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El secuestro broncopulmonar es una malformación del aparato respiratorio que consiste en tejido bronquial y pulmonar no funcionante, separado del árbol tráqueo-bronquial y alimentado por un vaso sanguíneo proveniente de la circulación sistémica. La incidencia es de 1 por cada 5000 nacimientos, comprende entre 0,15 % y 6,45 % de las patologías pulmonares. El pronóstico es, generalmente, favorable, reportándose regresión espontánea de la lesión en 50 % a 75 % de los pacientes. Puede ocasionar efecto de masa, comprimiendo el corazón y el pulmón hasta generar cambios hemodinámicos y falla cardíaca. Hay múltiples procedimientos para el tratamiento y manejo, principalmente en casos de gran tamaño y fetos hidrópicos, para mejorar el pronóstico perinatal. Se presentan los dos primeros casos de secuestro broncopulmonar tratados en Venezuela mediante fotocoagulación láser del vaso nutricio y su evolución perinatal, con sobrevida del 100 % y sin ninguna complicación registrada en el periodo perinatal(AU)

Bronchopulmonary sequestration is a malformation of the respiratory system consisting of non-functioning bronchial and pulmonary tissue, separated from the tracheo-bronchial tree and fed by a blood vessel from the systemic circulation. The incidence is 1 in 5000 births, ranging from 0.15% to 6.45% of pulmonary pathologies. The prognosis is generally favorable, with spontaneous regression of the lesion reported in 50% to 75% of patients. It can cause mass effect, compressing the heart and lung to the point of generating hemodynamic changes and heart failure. There are multiple procedures for treatment and management, mainly in large cases and hydropic fetuses, to improve perinatal prognosis. We present the first two cases of bronchopulmonary sequestration treated in Venezuela by laser photocoagulation of the nutrient vessel and their perinatal evolution, with 100% survival and without any complications recorded in the perinatal period(AU)

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La molestia alimentaria más común que los médicos escuchan de los padres, es que su hijo no come lo suficiente, sin embargo ningún texto o revisión arroja datos que indiquen en realidad el porcentaje que representa dentro de los problemas de la consulta. Etimológicamente anorexia significa ausencia de hambre e inapetencia, ausencia o falta de apetito; pero el niño que rechaza el alimento la mayoría de las veces no lo hace por no sentir los estímulos necesarios para generar una respuesta fisiológica a tan importantes señales indispensables para la vida, sino como producto de complejas y a la vez sutiles alteraciones en las interacciones socio-familiares que alteran el desarrollo de la conducta alimentaria. Debe hacerse una distinción entre la inapetencia verdadera de la falsa. La falsa es la situación en la cual el niño come poco en opinión de los familiares pero presenta un crecimiento y desarrollo nonnales, es la más frecuente y está detenninada en su mayor parte por errores de concepción y de conductas practicadas por los padres. La inapetencia verdadera puede obedecer a causas orgánicas o comporta mentales y puede llegar a comprometer el crecimiento. Una cuidadosa historia médica, del desarrollo y alimentaria sumada a un buen examen físico provee elementos necesarios para el diagnóstico. Solo después de descartar causas orgánicas se puede concluir acerca de problemas conductuales. Los exámenes de laboratorio no aportan en general mayor claridad en el manejo de la inapetencia si el problema es conductual. La intervención médica tiene por objeto tranquilizar a los padres, aclarar dudas y disminuir la ansiedad, promoviendo la modificación en el comportamiento alimentario del niño y la actitud de la familia. El uso de medicaciones se restringe a situaciones en que su eficacia y seguridad ha sido demostrada, bajo supervisión médica y valorando la relación riesgo/beneficio.

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OBJECTIVE: Measure the prevalence of physical and sexual abuse during pregnancy, determine the nature and severity of abuse, and assess correlates with abuse. METHOD: A total of 1314 women seeking prenatal care between July 2000 and January 2003 were approached at three public hospitals in Mexico City. An original composite case record form was created to measure physical and sexual abuse before and during pregnancy. RESULT: Forty-one percent of respondents had a history of physical or sexual abuse, with current abuse reported by 11.1%, and abuse during pregnancy by 7.6%. Among abused women, 71% reported an increase in the severity of abuse since becoming pregnant. Logistic regression revealed physically fighting with a partner and a history of abuse best predict violence during pregnancy. CONCLUSION: The severity of abuse among abused women appears to increase during pregnancy. Prenatal care visits in Mexico are an important opportunity for violence screening and intervention.

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The role of mitogen-activated protein kinase (MAPK) signaling pathways in the regulation of TNF-alpha and NOS2 production by human monocytes infected with Mycobacterium bovis BCG was examined. Inhibition studies showed that ERK1/2 and p38 MAPK activation were necessary for the monocyte response to M. bovis infection. Analysis of MAPK activation showed rapid phosphorylation of ERK1/2 and p38 in response to M. bovis BCG. Phosphorylation was not due to an autocrine effect of TNF-alpha secretion, since an anti-TNF-alpha antibody had no significant effect on the levels of p38 phosphorylation. The inhibitor PD98059 significantly reduced M. bovis BCG-induced TNF-alpha production and almost completely abrogated phosphorylation of ERK1/2; in addition the potent MEK inhibitor U0126 also abrogated phosphorylation. In contrast, studies using inhibitors selective for ERK1/2 and p38 showed that p38 plays an essential role in the induction of NOS2, whereas the role of ERK1/2 was minor. These results suggest that ERK1/2 and p38 kinases differentially regulate the M. bovis BCG-mediated induction of TNF-alpha and NOS2 in human monocytes.

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DESIGN: CC-chemokines are potent leukocyte activators and chemoattractants, which have an important role in granuloma formation, function critical for the immune responses to mycobacterial infection. This study investigated whether infection of human monocytes with Mycobacterium bovis bacillus Calmette-Guérin (BCG) elicits secretion of RANTES, macrophage inflammatory protein (MIP)-1alpha and MIP-1beta. METHODS: RANTES, MIP-1alpha and MIP-1beta synthesis was measured by the presence of protein secretion in the cell culture supernatant as determined by enzyme-linked immunosorbent assay. To investigate the mechanism of M. bovis BCG stimulation of RANTES, we carried out inhibition assays with antibodies to CD40 and we used an intracellular calcium chelator BAPTA-AM. RESULTS: Infection of human monocytes with M. bovis BCG induced RANTES, MIP-1alpha and MIP-1beta secretion in a dose-dependent manner. This stimulation of CC-chemokines production was not attributed to LPS contamination. M. bovis-induced RANTES secretion was dependent upon bacterial uptake and on tumor necrosis factor (TNF)-alpha. Interestingly, the production of RANTES by M. bovis BCG-infected monocytes occurs through a mechanism that requires intracellular calcium and was significantly inhibited (P<0.05) with antibodies to CD40. CONCLUSIONS: These results suggest that the ability of M. bovis BCG to produce CC-chemokines might lead to protection in the acquired immune response of mycobacterial infection and at the same time indicate that M. bovis BCG-induced RANTES secretion is mediated by CD40 and dependent on the intracellular calcium influx.

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The analysis for the present study was derived from 343 singleton pregnancies with a breech presentation. The variables associated with Apgar score at 5 minutes were, gestational age and birth weight. This association was observed in all patients and when they were analyzed separately according to route of delivery. The intrapartum and early neonatal mortality was absent in both groups. The perinatal outcome among the vaginally delivered frank breech infants at term was not statistically different compared with the group delivered by caesarean section.

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El aneurisma aórtico abdominal es una enfermedad arterio-esclerótica que complica la vida del paciente en caso de que sangre. Dentro de las apreciaciones generales, si el aneurisma es mayor a 6 cm de diámetro debe ser intervenido quirúrgicamente. En caso de tratarlo en el momento del sangrado se convierte en una emergencia quirúrgica, con un 50 por ciento de mortalidad. Actualmente se cuentan con métodos diagnósticos precisos y no muy costosos, como la ecografía abdominal con doppler color y la tradicional arteriografía aórtica. Su tratamiento quirúrgico ha sido innovado por técnicas hemodinámicas de cateterismo con colocación de endoprótesis expandibles (stentors). Presentamos el caso de un paciente de 74 años...

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Sexual assault is an enormous social and public health problem. Most victims are young women. The aim of this study was to describe the characteristics of this crime in adolescents. The study involved 213 patients separated in two subgroups: adolescents and non adolescents. In adolescents, much of this violence is perpetrated by an acquaintance or relative. Th frequency of sexually transmitted diseases was 20% and rape-related pregnancy was identified in 10% of victims. All victims of sexual assault must be encouraged for both medical and psychological evaluation.

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Obstetrical characteristics of pregnant adolescents. The aim of the present study was to determine the obstetrical characteristics of pregnant adolescents and to evaluate if the high risk comes from biological factors associate to their age or not. The obstetrical complications and the perinatal results were not different in relation from other groups, with exception of the minors of fifteen years in which the age constitutes an important risk. Nevertheless, the adolescent has other risks to the health such as the risk of acquiring sexual transmission diseases including HIV/AIDS. The child of a teen mother are also more likely to die in infancy, between the first month and the first year of life. Adolescents need information and services to protect their sexual and reproductive health.

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Se revisaron 96 casos de cáncer de mama de la unidad de patología mamaria del servicio de gineco-obstetricia del Hospital Militar "Dr. Carlos Arvelo" entre los años 1987-97. Se escogió una población de pacientes con cáncer de mama menores de 40 años para estudio de antecedentes familiares de cáncer y su relación con el cáncer hereditario, familiar y esporádico. Se presentaron 14 casos de CA de mama en mujeres< de 40 años, representado esto el 14,58 por ciento de la población estudiada, con un promedio de edad de 34.14 años y un rango de 30-39 años; encontrándose 35.7 por ciento de CA hereditario, 14,28 por ciento CA familiar, 42,8 por ciento CA esporádico y 7,14 por ciento donde los antecedentes familiares no fueron reportados. El cáncer de mama hereditario estuvo relacionado con antecedentes de CA de mama en un 50 por ciento, CA de vías digestiva (gástrico, colon) 30 por ciento y CA de próstata y otros cánceres en un 10 por ciento respectivamente. El CA de mama hereditario esta caracterizado por presentarse en edades tempranas, incidencia de CA mamario bilateral, antecedentes familiares de CA de ovario, colon, próstata y otros cánceres primarios; y el 90 por ciento de esta población presenta mutación del gen BRCA1 y BRCA2, debido al alto porcentaje del cáncer heredo-familiar encontrado en este trabajo en comparación con otros autores, de debe hacer hicapié en la identificación de los pacientes de alto riesgo y la realización de pruebas genéticas

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The pregnant women receive different types of medications many of whose safety has not been clearly demonstrated. The drug use profiles vary from community to community which justify to make local studies. Two hundred obstetrical patients were interviewed throughout the prenatal control to obtain data on maternal drug consumption. The patients were interrogated with respect to names of drug products, routes of administration, dosage regimens and prenatal consumption or underlying disease states during pregnancy. The interval between administration of a drug and the time of delivery were also noted. In the prenatal period 79% received at least one product. The average number of drug products was 2 with a range from 0 to 6 different drugs. The principal drugs ingested were: vitamins (32%), antibiotics (24%), iron (9%), antiemetics (7%), nonsteroidal anti-inflammatory analgesic (6%) and acetaminophen (5%). The only variable related to drug consumption was the presence of prenatal complications. This study represent an approach for monitoring the medical quality of prenatal care.

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A new synthetic absorbible suture was evaluated (poliglecaprone 25, in the Gynecology-Obstetric practice. 70 patients were studied, 33 obstetrical and 37 gynecological. We practiced trans and postoperative evaluations of the suture, as well as the characteristics of the tensil (stregth or force), memory, adjustment, etc. concluding that it is an excellent suture material and has great advantages over other materials.

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Este estudo mostra que pacientes com artrite reumatoide somente em uso de antiinflamatorios nao hormonais apresentam disturbios na relacao T4/T8 do liquido sinovial com niveis normais no sangue periferico associados com baixos numeros de rosetas autologas no liquido sinovial, sugerindo pontos adicionais de disturbios imunologicos em pacientes com artrite reumatoide

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