Combinación de técnicas quirúrgicas en la hernia gigante de Amyand irreductible

Las hernias gigantes de Amyand son hernias inguinales excepcionales por extenderse por debajo de la mitad del muslo en posición de pie y contener al apéndice cecal. Presentamos un paciente portador de una hernia gigante de Amyand irreductible, al cual se le realiza una reparación quirúrgicas, mediante una combinada de técnicas para su resolución. El tratamiento de las hernias inguinales gigantes es todo un desafío, debido a la distorsión anatomía existente, y por la pérdida de derecho a domicilio de los órganos que puede llegar a ocasionar. Consideramos que la combinación de las técnicas de Bassini y Lichtennstein asociado a las maniobras de Ombrédanne y de Camay es una estrategia adecuada para reparar exitosamente las hernias inguinales gigantes grado I. La apendicectomía en la hernia de Amyand tipo I es una alternativa de tratamiento cuando existe riesgo de apendicitis aguda.

Giant Amyand hernias are exceptional inguinal hernias because they extend below the middle of the thigh in the standing position and contain the cecal appendix. We present a patient with an irreducible giant Amyand hernia, who underwent surgical repair, using a combination of techniques for its resolution. The treatment of giant inguinal hernias is quite a challenge, due to the existing anatomical distortion, and the loss of the right to domicile of the organs that it can cause. We consider that the combination of the Bassini and Lichtenstein techniques associated with the Ombrédanne and Camay maneuvers is an appropriate strategy to successfully repair grade I giant inguinal hernias. Appendectomy in Amyand type I hernia is a treatment alternative when a risk of acute appendicitis exists.

Recomendaciones sobre el diagnóstico y el tratamiento de la alergia a la proteína de la leche de vaca en población pediátrica colombiana - Posición de expertos / Expert recommendations for diagnosis and treatment of cow's milk protein allergy in the Colombian pediatric population

Resumen Objetivo: generar recomendaciones sobre el diagnóstico y el tratamiento de la alergia a la proteína de la leche de vaca (APLV), que sirvan de referencia y consulta para los médicos pediatras y de cuidado primario. Materiales y métodos: el presente documento de posición de expertos fue desarrollado por un grupo de médicos, especialistas en diferentes áreas terapéuticas y con experiencia en APLV. Se definieron los temas más relevantes y se realizó una revisión de la literatura científica disponible, a fin de elaborar una propuesta de recomendaciones que fue discutida por los autores. Resultados: se elaboró un documento de posición que propone un enfoque práctico sobre la definición, el diagnóstico y el tratamiento de la APLV en el paciente pediátrico. Conclusiones: el diagnóstico temprano y el manejo adecuado de la APLV pueden contribuir a una disminución de la carga de esta enfermedad y sus complicaciones.

Abstract Objective: The objective of this paper is to develop and present recommendations for diagnosis and treatment of Cow's Milk Protein Allergy (CMPA) which can serve as a reference for pediatric and primary care physicians to consult. Materials and methods: This expert position document was developed by a group of doctors who are specialists in several therapeutic areas who have experience in CMPA. The most relevant topics were defined and a review of the available scientific literature was carried out to prepare a proposal for recommendations that was then discussed by the authors. Results: A position paper was developed that proposes a practical approach to definition, diagnosis and treatment of CMPA in pediatric patients. Conclusions: Early diagnosis and proper management of CMPA can help decrease the burden of this disease and its complications.

Simulación Mediante Elemento Finito de Sistemas Intramedulares Telescópicos para Rehabilitación de Pacientes con Osteogénesis Imperfecta / Simulation by Finite Element Method of Intramedullary Telescopic Systems for Rehabilitation of Patients with Osteogenesis Imperfecta

Resumen En el trabajo se plantea el análisis de diferentes geometrías para un dispositivo intramedular, las cuales ayudan a reducir y evitar la migración, deformación y rotura del implante en tejido óseo afectado con Osteogénesis Imperfecta (OI). Se realizaron diseños en CAD de diferentes prototipos, donde se analizan las propiedades mecánicas en el alma del dispositivo, así como en las roscas distal y proximal de los implantes macho y hembra. Asimismo, se obtuvieron modelos 3D de huesos de un infante afectado con OI para realizar simulaciones mediante elemento finito de la interacción entre el hueso y el dispositivo intramedular. Los resultados muestran que los prototipos propuestos disminuyen la deformación del dispositivo, así como el aumento en la rigidez de la relación hueso-prótesis. Asimismo, las roscas generaron un menor esfuerzo en la unión con el hueso, lo que prevé un menor daño al tejido óseo. El trabajo se limitó al análisis numérico del rediseño de implantes telescópicos intramedulares para afectados con OI. Concluyendo que la geometría semicircular 3/4 de caña, otorga un óptimo resultado en las pruebas realizadas, al tiempo que las roscas ACME proveen una mejor sujeción en las epífisis distal y proximal de los huesos largos.

Abstract In this work we propose the analysis of different geometries for an intramedullary device, which help to reduce and avoid the migration, deformation and rupture of the implant in bone tissue affected with Osteogenesis Imperfecta (OI). Designs of different prototypes were made in CAD, where the mechanical properties in the device's soul are analyzed, as well as in the distal and proximal threads of the male and female implants. Likewise, 3D bone models of an affected infant with OI were obtained to perform finite element simulations of the interaction between the bone and the intramedullary device. The results show that the prototypes proposed decrease the strain of the device, as well as the increase in the stiffnes of the bone-prosthesis relationship. Also, the threads generated less stress in the union with the bone, which provides less damage to the bone tissue. The work was limited to the numerical analysis of the redesign of intramedullary telescopic implants for patients with OI. Concluding that the semicircular geometry 3/4 of cane, gives an optimal result in the tests carried out, while the ACME threads provide a better subjection in the distal and proximal epiphyses of the long bones.

Bone marrow trephine biopsy involvement by lymphoma: pattern of involvement and concordance with flow cytometry, in 10 years from a single institution.

PURPOSE: To evaluate the features of bone marrow (BM) biopsy involvement by lymphoma, pattern of infiltration, morphological analysis and flow cytometry were reviewed at all lymphoma patients over a period of 10 years. METHODS/PATIENTS: 413 cases were included in the study if BM biopsy slides were available. Only 356 patients had both BM trephine biopsy and flow cytometry. RESULTS: The most frequent subtype was diffuse large B cell (31.2%), followed by follicular lymphoma (18.9%). The predominant pattern was mixed (nodular-interstitial) (9.2%). Morphological marrow infiltration was found in 138 cases, and flow cytometry identified 117 cases with BM involvement. A concordance between the two methods was detected in 305 cases (85.7%). There was discordance in 51 cases (14.3%): morphology positive/FC negative in 33 cases and morphology negative/FC positive in 18. CONCLUSIONS: Flow cytometry is slightly more useful in detecting involvement when the BM is affected, but this finding is not conclusive.

Air pollutant characterization in Tula industrial corridor, Central Mexico, during the MILAGRO study.

Pollutant emissions and their contribution to local and regional air quality at the industrial area of Tula were studied during a four-week period as part of the MILAGRO initiative. A recurrent shallow stable layer was observed in the morning favoring air pollutants accumulation in the lower 100 m atmospheric layer. In the afternoon the mixing layer height reached 3000 m, along with a featuring low level jet which was responsible of transporting air pollutants at regional scales. Average PM10 at Jasso (JAS) and Tepeji (TEP) was 75.1 and 36.8 µ g/m(3), respectively while average PM2.5 was 31.0 and 25.7 µ g/m(3). JAS was highly impacted by local limestone dust, while TEP was a receptor of major sources of combustion emissions with 70% of the PM10 constituted by PM2.5. Average hourly aerosol light absorption was 22 Mm(-1), while aerosol scattering (76 Mm(-1)) was higher compared to a rural site but much lower than at Mexico City. δ(13)C values in the epiphyte Tillandsia recurvata show that the emission plume directly affects the SW sector of Mezquital Valley and is then constrained by a mountain range preventing its dispersion. Air pollutants may exacerbate acute and chronic adverse health effects in this region.

The effect of cryodevice and cryoprotectant concentration on buffalo oocytes vitrified at MII stage

Vitrification is a common method for cryopreservation of gametes and embryos. Although successful oocyte vitrification has been achieved in several animal species, subsequent progress is still limited especially in buffalo. To improve the effectiveness of vitrification of buffalo oocytes, two experiments were conducted. The first experiment evaluated the effect of cryodevices on viability and maturation of vitrified, matured buffalo oocytes. The in vitro matured oocytes were divided into two groups, the first was vitrified using conventional French straws, while the other was vitrified using Cryotops. There was a significant reduction in the morphologically normal oocytes after vitrification with both methods. Maturation rates of vitrified thawed buffalo oocytes were significantly higher in Cryotops than straws. The survival rate after vitrification was similar for both straws and Cryotops. The percentages of viable oocytes were significantly lower in straw than in controls. The second experiment evaluated the effect of two concentrations of cryoprotectants on the vitrification of in vitro matured buffalo oocytes. Mixtures of DMSO and EG as cryoprotectant (CPA) solutions were prepared in TCM-199 with two concentrations of cryoprotectants. The first concentration was 6 M V2 (3 M E.G + 3 M DMSO), and the second concentration was 7 M V2 (3.5 M DMSO + 3.5 M EG). Each concentration of cryoprotectants was added in two steps, with the first step having half the concentration of the second (and final) concentration. The survival rate after vitrification was similar for both concentration (6 M and 7 M) groups. The maturation rates of vitrified thawed buffalo oocytes were significantly higher in 7 M concentration than in the 6 M group. In conclusion, the survivability and meiotic competence of buffalo oocytes improved with vitrification at higher concentration of cryoprotectants and using cryotops.

The effect of cryodevice and cryoprotectant concentration on buffalo oocytes vitrified at MII stage

Vitrification is a common method for cryopreservation of gametes and embryos. Although successful oocyte vitrification has been achieved in several animal species, subsequent progress is still limited especially in buffalo. To improve the effectiveness of vitrification of buffalo oocytes, two experiments were conducted. The first experiment evaluated the effect of cryodevices on viability and maturation of vitrified, matured buffalo oocytes. The in vitro matured oocytes were divided into two groups, the first was vitrified using conventional French straws, while the other was vitrified using Cryotops. There was a significant reduction in the morphologically normal oocytes after vitrification with both methods. Maturation rates of vitrified thawed buffalo oocytes were significantly higher in Cryotops than straws. The survival rate after vitrification was similar for both straws and Cryotops. The percentages of viable oocytes were significantly lower in straw than in controls. The second experiment evaluated the effect of two concentrations of cryoprotectants on the vitrification of in vitro matured buffalo oocytes. Mixtures of DMSO and EG as cryoprotectant (CPA) solutions were prepared in TCM-199 with two concentrations of cryoprotectants. The first concentration was 6 M V2 (3 M E.G + 3 M DMSO), and the second concentration was 7 M V2 (3.5 M DMSO + 3.5 M EG). Each concentration of cryoprotectants was added in two steps, with the first step having half the concentration of the second (and final) concentration. The survival rate after vitrification was similar for both concentration (6 M and 7 M) groups. The maturation rates of vitrified thawed buffalo oocytes were significantly higher in 7 M concentration than in the 6 M group. In conclusion, the survivability and meiotic competence of buffalo oocytes improved with vitrification at higher concentration of cryoprotectants and using cryotops.(AU)

Efecto del celecoxib en la colitis inducida en ratas / Effect of the colecoxib in the the colitis induced in rats

Debido a las controversias sobre los inhibidores selectivos de la ciclooxigenasa 2 (COX-2) sobre la inflamación intestinal, decidimos estudiar el Celecoxib, un inhibidor de COX-2 sobre la evolución de la inflamación experimental del colon de rata. Se utilizaron tres grupos de 12 ratas cada uno (ratas machos Sprague-Dawley). Al grupo control se les administró por vía intrarectal 2 ml de agua, al grupo inflamado 1 ml de ácido acético al 10 por ciento más 1 ml de agua, y al grupo medicado 1 ml de ácido acético y 1 ml de Celecoxib (10 mg/Kg-p). Se registró el peso durante 3 días, al cabo de ese tiempo se sacrificaron y se evaluó el colon macro y microscópicamente. El tratamiento con colecoxib ocasiona una significativa disminución de las lesiones macroscópicas. El grupo control no presentó edema, ulceración o erosión. Se encontró 33 por ciento de edema en el grupo medicado contra 93 por ciento en el grupo inflamado (p<0.0005); 22 por ciento de erosión en el grupo medicado contra 65 por ciento en el grupo inflamado (p<0.03) y 12 por ciento de ulceración en el grupo medicado contra el 44 por ciento en el grupo inflamado (p<0.047). La severidad de las lesiones microscópicas fueron significativamente menores en el grupo medicado con regeneración de la mucosa en el 50 por ciento y regenración parcial en 50 por ciento restante. En el grupo inflamado hubo pérdida del 90 por ciento de la mucosa y el grupo control sin alteraciones. La perdida de peso fue de 6g en el inflamado. El Celecoxib mejora notablemente el cuadro de inflamación en el colon de las ratas, mediante la inhibición de la Cox-2 y disminución de la interleucina 1 (IL-1)

Developmental study of immunocompetent cells in the bronchus-associated lymphoid tissue (BALT) from Wistar rats.

The aim of the present report was to study in growing Wistar rats the development of immunocompetent cells in the bronchus-associated lymphoid tissue (BALT). We found at day 4 postpartum, a high number of TCRgamma/delta+ T cells and very few CD8alpha+, CD8beta+, CD5+, TCRalpha/beta+ T cells in BALT. The latter cells and CD4+ T cells increase with age. Even though T cells expressing TCRgamma/delta outnumber those expressing TCRalpha/beta early in development, until 45 days of age, alpha/beta+ predominate over gamma/delta+ T cells only in adult rats (60 days of age). Moreover, a predominance of suppressor/cytotoxic T cells over T-helper cells was found in 60 days old rats. Surprisingly, more CD8alpha+ than CD8beta+ T cells in BALT are observed. The number of IgA+ B and CD4+ T cells found in the BALT increases with age. The early appearance - 4 days of age - of all T-cell phenotypes in BALT especially of gamma/delta+ T cells may imply a benefit to respond to inhaled antigen soon after birth.

Particulate Air Pollution in Mexico City: A Collaborative Research Project.

PM10, PM25, precursor gas, and upper-air meteorological measurements were taken in Mexico City, Mexico, from February 23 to March 22, 1997, to understand concentrations and chemical compositions of the city's particulate matter (PM). Average 24-hr PM10 concentrations over the period of study at the core sites in the city were 75 H g/m3. The 24-hr standard of 150 µ g/m3 was exceeded for seven samples taken during the study period; the maximum 24-hr concentration measured was 542 µ g/m3. Nearly half of the PM10 was composed of fugitive dust from roadways, construction, and bare land. About 50% of the PM10 consisted of PM2.5, with higher percentages during the morning hours. Organic and black carbon constituted up to half of the PM2.5. PM concentrations were highest during the early morning and after sunset, when the mixed layers were shallow. Meteorological measurements taken during the field campaign show that on most days air was transported out of the Mexico City basin during the afternoon with little day-to-day carryover.

Etiología microbiana de la enfermedad inflamatoria pélvica leve y moderada (EIP) / Microbial ethiology of mild and moderate pelvic inflammatory disease

La Enfermedad Inflamatoria Pélvica (EIP) es una de las complicaciones más severas de las Enfermedades de Transmisión Sexual (ETS) se puede deber entre otros eventos al ascenso de la microflora genital femenina o a la infección de gérmenes implicados en ETS como la Chlamydia trachomatis o Neisseria gonorrhoeae. Esto trae como consecuencia serias repercusiones desde el punto de vista gineco-obstétrico. Una de las principales limitaciones a la que se enfrenta el médico es el conocer su etiología. De tal manera que con el presente trabajo, se pretende establecer el tipo de microorganismos involucrados en esta patología a fin de que al identificarlos, mediante el cultivo de endocérvix, endometrio y líquido peritoneal; se otorgue a la paciente el tratamiento adecuado, oportuno y certero, logrando así una mayor eficacia terapéutica

Effect of RN-301 immunomodulator on bronchus-associated lymphoid tissue (BALT) in protein depleted rats at weaning.

It has been previously demonstrated in Wistar rats that severe protein deprivation at weaning, even after refeeding with a 20% casein diet for 21 days, provokes alterations in IgA+ B cell and T cell populations from gut and GALT (gut associated lymphoid tissue) that are reverted by immunomodulator IM-104. In the present report, we investigate the influence of RN-301 (quite similar to IM-104) given by the oral or subcutaneous route during the protein deprivation period, in the seeding of BALT with IgA+ B and CD5+ T cells. The immunomodulator RN-301 contains LPS from E. coli and membrane and ribosomal fractions of P. acne. Tissue sections of the lower respiratory tract were studied by immunohistochemistry. The immunomodulator RN-301 administered by the oral route favours the significant increase in the seeding of the BALT lamina propria with IgA+ B and CD5+ T cells (p < 0.001). However, the RN-301 given by the subcutaneous route does not favour the repopulation of the BALT lamina propria. The ribosomal fractions from P. acne associated with LPS from E. coli contained in the immunomodulator RN-301 administered by the oral route may rescue the small resting lymphocytes in the gut-associated lymphoid tissue (GALT). This event favours their proliferation and migration to the BALT.

Embarazo ectópico abdominal a termino: presentación de un caso / Ectopic terminal abdominal pregnancy: presentation of a case

Se reporta el caso de una paciente de 28 años de edad, G 6, P5, que se presenta a la emergencia de gineco-obstetricia del Hospital Dr. Luis E. Aybar en Santo Domingo, República Dominicana, con expulsión de líquido transvaginal de 9 días de evolución, trayendo reporte sonográfico de embarazo de 33 semanas, oligodramnios severo, situación transversa y masa placentaria; al realizar laparotomía encontramos embarazo abdominal de 38 semanas viable, extrayéndose producto femenino de 2892 gramos de peso

Rinoescleroma / Rhinoescleroma

El rinoescleroma es una enfermedad rara, granulomatosa, crónica, causada por Klebsiella rhinoscleromatis, la cual afecta predominantemente el tracto respiratorio superior, siendo más frecuente en países subdesarrollados