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ABSTRACT Objective: Follicular thyroid carcinoma (FTC) is less frequent but has a worse prognosis than papillary carcinoma. The available evidence on pre-operative characteristics of FTC is controversial. Our objective was to characterize the clinical, ultrasound and histopathological presentation of FTC patients treated Chile. Subjects and methods: Retrospective analysis of 97 patients treated for FTC in 6 large centers in Chile. We analyzed their ultrasonographic features and classified the nodules according to ATA risk of malignancy and TI-RADS score, as well as the cytological findings according to the Bethesda system. We described their clinical and histopathological findings at diagnosis and classified their risk of recurrence and mortality according to ATA 2015 recurrence risk category and the eighth edition of the AJCC/UICC staging system, respectively. Results: Median age was 48 years and 73.2% were females. The median diameter was 38.8 mm; only 9.5% of them were microtumors. According to ATA risk of malignancy, 86% of the nodules were low or intermediate suspicious, while 78% were category 3 or 4A nodules according to the TI-RADS. Regarding the Bethesda system, 65.9% had indeterminate cytology (20.6% category III and 45.3% category IV). At histological examination, most were minimally-invasive and angio-invasive tumors with less than 4 foci (54.7% and 28.4% respectively). More than 90% of FTC were unifocal and there was no lymphovascular or extrathyroidal invasion or lymph node involvement. Four patients (4.1%) had distant metastases at diagnosis. Most patients (95%) had stage I or II disease according to the AJCC/UICC staging system, while the risk of recurrence was low at 51.5% when using the ATA risk of recurrence scale. Conclusions: At diagnosis, most FTCs were nodules of low or intermediate suspicion at ultrasound, nearly two thirds had indeterminate cytology according to the Bethesda system, and nearly 50% of them were of low risk of recurrence.
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Objective: Follicular thyroid carcinoma (FTC) is less frequent but has a worse prognosis than papillary carcinoma. The available evidence on pre-operative characteristics of FTC is controversial. Our objective was to characterize the clinical, ultrasound and histopathological presentation of FTC patients treated Chile. Subjects and methods: Retrospective analysis of 97 patients treated for FTC in 6 large centers in Chile. We analyzed their ultrasonographic features and classified the nodules according to ATA risk of malignancy and TI-RADS score, as well as the cytological findings according to the Bethesda system. We described their clinical and histopathological findings at diagnosis and classified their risk of recurrence and mortality according to ATA 2015 recurrence risk category and the eighth edition of the AJCC/UICC staging system, respectively. Results: Median age was 48 years and 73.2% were females. The median diameter was 38.8 mm; only 9.5% of them were microtumors. According to ATA risk of malignancy, 86% of the nodules were low or intermediate suspicious, while 78% were category 3 or 4A nodules according to the TI-RADS. Regarding the Bethesda system, 65.9% had indeterminate cytology (20.6% category III and 45.3% category IV). At histological examination, most were minimally-invasive and angio-invasive tumors with less than 4 foci (54.7% and 28.4% respectively). More than 90% of FTC were unifocal and there was no lymphovascular or extrathyroidal invasion or lymph node involvement. Four patients (4.1%) had distant metastases at diagnosis. Most patients (95%) had stage I or II disease according to the AJCC/UICC staging system, while the risk of recurrence was low at 51.5% when using the ATA risk of recurrence scale. Conclusion: At diagnosis, most FTCs were nodules of low or intermediate suspicion at ultrasound, nearly two thirds had indeterminate cytology according to the Bethesda system, and nearly 50% of them were of low risk of recurrence.
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Adenocarcinoma Folicular , Neoplasias de la Tiroides , Nódulo Tiroideo , Femenino , Humanos , Persona de Mediana Edad , Masculino , Neoplasias de la Tiroides/patología , Estudios Retrospectivos , Chile , Adenocarcinoma Folicular/diagnóstico por imagen , Ultrasonografía , Nódulo Tiroideo/patologíaRESUMEN
Five yeast fungi strains (i.e., two Cryptococcus albidus, one Candida guillermondii, and two Candida tropicalis) were isolated from sugarcane and tested for their use of lignin as sole carbon source and their potential to grow in the presence of phenol and phenol derivatives (i.e., pentachlorophenol and p-nitrophenol). The full set of isolated yeasts showed ligninolytic activity, achieving at least 36% lignin degradation after 25 days. The C. albidus JS-B1 strain had the highest ligninolytic activity, achieving 27% lignin degradation within 4 days. This increased activity was associated with the production of ligninolytic laccase enzymes. All the tested yeast fungi strains showed growth in the presence of high concentrations of phenolic compounds (i.e., 900 mg/L phenol, 200 mg/L p-nitrophenol, 50 mg/L pentachlorophenol) and showed significant potential for lignin and lignin by-product degradation. Each of these five strains has the potential to be used in biological treatment processes for contaminated effluents from paper pulping and bleaching or phenol and phenol-derivative biodegradation processes for other industrial wastewater effluents.
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Lignina , Pentaclorofenol , Lignina/metabolismo , Pentaclorofenol/metabolismo , Nitrofenoles/metabolismo , Levaduras/metabolismo , Fenol/metabolismo , Biodegradación Ambiental , Fenoles/metabolismoRESUMEN
BACKGROUND: Classification of growth hormone (GH) - secreting tumors by the granular pattern might predict their clinical behavior in acromegalic patients. There are several other prognostic factors. AIM: To compare the features at presentation and cure rates of patients with GH secreting tumors according to the granular pattern, and to define independent prognostic factors for surgical treatment in these patients. MATERIAL AND METHODS: A retrospective, observational study of 85 active acromegalic patients surgically treated in two medical centers. RESULTS: Seventy-four patients (87%) were classified as having densely granulated (DG) and 11 (13%) as sparsely granulated (SG) tumors. The latter were less active biochemically, had a higher rate of macroadenoma and cavernous sinus invasion and had a lower rate of biochemical cure than the DG group. Several characteristics were associated with disease persistence but only age (Odds ratio (OR) = 0.93) and cavernous sinus invasion (OR = 21.7) were independently associated in the logistic regression model. CONCLUSIONS: The sparsely granulated pattern is associated with a more aggressive behavior, but the main determinants of prognosis are age and cavernous sinus invasion.
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Adenoma Hipofisario Secretor de Hormona del Crecimiento/patología , Adulto , Femenino , Adenoma Hipofisario Secretor de Hormona del Crecimiento/diagnóstico por imagen , Humanos , Inmunohistoquímica , Imagen por Resonancia Magnética , Masculino , Persona de Mediana Edad , Pronóstico , Estudios RetrospectivosRESUMEN
Background: Classification of growth hormone (GH) - secreting tumors by the granular pattern might predict their clinical behavior in acromegalic patients. There are several other prognostic factors. Aim: To compare the features at presentation and cure rates of patients with GH secreting tumors according to the granular pattern, and to define independent prognostic factors for surgical treatment in these patients. Material and Methods: A retrospective, observational study of 85 active acromegalic patients surgically treated in two medical centers. Results: Seventy-four patients (87%) were classified as having densely granulated (DG) and 11 (13%) as sparsely granulated (SG) tumors. The latter were less active biochemically, had a higher rate of macroadenoma and cavernous sinus invasion and had a lower rate of biochemical cure than the DG group. Several characteristics were associated with disease persistence but only age (Odds ratio (OR) = 0.93) and cavernous sinus invasion (OR = 21.7) were independently associated in the logistic regression model. Conclusions: The sparsely granulated pattern is associated with a more aggressive behavior, but the main determinants of prognosis are age and cavernous sinus invasion.
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Adenoma Hipofisario Secretor de Hormona del Crecimiento/patología , Pronóstico , Inmunohistoquímica , Imagen por Resonancia Magnética , Estudios Retrospectivos , Adenoma Hipofisario Secretor de Hormona del Crecimiento/diagnóstico por imagenRESUMEN
A new troglobitic species of the genus Antillobisium is described from Sancti Spiritus province, Cuba. Antillobisium tomasi n. sp. is the third known species of the genus and is well characterized by its large size and extremely slender appendages. Biogeographical and ecological considerations on the genus are given.
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Arácnidos , Ecología , Animales , CubaRESUMEN
The advent of high-throughput sequencing (HTS) technologies has revolutionized the way we understand the transformation of genetic information into morphological traits. Elucidating the network of interactions between genes that govern cell differentiation through development is one of the core challenges in genome research. These networks are known as developmental gene regulatory networks (dGRNs) and consist largely of the functional linkage between developmental control genes, cis-regulatory modules, and differentiation genes, which generate spatially and temporally refined patterns of gene expression. Over the last 20 years, great advances have been made in determining these gene interactions mainly in classical model systems, including human, mouse, sea urchin, fruit fly, and worm. This has brought about a radical transformation in the fields of developmental biology and evolutionary biology, allowing the generation of high-resolution gene regulatory maps to analyze cell differentiation during animal development. Such maps have enabled the identification of gene regulatory circuits and have led to the development of network inference methods that can recapitulate the differentiation of specific cell-types or developmental stages. In contrast, dGRN research in non-classical model systems has been limited to the identification of developmental control genes via the candidate gene approach and the characterization of their spatiotemporal expression patterns, as well as to the discovery of cis-regulatory modules via patterns of sequence conservation and/or predicted transcription-factor binding sites. However, thanks to the continuous advances in HTS technologies, this scenario is rapidly changing. Here, we give a historical overview on the architecture and elucidation of the dGRNs. Subsequently, we summarize the approaches available to unravel these regulatory networks, highlighting the vast range of possibilities of integrating multiple technical advances and theoretical approaches to expand our understanding on the global gene regulation during animal development in non-classical model systems. Such new knowledge will not only lead to greater insights into the evolution of molecular mechanisms underlying cell identity and animal body plans, but also into the evolution of morphological key innovations in animals.
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Regulación del Desarrollo de la Expresión Génica , Redes Reguladoras de Genes , Secuenciación de Nucleótidos de Alto Rendimiento/métodos , Invertebrados/genética , Vertebrados/genética , Animales , Invertebrados/crecimiento & desarrollo , Modelos Animales , Vertebrados/crecimiento & desarrolloRESUMEN
The thyroid nodule is a frequent cause of primary care consultation. The prevalence of a palpable thyroid nodule is approximately 4-7%, increasing up to 67% by the incidental detection of nodules on ultrasound. The vast majority are benign and asymptomatic, staying stable over time. The clinical importance of studying a thyroid nodule is to exclude thyroid cancer, which occurs in 5 to 10% of the nodules. The Board of SOCHED (Chilean Society of Endocrinology and Diabetes) asked the Thyroid Study Group to develop a consensus regarding the diagnostic management of the thyroid nodule in Chile, aimed at non-specialist physicians and adapted to the national reality. To this end, a multidisciplinary group of 31 experts was established among university academics, active researchers with publications on the subject and prominent members of scientific societies of endocrinology, head and neck surgery, pathology and radiology. A total of 14 questions were developed with key aspects for the diagnosis and subsequent referral of patients with thyroid nodules, which were addressed by the participants. In those areas where the evidence was insufficient or the national reality had to be considered, the consensus opinion of the experts was used through the Delphi methodology. The consensus was approved by the SOCHED board for publication.
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Consenso , Glándula Tiroides/diagnóstico por imagen , Glándula Tiroides/patología , Nódulo Tiroideo/diagnóstico , Biopsia con Aguja Fina , Chile , Humanos , Medición de Riesgo , Factores de RiesgoRESUMEN
The thyroid nodule is a frequent cause of primary care consultation. The prevalence of a palpable thyroid nodule is approximately 4-7%, increasing up to 67% by the incidental detection of nodules on ultrasound. The vast majority are benign and asymptomatic, staying stable over time. The clinical importance of studying a thyroid nodule is to exclude thyroid cancer, which occurs in 5 to 10% of the nodules. The Board of SOCHED (Chilean Society of Endocrinology and Diabetes) asked the Thyroid Study Group to develop a consensus regarding the diagnostic management of the thyroid nodule in Chile, aimed at non-specialist physicians and adapted to the national reality. To this end, a multidisciplinary group of 31 experts was established among university academics, active researchers with publications on the subject and prominent members of scientific societies of endocrinology, head and neck surgery, pathology and radiology. A total of 14 questions were developed with key aspects for the diagnosis and subsequent referral of patients with thyroid nodules, which were addressed by the participants. In those areas where the evidence was insufficient or the national reality had to be considered, the consensus opinion of the experts was used through the Delphi methodology. The consensus was approved by the SOCHED board for publication.
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Humanos , Glándula Tiroides/patología , Glándula Tiroides/diagnóstico por imagen , Nódulo Tiroideo/diagnóstico , Consenso , Chile , Factores de Riesgo , Medición de Riesgo , Biopsia con Aguja FinaRESUMEN
BACKGROUND: In most of the world, diagnostic surgery remains the most frequent approach for indeterminate thyroid cytology. Although several molecular tests are available for testing in centralized commercial laboratories in the United States, there are no available kits for local laboratory testing. The aim of this study was to develop a prototype in vitro diagnostic (IVD) gene classifier for the further characterization of nodules with an indeterminate thyroid cytology. METHODS: In a first stage, the expression of 18 genes was determined by quantitative polymerase chain reaction (qPCR) in a broad histopathological spectrum of 114 fresh-tissue biopsies. Expression data were used to train several classifiers by supervised machine learning approaches. Classifiers were tested in an independent set of 139 samples. In a second stage, the best classifier was chosen as a model to develop a multiplexed-qPCR IVD prototype assay, which was tested in a prospective multicenter cohort of fine-needle aspiration biopsies. RESULTS: In tissue biopsies, the best classifier, using only 10 genes, reached an optimal and consistent performance in the ninefold cross-validated testing set (sensitivity 93% and specificity 81%). In the multicenter cohort of fine-needle aspiration biopsy samples, the 10-gene signature, built into a multiplexed-qPCR IVD prototype, showed an area under the curve of 0.97, a positive predictive value of 78%, and a negative predictive value of 98%. By Bayes' theorem, the IVD prototype is expected to achieve a positive predictive value of 64-82% and a negative predictive value of 97-99% in patients with a cancer prevalence range of 20-40%. CONCLUSIONS: A new multiplexed-qPCR IVD prototype is reported that accurately classifies thyroid nodules and may provide a future solution suitable for local reference laboratory testing.
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Regulación Neoplásica de la Expresión Génica , Proteínas de Neoplasias/metabolismo , Glándula Tiroides/metabolismo , Neoplasias de la Tiroides/diagnóstico , Nódulo Tiroideo/diagnóstico , Biomarcadores de Tumor/metabolismo , Biopsia con Aguja Fina , Chile/epidemiología , Estudios de Cohortes , Biología Computacional , Diagnóstico Diferencial , Sistemas Especialistas , Estudios de Seguimiento , Humanos , Aprendizaje Automático , Proteínas de Neoplasias/genética , Estadificación de Neoplasias , Guías de Práctica Clínica como Asunto , Valor Predictivo de las Pruebas , Prevalencia , Estudios Prospectivos , Reproducibilidad de los Resultados , Sensibilidad y Especificidad , Glándula Tiroides/patología , Neoplasias de la Tiroides/epidemiología , Neoplasias de la Tiroides/metabolismo , Neoplasias de la Tiroides/patología , Nódulo Tiroideo/epidemiología , Nódulo Tiroideo/metabolismo , Nódulo Tiroideo/patologíaRESUMEN
La identificación de la morbilidad materna extrema grave ofrece una oportunidad para la investigación de muertes maternas. El cumplimiento de los procesos de atención y determinación de los posibles riesgos asociados, es indispensable para evitarla.Objetivo: describir los procesos de atención de las gestantes con morbilidad materna extremadamente grave en la atención prenatal en el 2009.Método: se realizó un estudio descriptivo cuyo universo fueron las 63 gestantes que se diagnosticaron con morbilidad materna extremadamente grave en los servicios de ginecobstetricia de los hospitales generales y maternos de La Habana. La información se obtuvo de los registros hospitalarios y las historias clínicas de las gestantes en la atención prenatal y hospitalaria; esta se recogió a través de un instrumento creado al efecto y se introdujo en una base de datos en Access.Resultados: los principales riesgos identificados fueron la hipertensión arterial, la anemia, la infección vaginal y la pre eclampsia. La consulta de reevaluación realizada por el especialista en ginecobstetricia se reflejó en un 33 por ciento, el promedio de 10 consultas durante el embarazo se constató en el 69,8 por ciento de las gestantes. La complicación por shock hipovolémico ocupó el primer lugar, seguido del shock séptico y la eclampsia.Conclusiones: la identificación de riesgos en la atención prenatal probablemente intervenga en la evolución de la MMEG en la Habana(AU)
Identification of extremely severe maternal morbidity provides an opportunity for research into maternal death. Fulfillment of care processes and determination of potential associated risks are indispensable to prevent extremely severe maternal morbidity.Objective: describe the prenatal care processes applied to pregnant women with extremely severe maternal morbidity in 2009.Method: a descriptive study was conducted with a universe of 63 pregnant women diagnosed with extremely severe maternal morbidity at gynecobstetric services of general and maternal hospitals in Havana. A dedicated tool was used to collect data from prenatal and hospital registries and medical records of the pregnant women. The data were stored in an Access database.Results: the main risks identified were hypertension, anemia, vaginal infection and preeclampsia. Re-evaluation by a gynecobstetrician was conducted in 33 percent of the cases. The average 10 prenatal consultations were performed with 69.8 percent of the pregnant women. Hypovolemic shock ranked first among complications, followed by septic shock and eclampsia.Conclusions: risk identification during prenatal care may play a role in the evolution of extremely severe maternal morbidity in Havana(AU)
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Humanos , Femenino , Embarazo , Complicaciones del Embarazo/epidemiología , Atención Prenatal/métodos , Indicadores de Salud , Morbilidad , Epidemiología Descriptiva , Factores de RiesgoRESUMEN
La identificación de la morbilidad materna extrema grave ofrece una oportunidad para la investigación de muertes maternas. El cumplimiento de los procesos de atención y determinación de los posibles riesgos asociados, es indispensable para evitarla. Objetivo: describir los procesos de atención de las gestantes con morbilidad materna extremadamente grave en la atención prenatal en el 2009. Método: se realizó un estudio descriptivo cuyo universo fueron las 63 gestantes que se diagnosticaron con morbilidad materna extremadamente grave en los servicios de ginecobstetricia de los hospitales generales y maternos de La Habana. La información se obtuvo de los registros hospitalarios y las historias clínicas de las gestantes en la atención prenatal y hospitalaria; esta se recogió a través de un instrumento creado al efecto y se introdujo en una base de datos en Access. Resultados: los principales riesgos identificados fueron la hipertensión arterial, la anemia, la infección vaginal y la pre eclampsia. La consulta de reevaluación realizada por el especialista en ginecobstetricia se reflejó en un 33 por ciento, el promedio de 10 consultas durante el embarazo se constató en el 69,8 por ciento de las gestantes. La complicación por shock hipovolémico ocupó el primer lugar, seguido del shock séptico y la eclampsia. Conclusiones: la identificación de riesgos en la atención prenatal probablemente intervenga en la evolución de la MMEG en la Habana(AU)
Identification of extremely severe maternal morbidity provides an opportunity for research into maternal death. Fulfillment of care processes and determination of potential associated risks are indispensable to prevent extremely severe maternal morbidity. Objective: describe the prenatal care processes applied to pregnant women with extremely severe maternal morbidity in 2009. Method: a descriptive study was conducted with a universe of 63 pregnant women diagnosed with extremely severe maternal morbidity at gynecobstetric services of general and maternal hospitals in Havana. A dedicated tool was used to collect data from prenatal and hospital registries and medical records of the pregnant women. The data were stored in an Access database. Results: the main risks identified were hypertension, anemia, vaginal infection and preeclampsia. Re-evaluation by a gynecobstetrician was conducted in 33 percent of the cases. The average 10 prenatal consultations were performed with 69.8 percent of the pregnant women. Hypovolemic shock ranked first among complications, followed by septic shock and eclampsia. Conclusions: risk identification during prenatal care may play a role in the evolution of extremely severe maternal morbidity in Havana(AU)
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Humanos , Femenino , Embarazo , Complicaciones del Embarazo/epidemiología , Factores de Riesgo , Atención Perinatal/métodos , Epidemiología Descriptiva , Encuestas de MorbilidadRESUMEN
Introducción: uno de los recursos más efectivos en traumatismos maxilofaciales es el empleo de la traqueostomía, esta se conoce desde hace más de doscientos años. Pocas intervenciones quirúrgicas han salvado tantas vidas como la traqueostomía pues esta, permite garantizar una vía respiratoria segura para el paciente, pero como todo proceder quirúrgico no está exenta de complicaciones. La derivación endotraqueal submandibular se presenta como una alternativa viable en los casos que se requiera una traqueostomía temporal, esta consiste en el paso del tubo endotraqueal de la boca para el exterior a través de una incisión en la región submandibular. Se denomina fractura panfacial cuando las lesiones comprometen los tercios superiores, medio e inferior da la cara y que resulta en una perturbación grave de la arquitectura facial. Objetivos: dar a conocer siete casos realizados desde el 2006 hasta la actualidad, cuatro en el Hospital General Docente "Abel Santamaría Cuadrado" de Pinar del Rio, Cuba, y tres en la Clínica Multiperfil de Luanda, Angola. Métodos: se exponen la técnica descrita por Altemir y detallada por Guevara Mantilla y cols en sus cuatro fases. Los pacientes fueron llevados al quirófano de forma urgente y electiva mediante coordinación con el Servicio de Anestesiología y Reanimación. Se realizó, primero la derivación submandibular y seguidamente el proceder programado para cada paciente. Conclusiones: el proceder permite un adecuado control de la vía respiratoria y constituye una alternativa segura y eficaz en pacientes con traumas complejos del tercio medio facial. No se han encontraron complicaciones ni durante ni en el posoperatorio(AU)
Introduction: tracheostomy is one of the most effective resources in the treatment of facial trauma. This technique has been used for more than two hundred years. Few surgical interventions have saved as many lives as tracheostomy, since it makes it possible to secure a safe airway for the patient. However, as with all surgical procedures, tracheostomy may also have complications. Submandibular endotracheal bypass is a viable alternative when temporary tracheostomy is required. It consists in the passage of an endotracheal tube from the mouth outwards through an incision in the submandibular region. It is called panfacial fracture when the lesions compromise the upper, middle and lower thirds of the face, resulting in serious disturbance of the facial architecture. Objectives: present seven cases treated from 2006 to the present: four at Abel SantamarÝa Cuadrado General Teaching Hospital in Pinar del RÝo, Cuba, and three at the Multiprofile Clinic of Luanda, Angola. Methods: a presentation is provided of the four stages of the technique described by Altemir and detailed by Guevara Mantilla and cols. Patients were carried to the operating room for emergency and elective surgery prior coordination with the Anesthesiology and Resuscitation Service. Submandibular bypass was performed first, followed by the procedure scheduled for each patient. Conclusions: the procedure allows appropriate control of the airway and constitutes a safe, effective alternative for patients with complex trauma of the facial middle third. No complications were found during surgery or in the postoperative period(AU)
Asunto(s)
Humanos , Traumatismos Maxilofaciales/cirugía , Traqueostomía/efectos adversos , Intubación Intratraqueal/métodos , Servicio de Anestesia en Hospital/métodosRESUMEN
Introducción: uno de los recursos más efectivos en traumatismos maxilofaciales es el empleo de la traqueostomía, esta se conoce desde hace más de doscientos años. Pocas intervenciones quirúrgicas han salvado tantas vidas como la traqueostomía pues esta, permite garantizar una vía respiratoria segura para el paciente, pero como todo proceder quirúrgico no está exenta de complicaciones. La derivación endotraqueal submandibular se presenta como una alternativa viable en los casos que se requiera una traqueostomía temporal, esta consiste en el paso del tubo endotraqueal de la boca para el exterior a través de una incisión en la región submandibular. Se denomina fractura panfacial cuando las lesiones comprometen los tercios superiores, medio e inferior da la cara y que resulta en una perturbación grave de la arquitectura facial. Objetivos: dar a conocer siete casos realizados desde el 2006 hasta la actualidad, cuatro en el Hospital General Docente "Abel Santamaría Cuadrado" de Pinar del Rio, Cuba, y tres en la Clínica Multiperfil de Luanda, Angola. Métodos: se exponen la técnica descrita por Altemir y detallada por Guevara Mantilla y cols en sus cuatro fases. Los pacientes fueron llevados al quirófano de forma urgente y electiva mediante coordinación con el Servicio de Anestesiología y Reanimación. Se realizó, primero la derivación submandibular y seguidamente el proceder programado para cada paciente. Conclusiones: el proceder permite un adecuado control de la vía respiratoria y constituye una alternativa segura y eficaz en pacientes con traumas complejos del tercio medio facial. No se han encontraron complicaciones ni durante ni en el posoperatorio.
Introduction: tracheostomy is one of the most effective resources in the treatment of facial trauma. This technique has been used for more than two hundred years. Few surgical interventions have saved as many lives as tracheostomy, since it makes it possible to secure a safe airway for the patient. However, as with all surgical procedures, tracheostomy may also have complications. Submandibular endotracheal bypass is a viable alternative when temporary tracheostomy is required. It consists in the passage of an endotracheal tube from the mouth outwards through an incision in the submandibular region. It is called panfacial fracture when the lesions compromise the upper, middle and lower thirds of the face, resulting in serious disturbance of the facial architecture. Objectives: present seven cases treated from 2006 to the present: four at Abel Santamaría Cuadrado General Teaching Hospital in Pinar del Río, Cuba, and three at the Multiprofile Clinic of Luanda, Angola. Methods: a presentation is provided of the four stages of the technique described by Altemir and detailed by Guevara Mantilla and cols. Patients were carried to the operating room for emergency and elective surgery prior coordination with the Anesthesiology and Resuscitation Service. Submandibular bypass was performed first, followed by the procedure scheduled for each patient. Conclusions: the procedure allows appropriate control of the airway and constitutes a safe, effective alternative for patients with complex trauma of the facial middle third. No complications were found during surgery or in the postoperative period.
RESUMEN
Analizar en forma retrospectiva nuestros resultados con uretroplastías en 2 grupos según la técnica utilizada. MATERIAL Y MÉTODO: En el periodo 1997-2012 se efectuaron 58 Uretroplastías, 32 de sustitución (grupo 1) en los que se utilizó principalmente colgajo de piel de pene (77 por ciento) y 26 Uretroplastías anastomóticas (grupo 2). Motivo de análisis son 30 y 24 casos respectivamente. Un buen resultado se definió por un factor subjetivo (relato del paciente), Flujometría igual o mayor de 10 ml/seg. c/s IPSS igual o < 9.RESULTADOS: En el grupo 1 el 77 por ciento la lesión era >4 cm y con 83 por ciento de buenos resultados a una mediana de seguimiento de 41meses. El 23 por ciento, requirió procedimientos complementarios. El 61 por ciento tuvo algún compromiso de vascularización de piel de pene. En el grupo 2 el 46 por ciento fue por fractura de pelvis con una tasa de buenos resultados de 92 por ciento con una mediana de seguimiento de 25.5 meses, 21 por ciento de procedimientos complementarios de retoque y sin complicaciones. CONCLUSIONES: Nuestra serie tiene resultados comparables con lo publicados en la literatura.
Throughout this study the researcher(s) personal experience in urethroplasty during the period 1997-2012 was analyzed. To conduct it, the studied cases were divided into two different groups; the first group were 30 cases of substitution urethroplasty with a forty-one-months median follow-up, where the success rate was 83 percent. The most frequent complications were impairment of vascular supply of the penile skin secondary the use of distal penile circular fascio cutaneus flap(61 percent). The second group (group nº2) was composed by 24 cases of anastomotic urethroplasty with a median follow-up of 25,5 months, in this group the success rate was 92 percent and no complications were observed. After this study, it is possible to assert that the obtained results are in concordance with what is stated in the international literature.
Asunto(s)
Humanos , Masculino , Adulto , Persona de Mediana Edad , Estrechez Uretral/cirugía , Procedimientos Quirúrgicos Urológicos Masculinos , Uretra/cirugía , Estudios de Seguimiento , Resultado del TratamientoRESUMEN
Background: Serum thyroglobulin (sTg) is an excellent marker of persistence or recurrence of disease in differentiated thyroid cancer (DTC), however its role as prognostic factor has not been fully established. Aim: To assess the value of the preablative thyroglobulin (pTg) as predictor of disease-free survival in DTC. Patients and Methods: Retrospective study of 104 patients with low and intermediate risk DTC subjected to total thyroidectomy and 131iodine ablation. TSH, pTg and thyroglobulin antibodies (AbTg) were determined by chemiluminescence. Patients with distant metastases or presence of AbTg were excluded. Results were analyzed using receiving operating characteristic (ROC) curves. Results: During the 40 ± 29 months of follow-up (range 6-132), 14 of 104 (13%) patients had recurrence of disease. pTg was an independent indicator to predict disease-free survival. Using a pTg cutoff of < 10 ng/ml the negative predictive value was 99%, sensitivity 93%, specificity 82%, positive likelihood ratio (LR) 5.2 and negative LR 0,087. Conclusions: pTg value is useful as a prognostic marker in predicting disease-free survival in DTC patients with low or intermediate risk of recurrence.
Asunto(s)
Adulto , Anciano , Femenino , Humanos , Masculino , Persona de Mediana Edad , Adulto Joven , Carcinoma/terapia , Recurrencia Local de Neoplasia/sangre , Tiroglobulina/sangre , Neoplasias de la Tiroides/terapia , Biomarcadores de Tumor/sangre , Carcinoma/sangre , Chile , Supervivencia sin Enfermedad , Estudios de Seguimiento , Radioisótopos de Yodo/uso terapéutico , Valor Predictivo de las Pruebas , Pronóstico , Curva ROC , Estudios Retrospectivos , Neoplasias de la Tiroides/sangre , Tiroidectomía/métodosRESUMEN
Introducción: el término morbilidad materna extremadamente grave o severa, se considera de gran utilidad al ser este un indicador muy asociado a la muerte materna y un estadio intermedio en prácticamente la totalidad de las fallecidas. Objetivo: caracterizar los procesos de atención hospitalaria a la morbilidad materna extremadamente grave en La Habana en el año 2009. Métodos: se realizó una investigación descriptiva en 6 servicios ginecobstétricos de hospitales generales y maternos de La Habana, en el período comprendido de enero-diciembre del 2009, con el objetivo de caracterizar los procesos de atención hospitalario a las maternas extremadamente graves. Para ello se consultaron las historias clínicas y se completó un formulario creado al efecto, cuyos resultados se vaciaron en una base de datos en Access. Los resultados se expresan a través de promedios y porcentajes y se muestran en tablas y gráficos. Resultados: la clasificación por código de colores y la identificación del riesgo obstétrico mostraron valores de 80,6 por ciento y 73,1 por ciento respectivamente. El seguimiento de los signos precoces de shock hipovolémico solo alcanzó un 81 por ciento y el 77 por ciento de estas pacientes fueron sometidas a la realización de una cesárea de las que el 75,5 por ciento tuvieron una complicación durante o después de este proceder. La morbilidad materna extremadamente grave por enfermedad específica con mayor frecuencia, fue por el shock hipovolémico. Conclusiones: el no cumplimiento de los procesos de atención pudiese influir negativamente en la atención a la morbilidad materna extremadamente grave e inclusive incrementar la mortalidad materna(AU)
Introduction: the term extremely serious or severe maternal morbidity is considered very useful as this is an indicator highly associated to maternal death and an intermediate stage in virtually all of the deceased cases. Objective: to characterize the processes of hospital care to extremely severe maternal morbidity in Havana during 2009. Methods: a descriptive study was conducted in six gynecological and maternal services in Havana from January to December 2009, in order to characterize the hospital processes of care to extremely serious maternal cases. Medical records and forms were completed for this purpose. The arising results were taken in a database in Access. Results are expressed through averages and percentages and are shown in tables and graphs. Results: classification by color coding and identification of risk obstetrics showed values of 80.6 percent and 73.1 percent respectively. Tracking early signs of hypovolemic shock only reached 81 percent and 77 percent of these patients underwent a cesarean, out of which 75.5 percent had a complication during or after this procedure. Hypovolemic shock was the extremely severe maternal morbidity for specific disease. Conclusions: non-compliance of care processes could adversely affect the care of extremely severe maternal morbidity and even increased mortality(AU)
Asunto(s)
Humanos , Femenino , Embarazo , Mortalidad Materna , Servicios de Salud Materna , Cesárea/mortalidad , Complicaciones del Trabajo de Parto/cirugía , Choque/complicaciones , Epidemiología DescriptivaRESUMEN
Introducción: el término morbilidad materna extremadamente grave o severa, se considera de gran utilidad al ser este un indicador muy asociado a la muerte materna y un estadio intermedio en prácticamente la totalidad de las fallecidas.Objetivo: caracterizar los procesos de atención hospitalaria a la morbilidad materna extremadamente grave en La Habana en el año 2009.Métodos: se realizó una investigación descriptiva en 6 servicios ginecobstétricos de hospitales generales y maternos de La Habana, en el período comprendido de enero-diciembre del 2009, con el objetivo de caracterizar los procesos de atención hospitalario a las maternas extremadamente graves. Para ello se consultaron las historias clínicas y se completó un formulario creado al efecto, cuyos resultados se vaciaron en una base de datos en Access. Los resultados se expresan a través de promedios y porcentajes y se muestran en tablas y gráficos.Resultados: la clasificación por código de colores y la identificación del riesgo obstétrico mostraron valores de 80,6 % y 73,1 porciento respectivamente. El seguimiento de los signos precoces de shock hipovolémico solo alcanzó un 81 porciento y el 77 porciento de estas pacientes fueron sometidas a la realización de una cesárea de las que el 75,5 porciento tuvieron una complicación durante o después de este proceder. La morbilidad materna extremadamente grave por enfermedad específica con mayor frecuencia, fue por el shock hipovolémico.Conclusiones: el no cumplimiento de los procesos de atención pudiese influir negativamente en la atención a la morbilidad materna extremadamente grave e inclusive incrementar la mortalidad materna
Introduction: the term extremely serious or severe maternal morbidity is considered very useful as this is an indicator highly associated to maternal death and an intermediate stage in virtually all of the deceased cases.Objective: to characterize the processes of hospital care to extremely severe maternal morbidity in Havana during 2009.Methods: a descriptive study was conducted in six gynecological and maternal services in Havana from January to December 2009, in order to characterize the hospital processes of care to extremely serious maternal cases. Medical records and forms were completed for this purpose. The arising results were taken in a database in Access. Results are expressed through averages and percentages and are shown in tables and graphs.Results: classification by color coding and identification of risk obstetrics showed values of 80.6 per cent and 73.1 per cent respectively. Tracking early signs of hypovolemic shock only reached 81per cent and 77per cent of these patients underwent a cesarean, out of which 75.5 per cent had a complication during or after this procedure. Hypovolemic shock was the extremely severe maternal morbidity for specific disease.Conclusions: non-compliance of care processes could adversely affect the care of extremely severe maternal morbidity and even increased mortality
RESUMEN
Introducción: la obesidad es una de origen multifactorial caracterizada por acumulación excesiva de grasa o hipertrofia general del tejido adiposo en el cuerpo; factor de riesgo conocido para múltiples enfermedades, con repercusión estética y social. Objetivo: obtener el peso ideal en pacientes obesos mediante la combinación de dieta, homeopatía e implantación de catgut en puntos de acupuntura, tratando de equilibrar la energía y cambiar estilos de vida. Material y método: se realizó un estudio descriptivo, longitudinal, y prospectivo en el servicio de Medicina Tradicional y Natural del Hospital General Docente Abel Santamaría Cuadrado de Pinar del Río en el año 2011. El universo y la muestra coinciden estando constituidas por 80 pacientes, a todos los pacientes se les realizó en la primera consulta historia clínica y se les calculó el índice de masa corporal. Los pacientes se valoraron mensualmente y tratados con dieta y homeopatía (grupo I) y dieta, homeopatía y siembra de catgut en puntos de acupuntura (grupo II). Resultados: se obtuvo un predominio de la obesidad grado II, en el sexo femenino entre 27 y 37 años. Las alternativas de tratamiento utilizadas para la obesidad fueron efectivas en un 93,8 % de los pacientes y la mayoría de los que alcanzaron el peso ideal lo hicieron entre el cuarto y sexto mes de tratamiento. Conclusiones: la asociación de dieta, homeopatía e implantación de catgut en puntos de acupuntura para el tratamiento de la obesidad exógena fue más efectiva que la utilización solo de dieta y homeopatía.
Introduction: obesity is a multifactorial-origin disorder that is characterized by the excessive accumulation of fat and general hypertrophy of adipose tissue in the body; a risk factor known as multiple diseases with esthetic and social repercussion. Objective: to achieve the ideal weight in obese patients by means of combining the diet, homeopathy and implantation of catgut suture in acupuncture points, trying to balance the energy and changing lifestyles. Material and method: a descriptive, longitudinal and prospective study was conducted in the service of Natural and Traditional Medicine at "Abel Santamaria Cuadrado" Pinar del Rio, during 2011. The target group and the sample coincided, both were comprised of 80 patients, a clinical history was made to each patient and body mass index was calculated. Patients were monthly assessed and treated using diet and homeopathy (group I), as well as diet, homeopathy and catgut applied on the acupuncture points (group II). Results: degree II of obesity prevailed in female sex from 27 to 37 years old. The alternatives of treatment used to treat obesity were effective in 93,8% of patients and the majority reached the ideal weight between the 4th and 6th months of treatment. Conclusions: the association of diet, homeopathy and implantation of catgut in acupuncture points to the treatment of exogenous obesity was more effective than the purely use of diet and homeopathy.
RESUMEN
BACKGROUND: Serum thyroglobulin (sTg) is an excellent marker of persistence or recurrence of disease in differentiated thyroid cancer (DTC), however its role as prognostic factor has not been fully established. AIM: To assess the value of the preablative thyroglobulin (pTg) as predictor of disease-free survival in DTC. PATIENTS AND METHODS: Retrospective study of 104 patients with low and intermediate risk DTC subjected to total thyroidectomy and 131iodine ablation. TSH, pTg and thyroglobulin antibodies (AbTg) were determined by chemiluminescence. Patients with distant metastases or presence of AbTg were excluded. Results were analyzed using receiving operating characteristic (ROC) curves. RESULTS: During the 40 ± 29 months of follow-up (range 6-132), 14 of 104 (13%) patients had recurrence of disease. pTg was an independent indicator to predict disease-free survival. Using a pTg cutoff of < 10 ng/ml the negative predictive value was 99%, sensitivity 93%, specificity 82%, positive likelihood ratio (LR) 5.2 and negative LR 0,087. CONCLUSIONS: pTg value is useful as a prognostic marker in predicting disease-free survival in DTC patients with low or intermediate risk of recurrence.