. Paciente de 38 años, con antecedente de síndrome de ovario poliquístico y obesidad. En la histeroscopia el endometrio se encontró hiperplásico, irregular, con cambios vasculares y pólipos con zonas superficiales hiperrefringentes, sólidas y blancas. CONCLUSIONES: En pacientes jóvenes, con hallazgo histeroscópico de pólipo metaplásico debe considerarse y descartar la enfermedad premaligna y maligna endometrial. El estudio debe completarse con marcadores de inmunohistoquímica (p63), específicos de la metaplasia escamosa.

Abstract BACKGROUND: Endometrial polyps are overgrowths of the endometrial mucosa, one of the most common causes of abnormal uterine bleeding and may be associated with premalignant and malignant endometrial lesions. There are hysteroscopic features that help differentiate a benign or malignant lesion. Metaplastic polyp is a hysteroscopic finding characterized by lamellar surfaces and hyperkeratosis, with white and hyperreflective areas. CLINICAL CASES: Three clinical cases of patients under 40 years of age, with abnormal uterine bleeding where the common hysteroscopic finding was metaplastic polyp, a premalignant finding that was confirmed by pathological analysis and positivity of the immunohistochemistry marker p63. Case 1. 28-year-old female, nulliparous, obese, with a history of polycystic ovary syndrome, with endometrial thickening and hysteroscopy, with polyp with hyperkeratotic surface, in the form of irregular sheets, with excrescences and exophytic lesions. Case 2. 25-year-old patient, with irregular thickened endometrium and hysteroscopy with finding of transparent polyps, with mild vascular changes and surface with whitish hyperrefringent areas. Case 3. 38-year-old patient with a history of polycystic ovary syndrome and obesity. At hysteroscopy the endometrium was found to be irregularly hyperplastic, with vascular changes and polyps with hyper-refringent, solid, white superficial areas. CONCLUSIONS: In young patients, with hysteroscopic finding of metaplastic polyp should be considered and premalignant and malignant endometrial disease should be ruled out. The study should be completed with immunohistochemical markers (p63), specific for squamous metaplasia.

Mesotelioma en paciente colombiano con sobrevida mayor a tres años: presentación de caso / Mesothelioma in a Colombian Patient over three years: Case Presentation / Mesotelioma em paciente colombiano com sobrevivência superior a três anos: apresentação de caso

Resumen Introducción: el mesotelioma epitelioide es un tumor que se desarrolla en las capas embrionarias mesoteliales; es de etiología desconocida, pero se relaciona con la exposición al asbesto, con una presentación clínica inespecífica y con un pronóstico de sobrevida corto después del diagnóstico. Presentación del caso: hombre de profesión mecánico automotor, con tos sin expectoración, disnea, hipertermia y emaciación posterior a la extracción quirúrgica de lipomas que afectaban el tórax, quien posteriormente fue diagnosticado con mesotelioma epitelioide maligno con ubicación en la pleura del hemitórax derecho y fue tratado con toracotomía, quimioterapia con los medicamentos pemetrexed y cisplatino y sesiones de radioterapia, que mostraron un aumento en la sobrevida 3 tres años. Conclusión: este caso permitió identificar que el uso de la pleurodesis química con quimioterapia como tratamiento podría ser responsable del aumento de la esperanza de vida y la calidad de esta en los pacientes que padecen este tipo de tumor.

Abstract Introduction: Epithelioid mesothelioma is a tumor that develops in the mesothelial embryonic layers; it is of an unknown etiology, but it is related to asbestos exposure with a nonspecific clinical presentation and a short survival prognosis after diagnosis. Case presentation: An automotive mechanic patient presents with cough without expectoration, dyspnea, hyperthermia, and emaciation following surgical removal of lipomas. This affected the chest and the patient was subsequently diagnosed with malignant epithelioid mesothelioma located in the pleura of the right hemithorax. The patient was treated with thoracotomy, chemotherapy with the drugs pemetrexed and cisplatin, and radiation therapy sessions which resulted in an increased survival rate at 4 years. Conclusion: This case report identifies the use of chemical pleurodesis in combination with chemotherapy as an effective treatment for increasing the life expectancy and quality of life in patients suffering from this type of tumor.

Resumo Introdução: o mesotelioma epitelióide é um tumor que se desenvolve nas camadas embrionárias mesote-liais; é de causa desconhecida, mas está relacionado com a exposição ao amianto e possui uma manifestação clínica inespecífica e com prognóstico de sobrevivência curto após o diagnóstico. Apresentação do caso: o paciente é um mecânico automotivo, que apresentou tosse seca, dispneia, hipertermia e emagrecimento posterior a extração cirúrgica de lipomas que afetavam o tórax sendo posteriormente diagnosticado com mesotelioma epitelióide maligno localizado na pleura do hemitórax direito e foi tratado com toracotomia, quimioterapia com os medicamentos pemetrexed e cisplatino além de sessões de radioterapia, mostrando um aumento de expectativa de vida para 4 anos. Conclusão: este estudo de caso permite identificar que o uso da pleurodese química com quimioterapia como tratamento poderia ser a responsável pelo aumento da expectativa e qualidade de vida em pacientes acometidos por este tipo de tumor.

Intoxicaciones agudas exógenas en niños y adolescentes ingresados en cuidados intensivos pediátricos / Exogenous acute poisonings in children and adolescents admitted in Pediatric intensive care services

Introducción: La utilización creciente de productos tóxicos a escala mundial ha generado un amplio espectro de problemas. El suicidio, entre ellos, constituye un problema de salud internacional. En Cuba ocupa el sexto lugar como causa de mortalidad general y el segundo en el grupo de 15 a 49 años. Objetivo: caracterizar algunas variables epidemiológicas relacionadas con las intoxicaciones exógenas agudas en infantes. Métodos: Estudio observacional descriptivo retrospectivo en una muestra constituida por 142 pacientes. ingresados con el diagnóstico de intoxicación exógena en la Unidad de Cuidados Intensivos Pediátricos del Hospital General Docente Comandante Pinares de San Cristóbal, Artemisa, durante el periodo comprendido desde enero de 2008 a diciembre de 2016 Resultados: El grupo de 10-14 años representó la mayoría de la muestra para 39,4 por ciento y el 71,9. por ciento de esta muestra total correspondió al sexo femenino. El mayor porcentaje de las intoxicaciones ocurrieron de forma intencional (tentativa suicida) (64,1 por ciento). Los medicamentos ocuparon el primer lugar (87,3 por ciento) de los tóxicos identificados, el consumo de psicofármacos representó el 68,3 por ciento muchas veces asociado a la ingestión de alcohol (20,4 por ciento). Predominaron los síntomas neurológicos (66,3 por ciento), El lavado gástrico se le realizó en 79,6 por ciento y fue necesario realizar gastroenterodiálisis en 65,4 por ciento. Conclusiones: Las intoxicaciones exógenas constituyen una de las causas prevenibles que aportan incremento de la morbilidad y mortalidad en infantes. Su atención debe ser multidisciplinaria e intersectorial, lo que influirá positivamente en la calidad de vida de los grupos poblacionales vulnerables(AU)

Introduction: The increasing use of toxic products on a global scale has generated a broad spectrum of problems. Suicide, among them, is an international health problem. In Cuba, it is the sixth main cause of death and the second in the group of 15 to 49 years. Objective: To characterize some epidemiological variables related to exogenous acute poisonings in infants. Methods: An observational descriptive retrospective study was conducted in a sample of 142 patients admitted with the diagnosis of exogenous poisoning in the Pediatric Intensive Care Unit of Comandante Pinares General Teaching Hospital, San Cristóbal, Artemisa province, during the period from January 2008 to December 2016. Results: The group of 10-14 years represented the majority of the sample for a 39.4 percent, and the 71.9 percent of the total sample was female sex. The largest percentage of the poisonings were intentional (suicide attempt) (64.1percent). Drugs were the first (87.3 percent) of the toxic chemicals identified; the consumption of psychotropic drugs represented the 68.3 percent often associated with alcohol ingestion (20.4 percent). There was a predominance of neurological symptoms (66.3 percent). The gastric lavage was performed in 79.6 percent and it was necessary to perform gastroentero dyalisis in 65.4 percent. Conclusions: Exogenous poisonings are one of the preventable causes that increase morbidity and mortality in infants. Their attention must be with a multidisciplinary and intersectoral approach, which positively influences the quality of life of vulnerable population groups(AU)

Trombosis venosa profunda de los miembros inferiores: utilidad de la ecografía doppler / Doppler ecography: a safe method for diagnosis of Deep venous thrombosis

In this review, the different diagnostic methods of deep vein thrombosis will be treated, to which the first symptoms of the pathology appear once, and as it has varied until currently using Doppler Ultrasound, which provides a safe non-invasive method able to provide an anatomical and hemodynamic topography.

En esta revisión, se tratarán los diferentes métodos de diagnóstico de la trombosis venosa profunda, a los que se recurren una vez los primeros síntomas de la patología aparece, y como ha variado hasta usar actualmente la ecografía doppler, que proporciona un método seguro no invasivo capaz de suministrar una topografía anatómica y hemodinámica.

Cáncer de mama en mujeres pinareñas menores de 45 años, serie cronológica de 23 años / Breast cancer in Pinar del Río on women under 45 years old: chronological series of 23 years

RESUMEN Introducción: el cáncer de mama es un problema de salud mundial, constituye la primera causa de muerte por tumor maligno en féminas. En los últimos años se ha apreciado un descenso en la edad de presentación de la enfermedad, y la necesidad de disponer de una investigación que la reporte en la provincia. Objetivo: caracterizar el cáncer de mama en mujeres menores de 45 años atendidas en el Hospital General Docente "Abel Santamaría Cuadrado" de Pinar del Río en el período 1995-2018. Métodos: se realizó un estudio, observacional, descriptivo, longitudinal y retrospectivo en mujeres menores de 45 años operadas por cáncer de mama. Universo 1 223 mujeres, el muestreo fue intencional (n=256). Se aplicaron métodos de estadística descriptiva, los datos fueron obtenidos de la base de datos de la consulta central de mama del hospital. Resultados: el 21,48 % tenían antecedente familiar de cáncer, la mama derecha fue la más afecta (57,42 %), el estadio clínico más frecuente fue IIA, (31,25 %), la técnica quirúrgica frecuente fue la cirugía conservadora (69,14 %), el carcinoma ductal con sus diferentes variables fue el tipo histológico predominante (56,64 %). Conclusiones: el cáncer de mama es un problema de salud pública, cada año aparece en pacientes más jóvenes y con antecedentes familiares de cáncer, el diagnostico se realiza precoz en la mayoría de los casos y las técnicas quirúrgicas conservadoras fueron las empleadas.

ABSTRACT Introduction: breast cancer is a worldwide health problem; it is the leading cause of death from malignant tumor in female gender. In recent years there has been a decrease in the age of onset of this disease, and it is a need for the province to carry out research works regarding this entity. Objective: to characterize breast cancer in women under the age of 45 treated at Abel Santamaría Cuadrado General Teaching Hospital in Pinar del Río during in the period 1995 - 2018. Methods: an observational, descriptive, longitudinal and retrospective study was conducted including women less than 45 years old operated on breast cancer. The target group comprised 1223 women, the sampling was intentional (n=256). Methods of descriptive statistics were applied; data were obtained from the central database of the clinic of breast cancer. Results: 21,48 % had a family history of cancer, the right breast was the most affected (57,42 %), the most frequent clinical stage was IIA (31,25 %), conservative surgery was the most frequent surgical technique applied (69,14 %); duct carcinoma with its different variables was the predominant histological type (56,64 %). Conclusions: breast cancer is a public health problem, each year it emerges in younger patients with a family history of cancer, diagnosis is early made in most cases and conservative surgical procedures were the ones applied.

Ventajas en técnica Nyhus versus Lichtenstein para el tratamiento quirúrgico de la hernia inguinal bilateral / Advantages of Nyhus versus Lichtenstein technique for surgical treatment of bilateral inguinal hernia

RESUMEN Introducción: la técnica de Lichtenstein y Nyhus representan hernioplastias seguras; Nyhus es un proceder que aún no se reporta como elección para la hernia inguinal bilateral. Objetivo: describir las ventajas de la técnica Nyhus en comparación con la técnica de Lichtenstein en el tratamiento de elección en pacientes afectos de hernia inguinal bilateral. Métodos: se realizó un estudio observacional, analítico, y transversal, de casos control, en el Hospital General Docente "Abel Santamaría Cuadrado" Pinar del Río, Cuba, 2014-2017. La muestra quedó constituida por 62 casos, en dos grupos de 31; Grupo A: operados por técnica de Nyhus. Grupo B: operados en dos tiempos por técnica de Lichtenstein. Se aplicaron herramientas de estadística descriptiva e inferencial. Resultados: en el grupo A, la media del tiempo quirúrgico fue 42 minutos, el grupo B resultó por encima de los 60, el estadígrafo Chi-Cuadrado mostró la no homogeneidad entre las frecuencias, al ser una estadística significativa con un valor de p=0,00020. El tiempo de hospitalización en A promedió 26 horas, el grupo B predominó más de 48 horas, el estadígrafo Chi-Cuadrado mostró la no homogeneidad entre las frecuencias al ser la diferencia con un valor de p=0,00000059, una estadística significativa. La razón de complicaciones del grupo A y B fue de 1,57. En los pacientes del grupo A no se presentaron recurrencia ni inguinodinias, en los del grupo B se precisaron tres inguinodinias. Conclusiones: la técnica Nyhus es de elección preferente para el tratamiento quirúrgico de la hernia inguinal bilateral.

ABSTRACT Introduction: Lichtenstein's and Nyhus techniques represent safe hernioplasties; Nyhus is a procedure not yet reported as the choice for bilateral inguinal hernia. Objective: to describe the advantages of Lichtenstein technique comparing Nyhus technique for the management of inguinal hernia as the treatment of choice in patients suffering from bilateral inguinal hernia. Methods: an observational, analytical, and cross-sectional study of control cases was conducted at Abel Santamaría Cuadrado General Teaching Hospital during 2014-2017 in Pinar del Río, Cuba. The sample consisted of 62 cases, in two groups that included 31 patients; Group A: operated by Nyhus technique. Group B: operated in two stages by Lichtenstein technique. Descriptive and inferential statistical tools were applied. Results: in group A, the standard surgical time was 42 minutes, group B was over 60, the chi-square statistician showed the non-homogeneity between the frequencies being statistically significant the difference when observing the value of p=0,00020. The hospitalization time in A averaged 26 hours, in group B predominated more than 48 hours, the statistician chi-square showed the non-homogeneity between the frequencies being statistically significant the difference when observing the value of p=0.00000059. The ratio of complications of group A and B was 1.57. Patients belonging to Group A had no recurrence or inguinodynia symptoms, patients from Group B presented 3 inguinodynia episodes. Conclusions: Nyhus technique is the preferred choice for surgical treatment of bilateral inguinal hernia.

Protein value of cereals and cereal by-products for ruminants: a comparison between crude protein and protein-based estimates.

In situ estimates of ruminal undegraded fraction (RU) and effective intestinal digestibility (EID, corrected for microbial colonisation) of dry matter (DM), crude protein (CP) and total analysed amino acids (TAA) of rye, wheat and corn grains, wheat bran, wheat and barley distillers' dried grains with solubles (DDGS) and corn gluten feed were measured on three rumen and duodenum cannulated wethers using (15)N labelling techniques and considering ruminal rates of particle comminution (kc) and outflow. Results indicate that not considering kc and microbial colonisation led to considerable overestimations of RU which increased with feed ruminal degradation. Microbial colonisation may be also associated with overestimations of EID, whose estimates for DM, CP and TAA were predicted from parameters related with the ruminal escape of intestinally indigestible materials. The RU estimates were higher for TAA than for CP in grains, but the opposite was observed in by-products, whereas EID estimates were higher for TAA in all feeds. To obtain accurate protein values in these feedstuffs, it is required to consider both kc and ruminal microbial colonisation. The CP-based results underestimate the intestinally digested protein in grains and the opposite is evidenced in cereal by-products. Microbial protein synthesised in the rumen is largely the major fraction of the feedstuff protein value with the exception of DDGS.

Bioprospecting the American alligator (Alligator mississippiensis) host defense peptidome.

Cationic antimicrobial peptides and their therapeutic potential have garnered growing interest because of the proliferation of bacterial resistance. However, the discovery of new antimicrobial peptides from animals has proven challenging due to the limitations associated with conventional biochemical purification and difficulties in predicting active peptides from genomic sequences, if known. As an example, no antimicrobial peptides have been identified from the American alligator, Alligator mississippiensis, although their serum is antimicrobial. We have developed a novel approach for the discovery of new antimicrobial peptides from these animals, one that capitalizes on their fundamental and conserved physico-chemical properties. This sample-agnostic process employs custom-made functionalized hydrogel microparticles to harvest cationic peptides from biological samples, followed by de novo sequencing of captured peptides, eliminating the need to isolate individual peptides. After evaluation of the peptide sequences using a combination of rational and web-based bioinformatic analyses, forty-five potential antimicrobial peptides were identified, and eight of these peptides were selected to be chemically synthesized and evaluated. The successful identification of multiple novel peptides, exhibiting antibacterial properties, from Alligator mississippiensis plasma demonstrates the potential of this innovative discovery process in identifying potential new host defense peptides.

Relación entre características de alimentación complementaria y longitud en lactantes de 6-11 meses de edad de un Centro Materno Infantil-Lima / Relationship between characteristics of complementary feeding and length in infants of 6-11 months of age in a center maternal child-Lima

Introducción: El consumo de alimentos en cantidades insuficientes y en calidad inadecuada ejerce un efecto perjudicial en el crecimiento y desarrollo de niños menores. Objetivo: Determinar la relación entre características de alimentación complementaria y longitud en lactantes de 6-11 meses de edad de un Centro Materno Infantil-Lima. Diseño: Estudio con enfoque cuantitativo, descriptivo de asociación cruzada. Lugar: Centro Materno Infantil Juan Pablo II de Villa el Salvador. Participantes: 45 lactantes que reciben alimentación complementaria. Intervenciones: Se utilizó la encuesta de recordatorio de 24 horas sobre las preparaciones y cantidades de alimentos que el niño ingirió el día anterior, ello permitió determinar su ingesta estimada de nutrientes. Además se tomó los datos de longitud para determinar si el niño presentaba longitud baja, riesgo de longitud baja o normal. Para determinar la relación entre las características de la alimentación complementaria que recibe el lactante de 6 a 11 meses de edad y su longitud se aplicó Chi2, T de Student y prueba de diferencia de medianas U de Mann Whitney. Adicionalmente se calculó el Odds Rattio (OR) para establecer la fuerza de asociación. Se utilizaron EXCEL 2013 y SPSS versión 22. Principales medidas de resultados: Longitud para la edad (Longitud Normal y Riesgo-baja Longitud) y tipo de características alimentarias y su puntaje < 7 (Inadecuado), 7-9 (Regular) y 10-12 (Adecuado). Resultados: Hubo mayor cantidad de niños de 7 y 8 meses de edad (68 por ciento) con respecto a las demás edades. Se encontró mayor porcentaje de niñas (56.5 por ciento) con longitud normal. En cuanto al consumo en energía, carbohidratos y proteínas los niños con longitud normal presentaron mayor porcentaje de consumo adecuado. Se observó ligero mayor porcentaje de consumo adecuado de grasas en los niños de Riesgo-Baja Longitud. Con respecto al consumo de micronutrientes también se encontró mayor porcentaje de consumo adecuado en los...

Introduction: The food consumption in insufficient quantities and in inadequate quality exercises a harmful effect in the growth and development of less children. Objective: To determine the relation between characteristics of complementary feeding and length in nursing of 6-11 months of age of an infantile - Center Maternal Child. Design: Study with quantitative, descriptive approach of crossed association. Place: Infantile Maternal center Juan Pablo II of Villa El Salvador. Participants: 45 infants that receive complementary feeding. Interventions: There was used the survey of reminder of 24 hours of the preparations and food quantities that the child consumed the previous day, it allowed to determine its estimated nutrients ingestion. Also one took the length information to determine if the child was presenting low length, risk of low or normal length. To determine the relation between the characteristics of the complementary feeding that the nursing one receives from 6 until 11 months of age and its length was applied Chi2, T de Student and difference test of medians U of Mann Whitney. Additionally Odds Rattio (OR) was calculated to establish the association force. EXCEL was used 2013 and SPSS version 22. Main results measurements: Length for the age (Normal Length and Risk - fall Length) and type of food characteristics and its score Inadequate (<7), to Regulate (7-9) and Adequate (10-12). Results: There was children's major quantity of 7 and 8 months of age (68 per cent) with regard to other ages. There met major percentage of girls (56.5 per cent) normal length. As for the consumption in energy, carbohydrates and proteins the children with normal length presented major percentage of suitable consumption. Length observed major light percentage of suitable consumption of fats in the Risk-fall children. With regard to the micronutrients consumption also there met major percentage of consumption adapted in the children normal length, although it was...

Effect of folylpolyglutamate synthase A22G polymorphism on the risk and survival of patients with acute lymphoblastic leukemia.

Folylpolyglutamate synthase (FPGS) is the key enzyme that converts the chemotherapeutic agent, methotrexate (MTX), into MTX polyglutamate. An A22G polymorphism has been found in the FPGS gene. This study aimed to evaluated whether the A22G polymorphism in the FPGS gene is associated with an increased risk of acute lymphoblastic leukemia (ALL) and whether it plays a role in increasing the survival of patients with ALL. In this study, a total of 70 patients with ALL and 100 healthy individuals were genotyped by polymerase chain reaction and sequencing methods. The homozygous variant, 22G/G [odds ratio (OR)=3.88; 95% confidence interval (CI): 2.50-6.03] and the heterozygous variant, 22A/G (OR=1.37; 95% CI: 1.26-48.95) were risk factors for ALL. Patients with the 22A/G genotype had an OR of 1.81 (95% CI: 1.57-5.74; P=0.049) and carriers of the 22G/G genotype had an OR of 2.44 (95% CI: 2.40-11.82; P=0.017) for relapse. A significant association between the A22G polymorphism and survival of patients with ALL was found (P<0.05); whereas, individuals with A/G or G/G genotypes had a decreased overall survival (log-rank test, P=0.044). Although preliminary, these data suggest that the genotypes of the A22G polymorphism may be risk factors for ALL and may play a role in the survival of patients with ALL.

[Rational use of animal models for research and microsurgery training]. / Uso racional de modelos animais para pesquisa e ensino de microcirurgia.

The objective of this study is to disclose an experimental model of low cost, which complies with the regulatory norms of animal experiments by using dead animals from other experiments, contributing to the improvement of microsurgery learning. Cadavers of Wistar rats, originated from disposal of other courses, are used. The corpses of thawed mice are used for basic microsurgical training of medical students at the Nove de Julho University, aiming to contribute to the students' training. Their use is justified by the low cost of the material used, many animals being spared during the intermediate phase of skill development for realization of micro-anastomoses. This experimental model is inexpensive and allows the rational use of animals, corroborating with the ethical standards of experimental research and contributing to the education and training of microsurgery.

Uso racional de modelos animais para pesquisa e ensino de microcirurgia / Rational use of animal models for research and microsurgery training

O objetivo deste estudo é divulgar um modelo experimental de baixo custo, que respeita as normas regulamentadoras das experiências com animais Utilizando animais mortos em outros experimentos contribuindo com a melhora do aprendizado de microcirurgia. São utilizados cadáveres de ratos da raça Wistar, oriundo de descarte de outros cursos. Os cadáveres dos ratos descongelados são utilizados para o treinamento básico de microcirurgia dos acadêmicos do curso de medicina da Universidade Nove de Julho, visando contribuir para o treinamento de acadêmicos, sua utilização se justifica pelo baixo custo do material empregado e muitos animais são poupados durante a fase intermediária do desenvolvimento de habilidades para realização das micro-anastomoses. Este modelo experimental é de baixo custo e permite a utilização racional de animais, corroborando com as normas éticas da pesquisa experimental e contribuindo com o ensino e treinamento da microcirurgia.

The objective of this study is to disclose an experimental model of low cost, which complies with the regulatory norms of animal experiments by using dead animals from other experiments, contributing to the improvement of microsurgery learning. Cadavers of Wistar rats, originated from disposal of other courses, are used. The corpses of thawed mice are used for basic microsurgical training of medical students at the Nove de Julho University, aiming to contribute to the students' training. Their use is justified by the low cost of the material used, many animals being spared during the intermediate phase of skill development for realization of micro-anastomoses. This experimental model is inexpensive and allows the rational use of animals, corroborating with the ethical standards of experimental research and contributing to the education and training of microsurgery.

Tumor filoide de la mama / Phyllodes Breast Tumor

El tumor filoide de la mama, es una neoplasia poco frecuente, de origen fibroepitelial con potencial agresivo, que representa el 0,3 por ciento al 1,0 por ciento de todos los tumores de mama. El objetivo fue caracterizar clínica y patológicamente los tumores filoides diagnosticados. Se realizó un estudio retrospectivo, descriptivo de las pacientes portadoras de tumor filoide de la mama, atendidas en el servicio de cirugía general del Hospital General Docente Abel Santamaría Cuadrado de Pinar del Río, durante el periodo comprendido entre los años 1991 y 2009. Fueron operadas 2000 pacientes con tumores en las mamas durante este periodo, en 82 mujeres (4,1 por ciento), el diagnostico histopatológico fue de tumor filoide, de estas, 6 de forma bilateral, 48 (58,53 por ciento), presentaron afectación de la mama derecha, 70 fueron benignos (85,36 por ciento), 5 malignos (6,09 por ciento), y 7 borderline (8,53 por ciento). El 91,46 por ciento de las pacientes tenían una edad menor o igual a 50 años. El tamaño tumoral fue variable, sin embargo, de los 5 casos informados como malignos, 3 presentaron diámetros mayores de10 cm. De las 5 pacientes con tumores malignos, 4 (80 por ciento), fueron tratadas con mastectomías simples y 1 (20 por ciento) con cirugía conservadora. Una paciente presentó metástasis a la cadera, a los 5 años y en las demás la evolución fue satisfactoria. El tumor filoide es una entidad poco frecuente, que afecta principalmente a mujeres menores de 50 años, el tratamiento de elección es quirúrgico(AU)

Phyllodes Breast Tumor, is a very rare type of neoplasm having a fibroepithelial origin with aggressive potential, which represents from 0,3 percent to 1,0 per cent of all breast cancers. The objective was a clinical and epidemiological characterization of the diagnosed Phyllodes Breast Tumors. A retrospective, descriptive study of patients suffering from phyllodes breast tumor who attended to Abel Santamaria Cuadrado General University Hospital, Pinar del Rio from 1991 to 2009. 2000 patients who suffered from breast tumors in the period of the study, in 82 women (4,1 per cent) which histopathological diagnosis was phyllodes breast tumor, out of them, 6 presented bilateral form, 48 (58,53 per cent), presented the tumor in the right breast, 70 were benign (85,36 percent), 5 malignant, and 7 in the borderline (8,53 percent). The 91,46 percent of patients were younger than 50 years old or in the 50s. The size of tumor was inconsistent, though, from the 5 malignant cases, 3 presented more than 10cm greater. Out of the 5 patients suffering from malignant tumors 4 (80 per cent) underwent simple mastectomy and 1 (20 per cent) by conservative surgery. One patient presented metastasis in the hip, at five years and in the other check-ups the evolution was satisfactory. Phyllodes breast tumor is a very rare entity which affects 50 years old women or under this age, surgery is the elective treatment(AU)

Tumor phyllodes de la mama / Phyllodes Breast Tumor

El tumor phyllodes de la mama, es una neoplasia poco frecuente, de origen fibroepitelial con potencial agresivo, que representa el 0,3% al 1,0% de todos los tumores de mama. Objetivo: caracterizar clínica y patológicamente los tumores phyllodes diagnosticados. Método: se realizó un estudio retrospectivo, descriptivode las pacientes portadoras de tumor phyllodes de la mama, atendidas en el servicio de cirugía general del Hospital General Docente «Abel Santamaría Cuadrado¼ de Pinar del Río, durante el periodo comprendido entre los años 1991 y 2009. Resultados: fueron operadas 2000 pacientes con tumores en las mamas durante este periodo, en 82 mujeres (4,1%), el diagnostico histopatológico fue de tumor phyllodes, de estas, 6 de forma bilateral, 48 (58,53%), presentaron afectación de la mama derecha, 70 fueron benignos (85,36%), 5 malignos (6,09%), y 7 borderline (8,53%). El 91,46% de las pacientes tenían una edad menor o igual a 50 años. El tamaño tumoral fue variable, sin embargo, de los 5 casos informados como malignos, 3 presentaron diámetros mayores de10 cm. De las 5 pacientes con tumores malignos, 4 (80%), fueron tratadas con mastectomías simples y 1 (20%) con cirugía conservadora. Una paciente presentó metástasis a la cadera, a los 5 años y en las demás la evolución fue satisfactoria. Conclusión: el tumor phyllodes es una entidad poco frecuente, que afecta principalmente a mujeres menores de 50 años, el tratamiento de elección es quirúrgico.

Phyllodes Breast Tumor, is a very rare type of neoplasm having a fibroepithelial origin with aggressive potential, which represents from 0,3% to 1,0% of all breast cancers. Objective: clinical and epidemiological characterization of the diagnosed Phyllodes Breast Tumors. Method: a retrospective, descriptive study of patients suffering from phyllodes breast tumor who attended to "Abel Santamaria Cuadrado" General University Hospital, Pinar del Rio from 1991 to 2009. Results: 2000 patients who suffered from breast tumors in the period of the study, in 82 women (4,1%) which histopathological diagnosis was phyllodes breast tumor, out of them, 6 presented bilateral form, 48 (58,53%), presented the tumor in the right breast, 70 were benign (85,36%), 5 malignant, and 7 in the borderline (8,53%). The 91,46% of patients were younger than 50 years old or in the 50s. The size of tumor was inconsistent, though, from the 5 malignant cases, 3 presented more than 10cm greater. Out of the 5 patients suffering from malignant tumors 4 (80%) underwent simple mastectomy and 1 (20%) by conservative surgery. One patient presented metastasis in the hip, at five years and in the other check-ups the evolution was satisfactory. Conclusion: phyllodes breast tumor is a very rare entity which affects 50 years old women or under this age, surgery is the elective treatment.

Linfomas no hodgkin: área metropolitana de Bucaramanga / Non-hodgkin lymphomas from Bucaramanga metropolitan area

Introducción: Ninguna neoplasia ha generado tanta confusión en sus sistemas de clasificación como los linfomas no Hodgkin (LNH). Una correcta tipificación es necesaria para el diagnóstico, pronóstico y tratamiento. El propósito de este estudio fue clasificar los LNH del registro poblacional de cáncer del área metropolitana de Bucaramanga. Pacientes y métodos: Se realizó un estudio observacional de corte transversal, utilizando como población los pacientes con LNH del área metropolitana de Bucaramanga de enero de 2000 a diciembre de 2006. La información se obtuvo de las historias clínicas y de inmunohistoquímica en bloques de parafina. Se utilizo la clasificación de linfomas de la OMS. Resultados: Se estudiaron 320 pacientes y se encontró predominio de la enfermedad en la 6ª y 7ª década. La distribución por género fue mayor en hombres con 61,26% y mujeres 45,6%. El sitio anatómico de compromiso más frecuente fue ganglios cervicales con 25,6%. La mayoría expresaron antígenos B, 86,8%, y T, 1,8%. El subtipo más frecuente fue difuso de célula grande en el 29,6%. Conclusiones: La mayoría los LNH del área metropolitana de Bucaramanga son de linajes B, nodales y de célula grande difuso. Fue evidente el uso limitado de otras técnicas para la clasificación de estas neoplasias en nuestra región.

Introduction: There is not a neoplasm that has generated such confusion on its classification system such as the Non- Hodgkin’s lymphoma. An adequate classification is necessary for diagnosis, prognostic and treatment. The purpose of this study was to classify the NHL from the Bucaramanga metropolitan area poblational cancer registry. Patients and methods: An observational cross-sectional study was made, using as population the patients with NHL from the Bucaramanga metropolitan area from January 2000 until December 2006. The information was obtained from the clinical records and inmunohistochemistry in paraffin blocks. The WHO lymphoma classification was used. Results: 320 patients were studied and a predominance of the disease was found on the 6th and 7th decade of life. Gender distribution was higher in men with 61.26% and women 45.6%. The anatomical site more frequently affected were the cervical lymph nodes with 25.6%. Most of them expressed B antigens, 86.8%, and T, 1.8%. The most frequent subtype was diffuse large B cell in 29.6%. Conclusions: Most of the NHL from the Bucaramanga metropolitan area are nodal, of B lineage, and diffuse large cell subtype. The limited use of other techniques for the classification of these neoplasms in our region was evident.