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This work describes the spatio-temporal distribution of suspected plastic and microplastic (MP) particles in estuarine plumes and analyzes the microplastic/zooplankton ratio. Subsurface hauls with a conical-cylindrical net were deployed in the coastal area of Tamandare (Pernambuco, Brazil), covering the plume of two rivers and a bay adjacent to coral reefs. A total of 2079 suspected plastic particles were detected, mostly fibers and fragments (>60%). Organic matter digestion was made using a 30% hydrogen peroxide solution, of which approximately 50% of suspected particles were validated as MPs. The average MP abundance was significantly higher during the high rainfall season (53.8 ± 89.6 and 18.8 ± 32.3 particles/m³, respectively), with higher values registered in the plume area (108.9 ± 158.5 and 44.6 ± 55.5 particles/m³). Polymer identification using FT-IR confirmed that suspected particles were mainly polypropylene, polyamide, and polyurethane. These results confirm the hypothesis of a temporal transport variation of MPs from the river to the coastal environments, particularly since the plume influences debris input. Eleven animal phyla were identified, and the subclass Copepoda was predominant (90%), particularly the nauplius stage (70%). Over 70% of verified MPs range between 20 and 2000 µm, equivalent to the most common size of zooplanktonic organisms. Results support that coastal areas near estuarine plumes are exposed to microplastic contamination, affecting species dependent on zooplankton in marine coastal food webs.

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INTRODUCTION: Multiple Sclerosis (MS) is one of the leading causes of disability in young adults. Its prevalence varies according to different countries. In Argentina there is a wide heterogeneity regarding data published in different areas of the country. Prevalence established in most studies is 17 cases per 100,000 inhabitants; however, most of the available data comes from studies that took place in Buenos Aires. There is little or no information from other provinces, especially from Northwest of Argentina (NOA), where there are no studies of the disease prevalence. The aim of this study is to investigate MS prevalence, phenotypes and epidemiological characteristics in Salta, Argentina, in order to contribute to the current knowledge of MS epidemiology and distribution in our country. METHODS: A descriptive, observational, transversal study was carried out in the capital city of Salta. Researchers from all public and private hospitals with a Neurology Department have participated. Private researchers who are well known leaders in demyelinating diseases in the city provided valuable information. Patients who did not have medical control for the past two years as well as patients whose last address was not registered in Salta were excluded. RESULTS: 120 registries were obtained from the four hospitals that participated and from the 12 private researchers. Ten patients were excluded due to overlapping data. The population of the area based on 2010 census was 535,310, so we estimated an MS prevalence 23.8 cases per 100,000 inhabitants (95% CI 20.1-27.4), 24.1 cases per 100,000 inhabitants in female population (95% CI 21.2-28.6) and 18.2 cases per 100,000 inhabitants (95% CI 15.2-21.1) in male population. In our analysis, 64 (58.2%) were female and the average age was 42.1 years. 81.8% are recurrent remitting forms, 16.4% secondary progressive and 1.8% primary progressive. CONCLUSION: This is the first study that provides epidemiological data on the prevalence and clinical forms of MS in Salta City as well as in the entire Northwest Region of Argentina(NOA). We estimate a prevalence of 23.8 cases per 100,000 inhabitants, which establishes a moderate risk area for MS.

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Almost 10% of patients with Crest syndrome associated with severe gastroesophageal reflux and 5-10% of patients with failed cardiomyotomy for achalasia present with cardial or distal esophageal organic stricture. Some of these cases are poor risk patients for surgery and therefore the surgeon must offer a safe procedure with low morbimortality, keeping in mind the pathophysiological motor pattern of these patients.In order to treat the stricture to improve the esophageal transit we treated patients with esophagocardioplasty associated with vagotomy-antrectomy and Roux-en-Y gastrojejunostomy, thereby avoiding the potential acid or biliary reflux in poor risk patients in whom esophagectomy would be a very deleterious procedure. All four patients had a good postoperative evolution and late control demonstrated good esophagogastric transit with no postoperative esophagitis.

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Antecedentes: La gonartrosis es una patología degenerativa que limita de forma importante la funcionalidad de una persona. Se recurre al manejo quirúrgico cuando el paciente presenta una limitación funcional importante así como dolor intenso. La artroplastía de rodilla es una de las cirugías con mejores resultados funcionales en pacientes con esta patología, pero dentro de sus limitaciones está la posibilidad de un sangrado importante y, por consiguiente, la necesidad de hemotransfundir al paciente. El objetivo de este estudio fue evaluar la necesidad de hemotransfundir a los pacientes operados de artroplastía de rodilla que utilizaron recuperador sanguíneo en el postoperatorio y las diferencias entre los costos del recuperador sanguíneo y la transfusión clásica. Métodos: Estudio retrospectivo, transversal y retrolectivo de 300 expedientes de pacientes operados en el Hospital Ángeles de Querétaro de artroplastía de rodilla que utilizaron recuperador sanguíneo que requirieron hemotransfusión alogénica entre Octubre 2001 y Junio 2013. Resultados: De las 246 rodillas operadas, solamente tres requirieron hemotransfusión alogénica. Ninguna complicación/infección con el uso de recuperador sanguíneo. La edad promedio de los pacientes fue de 67.1 ± 9.78 años con un predominio femenino siendo éstos 141 (60.5%) en comparación con 92 (39.5%) masculinos. La sangre recolectada vía recuperador sanguíneo varió de 150 a 1,225 ml con un promedio de 318 ± 100.6 ml, la cual fue retransfundida a cada paciente. Conclusiones: El uso de recapturador sanguíneo en pacientes postoperados de artroplastía de rodilla disminuye de forma importante la necesidad de hemotransfusión alogénica.

Backgound: Gonarthrosis is a degenerative condition that importantly limits an individual's performance. Surgical treatment is used in patients with important functional limitation and severe pain. Knee arthroplasty is one of the surgeries with the best functional results in patients with this condition. However, its limitations include the risk of heavy bleeding and the resulting need for blood transfusion. The objective of this study was to assess the need for blood transfusion in patients undergoing knee arthroplasy in whom the cell saver was used postoperatively and find out the cost differences between the cell saver and standard blood transfusion. Methods: Retrospective, cross-sectional, retrolective trial including 300 records of patients who underwent knee arthroplasty at Hospital Ángeles Querétaro that included the use of the cell saver and allogeneic blood transfusion from October 2001 to June 2013. Results: Only 3 of the 246 operated knees required allogeneic blood transfusion. There were no complications/infections resulting from the use of the cell saver. Mean age of patients was 67.1 ± 9.78 years; females were predominant, as they were 141 (60.5%), compared to 92 (39.5%) males. The blood collected with the cell saver ranged from 150 to 1,225 ml with a mean of 318 ± 100.6 ml and was retransfused to each patient. Conclusions: Cell saver use in patients subjected to knee arthroplasty importantly decreases the need for allogeneic blood transfusion.

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BACKGOUND: Gonarthrosis is a degenerative condition that importantly limits an individua's performance. Surgical treatment is used in patients with important functional limitation and severe pain. Knee arthroplasty is one of the surgeries with the best functional results in patients with this condition. However, its limitations include the risk of heavy bleeding and the resulting need for blood transfusion. The objective of this study was to assess the need for blood transfusion in patients undergoing knee arthroplasy in whom the cell saver was used postoperatively and find out the cost differences between the cell saver and standard blood transfusion. METHODS: Retrospective, cross-sectional, retrolective trial including 300 records of patients who underwent knee arthroplasty at Hospital Angeles Querétaro that included the use of the cell saver and allogeneic blood transfusion from October 2001 to June 2013. RESULTS: Only 3 of the 246 operated knees required allogeneic blood transfusion. There were no complications/infections resulting from the use of the cell saver. Mean age of patients was 67.1 +/- 9.78 years; females were predominant, as they were 141 (60.5%), compared to 92 (39.5%) males. The blood collected with the cell saver ranged from 150 to 1,225 ml with a mean of 318 +/- 100.6 ml and was retransfused to each patient. CONCLUSIONS: Cell saver use in patients subjected to knee arthroplasty importantly decreases the need for allogeneic blood transfusion.

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Human consumption of flaxseed is increasing due to its health benefit properties and extrusion processes can enhance its nutritional quality. Extruded flaxseed meal (EFM) obtained in a pilot plant was characterized and incorporated in flour mixes and cereal-based bars to demonstrate its nutritious usefulness. Amino acid content was not affected by extrusion and, despite lysine was the limitating amino acid, the chemical score (CS) was 83 %. Thiamin and riboflavin decreased slightly as consequence of extrusion, phytic acid did not change and trypsin inhibitor activity was undetectable. Proximate composition and nutritional quality determined by biological and chemical indexes were compared among EFM, flour mixes (FM) and cereal bars (CB). They presented high protein levels (26, 20 and 17 %, respectively), good biological value (BV) (80, 79 and 65, respectively), acceptable true protein digestibility (TD) (73, 79 and 78, respectively), and high dietary fiber (33, 20.5 and 18 %, respectively). The ratio of ω6:ω3 for CB was within the WHO/FAO recommendations. These results open a new venue for the usefulsess of nutritious/healthy extruded flaxseed flours into ready-to-eat cereal-based products with improved nutritional quality.

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INTRODUCTION: Stroke is the third leading cause of death globally , act on modifiable risk factors is now the best prevention strategy. Medical complications are common in patients hospitalized for stroke , the valuation of income NIHSS , is associated with the final result in terms of duration of hospitalization, survival and discharge location. OBJETIVE: Determining risk factors ( RF) in patients hospitalized for stroke in Hospital Nacional de Clinicas de Córdoba (HNC) and characterize neurological complications NIHSS relative to income. MATERIAL AND METHODS: Prospective study of patients admitted to the Service of Neurology at HNC diagnosed with the first of September , 2010 to December 30, 2012 , we applied the admission NIHSS scale. Were determined cerebrovascular risk factors , we evaluated neurological complications during hospitalization. RESULTS: The total number of patients admitted for stroke was 200 , with 168 ischemic stroke ( 84%) and hemorrhagic stroke 32 (16 % ) . The FR Hypertension was the most frequent ( 83.5 %), over 40% had 3 or more FR for stroke. Had complications : 32 % of patients , the respiratory infection was the most frequent (14.5 % ). Patients with NIHSS greater than 10 points had a higher rate of complications. CONCLUSION: The multiple RF control is an effective strategy to decrease the incidence of stroke . Prevention of medical complications enable better patient care and reduce morbidity associated with stroke.

El Accidente cerebro vascular (ACV) constituye la tercera causa de muerte a nivel mundial; actuar sobre los factores de riesgo modificables constituye hoy la mejor estrategia de prevención. Las complicaciones médicas son frecuentes en los pacientes internados por ACV; la valoración del NIHSS de ingreso, está asociado al resultado final en términos de duración de internación, supervivencia y ubicación al alta. Objetivo. Determinar los factores de riesgo (FR) en pacientes internados por ACV en el HNC de Córdoba y caracterizar las complicaciones no neurológicas en relación al NIHSS de ingreso. Material y métodos. Estudio prospectivo de pacientes internados en el HNC con diagnóstico de ACV del primero de septiembre de 2010 al 30 de diciembre de 2012, se aplicó la escala de NIHSS al ingreso. Se determinaron los factores de riesgo cerebrovasculares; se evaluaron las complicaciones no neurológicas durante la internación. Resultados. El total de pacientes ingresados por ACV fue de 200, con ACV isquémico 168 (84%) y ACV hemorrágico 32(16%). La Hipertensión Arterial fue el FR más frecuente (83,5%); más del 40% tenía 3 o más FR para ACV. Tuvieron complicaciones: 32% de los pacientes, la Infección respiratoria fue la más frecuente (14.5%)Pacientes con NIHSS superior a 10 puntos presentaron mayor porcentaje de complicaciones. Conclusión. El control de FR múltiples constituye una estrategia efectiva para disminuir la incidencia de ACV. La prevención de las complicaciones médicas permiten un mejor cuidado del paciente y reducen la morbilidad relacionada al ACV.

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INTRODUCTION: Stroke is the third leading cause of death globally , act on modifiable risk factors is now the best prevention strategy. Medical complications are common in patients hospitalized for stroke , the valuation of income NIHSS , is associated with the final result in terms of duration of hospitalization, survival and discharge location. OBJETIVE: Determining risk factors ( RF) in patients hospitalized for stroke in Hospital Nacional de Clinicas de Córdoba (HNC) and characterize neurological complications NIHSS relative to income. MATERIAL AND METHODS: Prospective study of patients admitted to the Service of Neurology at HNC diagnosed with the first of September , 2010 to December 30, 2012 , we applied the admission NIHSS scale. Were determined cerebrovascular risk factors , we evaluated neurological complications during hospitalization. RESULTS: The total number of patients admitted for stroke was 200 , with 168 ischemic stroke ( 84

) and hemorrhagic stroke 32 (16

) . The FR Hypertension was the most frequent ( 83.5

), over 40

had 3 or more FR for stroke. Had complications : 32

of patients , the respiratory infection was the most frequent (14.5

). Patients with NIHSS greater than 10 points had a higher rate of complications. CONCLUSION: The multiple RF control is an effective strategy to decrease the incidence of stroke . Prevention of medical complications enable better patient care and reduce morbidity associated with stroke.

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INTRODUCTION: Stroke is the third leading cause of death globally , act on modifiable risk factors is now the best prevention strategy. Medical complications are common in patients hospitalized for stroke , the valuation of income NIHSS , is associated with the final result in terms of duration of hospitalization, survival and discharge location. OBJETIVE: Determining risk factors ( RF) in patients hospitalized for stroke in Hospital Nacional de Clinicas de Córdoba (HNC) and characterize neurological complications NIHSS relative to income. MATERIAL AND METHODS: Prospective study of patients admitted to the Service of Neurology at HNC diagnosed with the first of September , 2010 to December 30, 2012 , we applied the admission NIHSS scale. Were determined cerebrovascular risk factors , we evaluated neurological complications during hospitalization. RESULTS: The total number of patients admitted for stroke was 200 , with 168 ischemic stroke ( 84

) and hemorrhagic stroke 32 (16

) . The FR Hypertension was the most frequent ( 83.5

had 3 or more FR for stroke. Had complications : 32

of patients , the respiratory infection was the most frequent (14.5

). Patients with NIHSS greater than 10 points had a higher rate of complications. CONCLUSION: The multiple RF control is an effective strategy to decrease the incidence of stroke . Prevention of medical complications enable better patient care and reduce morbidity associated with stroke.

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The foraging, territoriality and displacement of the Snail Kite were studied over 232 hours of observations in an urban lake during the dry and wet seasons. The temperature and rainfall variations were used to correlate with predation rates and the correlation coefficients were 0,39 and 0,34, respectively. Snail Kites spent more time foraging during the wet than the dry season when perching is more frequently recorded. The higher predation in the wet season can be explained by the higher abundance of apple snails and the energy demand for reproduction. In the wet season, the territories were smaller and the conspecific conflicts decreased as prey were more available. However, due to the lack of food in the dry season, intra-specific conflicts and expansion of male territories were observed and the female and immatures were expelled from their foraging area to another location. In this way, site tenacity of Snail Kites should be interpreted in relation to the variations on food and dominance gradients according to the temporal changes (time) and foraging sites (space).

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The foraging, territoriality and displacement of the Snail Kite were studied over 232 hours of observations in an urban lake during the dry and wet seasons. The temperature and rainfall variations were used to correlate with predation rates and the correlation coefficients were 0,39 and 0,34, respectively. Snail Kites spent more time foraging during the wet than the dry season when perching is more frequently recorded. The higher predation in the wet season can be explained by the higher abundance of apple snails and the energy demand for reproduction. In the wet season, the territories were smaller and the conspecific conflicts decreased as prey were more available. However, due to the lack of food in the dry season, intra-specific conflicts and expansion of male territories were observed and the female and immatures were expelled from their foraging area to another location. In this way, site tenacity of Snail Kites should be interpreted in relation to the variations on food and dominance gradients according to the temporal changes (time) and foraging sites (space).

Foram estudados os comportamentos territoriais e de forrageio do gavião-caramujeiro em uma lagoa urbana durante as estações seca e chuvosa. Observaram-se esses comportamentos durante 232 horas, sendo a amostragem divida em períodos matutino e vespertino. A maior atividade de forrageio foi observada durante o período matutino. Os principais itens predados foram espécimes do gênero Pomacea spp. No entanto, durante o período de seca, os gaviões-caramujeiros também predaram caranguejos. Essas aves exibiram diferentes estratégias de forrageamento e territorialidade durante as diferentes estações. Os gaviões-caramujeiros dispenderam maior tempo de forrageamento durante a estação chuvosa e maior tempo pousados, durante a estação seca. A expansão/contração dos territórios realizados pelos machos é dependente da disponibilidade de alimento, que varia durante as estações: a) estação seca (pouco alimento): conflitos agonísticos intraespecíficos, seguidos de expansão dos territórios; b) estação chuvosa: conflitos agonísticos decresceram à medida que a oferta de alimento aumentou e, consequentemente, houve redução do tamanho dos territórios. Desse modo, conclui-se que os padrões de movimentação para forragear e estabelecer territórios são altamente dependentes da distribuição de recursos no espaço e no tempo, e estão também associados ao comportamento social, por meio de dominância dos machos.

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The foraging, territoriality and displacement of the Snail Kite were studied over 232 hours of observations in an urban lake during the dry and wet seasons. The temperature and rainfall variations were used to correlate with predation rates and the correlation coefficients were 0,39 and 0,34, respectively. Snail Kites spent more time foraging during the wet than the dry season when perching is more frequently recorded. The higher predation in the wet season can be explained by the higher abundance of apple snails and the energy demand for reproduction. In the wet season, the territories were smaller and the conspecific conflicts decreased as prey were more available. However, due to the lack of food in the dry season, intra-specific conflicts and expansion of male territories were observed and the female and immatures were expelled from their foraging area to another location. In this way, site tenacity of Snail Kites should be interpreted in relation to the variations on food and dominance gradients according to the temporal changes (time) and foraging sites (space).

Foram estudados os comportamentos territoriais e de forrageio do gavião-caramujeiro em uma lagoa urbana durante as estações seca e chuvosa. Observaram-se esses comportamentos durante 232 horas, sendo a amostragem divida em períodos matutino e vespertino. A maior atividade de forrageio foi observada durante o período matutino. Os principais itens predados foram espécimes do gênero Pomacea spp. No entanto, durante o período de seca, os gaviões-caramujeiros também predaram caranguejos. Essas aves exibiram diferentes estratégias de forrageamento e territorialidade durante as diferentes estações. Os gaviões-caramujeiros dispenderam maior tempo de forrageamento durante a estação chuvosa e maior tempo pousados, durante a estação seca. A expansão/contração dos territórios realizados pelos machos é dependente da disponibilidade de alimento, que varia durante as estações: a) estação seca (pouco alimento): conflitos agonísticos intraespecíficos, seguidos de expansão dos territórios; b) estação chuvosa: conflitos agonísticos decresceram à medida que a oferta de alimento aumentou e, consequentemente, houve redução do tamanho dos territórios. Desse modo, conclui-se que os padrões de movimentação para forragear e estabelecer territórios são altamente dependentes da distribuição de recursos no espaço e no tempo, e estão também associados ao comportamento social, por meio de dominância dos machos.

RESUMO

OBJECTIVE: We conducted a pilot screening program to define the prevalence of non-syndromic deafness and establish the frequency of mutations in the GJB2 gene (Cx26) in a population of children with congenital deafness in Bogotá, Colombia. METHOD: From a cohort of 731 children in 8 institutions for the deaf, we identified 322 (44%) with presumed non-syndromic deafness. These were invited to a more detailed evaluation, but 46 chose not to participate. The remaining 276 individuals received a complete ophthalmological evaluation that was normal in 205 (74.3%) and showed salt and pepper retinopathy in 55 (19.9%) and other ocular abnormalities in 16 (5.8%). A comprehensive medical history, and a detailed physical examination were performed in the 205 children with normal ocular exam. Of these, 93 were found to have acquired deafness and/or associated anomalies and 112 (15.3% of the initial 731 children), non-syndromic deafness. The GJB2 gene was sequenced in these 112 individuals. RESULTS: Based on family history, 59.8% (67/112) of these cases had autosomal recessive non-syndromic sensorineural hearing loss and the remaining 40.2% (45/112) were sporadic, without apparent known cause. We identified three mutations in the GJB2 gene: 35delG, S199F, and 167delT, all of which have been previously reported in the literature, the variant M34T, and the polymorphism V27I. S199F was the most frequent mutation (17.9%), followed by 35delG (17.0%) and 167delT (0.4%). The mutations in the GJB2 gene were present in 50.7% of the autosomal recessive group and in 33.3% of the sporadic cases. CONCLUSIONS: Our pilot study showed that 15.3% of institutionalized deaf children in Bogotá have non-syndromic deafness and among them, the frequency of the S199F mutation was higher than reported in previous studies, whereas the frequency of the 35delG is similar to Caucasian populations. The fact that the S199F mutation was the most frequent allele in our study confirms the fact that the prevalence of GJB2 mutations depends on the ethnic origin. We emphasize the need to follow a strict protocol to identify bona fide cases of non-syndromic deafness among individuals with congenital hearing loss in order to identify the molecular basis of this condition.

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Pigeon pea (Cajanus cajan var. aroíto) seeds were fermented in order to remove antinutritional factors and to obtain functional legume flour to be used as pasta ingredients. Fermentation brought about a drastic reduction of alpha-galactosides (82%), phytic acid (48%), and trypsin inhibitor activity (39%). Fermented legume flours presented a notable increase of fat and total soluble available carbohydrates, a slight decrease of protein, dietary fiber, calcium, vitamin B2, vitamin E, and total antioxidant capacity, and a decrease of soluble dietary fiber, Na, K, Mg, and Zn contents. No changes were observed in the level of starch and tannins as a consequence of fermentation. The fermented flour was used as an ingredient to make pasta products in a proportion of 5, 10, and 12%. The supplemented pasta products obtained had longer cooking times, higher cooking water absorptions, higher cooking loss, and higher protein loss in water than control pasta (100% semolina). From sensory evaluations, fortified pasta with 5 and 10% fermented pigeon pea flour had an acceptability score similar to control pasta. Pasta supplemented with 10% fermented pigeon pea flour presented higher levels of protein, fat, dietary fiber, mineral, vitamin E, and Trolox equivalent antioxidant capacity than 100% semolina pasta and similar vitamins B1 and B2 contents. Protein efficiency ratios and true protein digestibility improved (73 and 6%, respectively) after supplementation with 10% fermented pigeon pea flour; therefore, the nutritional value was enhanced.

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BACKGROUND: Although laparoscopic appendectomy has some advantages over open appendectomy, some reports do show more postoperative intraabdominal abscesses. METHODS: A retrospective review of complicated appendicitis managed surgically by eight surgical groups from six countries was undertaken. Among 3,433 patients with appendicitis, 1,017 (29.5%) had complicated appendicitis, which included perforated or gangrenous appendicitis with or without localized or disseminated peritonitis. There were 74 preoperative abscesses (7.4%) and 5 small bowel obstructions. RESULTS: One patient died. There were 29 postoperative intraabdominal abscesses (2.8%) and 112 mostly minor complications. Conversion to laparotomy was necessary for 28 patients (2.7%). The surgical time ranged from 32 to 132 min (mean, 62 min), and the hospital stay ranged from 1 to 18 days (mean, 3.5 days). CONCLUSIONS: The morbidity rates, particularly for intraabdominal abscesses, were less for laparoscopic appendectomy in complicated appendicitis than those reported in the literature for open appendectomy, whereas operating times and hospital stays were similar.

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El puntaje de Gleason de la biopsia por punción es un factor pronóstico independiente en el cáncer de próstata, por lo cual constituye un antecedente fundamental en la elección del tratamiento. Existe sin embargo una significativa sub y supraetapificación con respecto al puntaje de la pieza de la cirugía radical en las biopsias por sextantes. Evaluamos en forma prospectiva el rendimiento de biopsias con esquemas ampliados en la predicción del puntaje final, comparándose la concordancia con la del esquema de punción clásico. 92 pacientes fueron sometidos a prostatectomía radical entre octubre 2001 y julio 2005. En 51 casos el diagnóstico fue efectuado mediante el esquema clásico (6 muestras) y a partir de marzo de 2003 en 41 pacientes mediante esquemas ampliados (10-12 muestras). Se analizaron correlaciones entre los especímenes efectuándose estudios de asociación. Los grupos fueron comparables en cuanto a las características clínicas e histopatológicas. La concordancia de la suma de puntajes entre la biopsia por punción y la biopsia de la prostatectomía radical fue de 31,4 por ciento (n=16) para el esquema clásico por sextantes y de 53,7 por ciento (n=22) para los esquemas con mayor número de muestras (p=0,021). Al analizar el puntaje primario por separado se establecieron concordancias de 49 por ciento y 78 por ciento, respectivamente (p=0,005). Esta diferencia fue más significativa en muestras con puntaje de Gleason <7 (p=0,018). Se observó subetapificación en 30 casos (58,8 por ciento) del esquema clásico y en 15 casos (36,6 por ciento) de las biopsias con esquemas ampliados (p=0,038). Se objetivó un incremento en la precisión del puntaje de Gleason a partir de la implementación de esquemas ampliados en las biopsias prostáticas por punción. La adición de mayor número de muestras, junto con aumentar en forma significativa la tasa de detección de tumores, permite asimismo optimizar el valor predictivo de la muestra. De esta manera se dispone de mayores antec...

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El manejo de pacientes con sospecha de cáncer y con biopsias prostáticas previas negativas representa un desafío para el urólogo. En la literatura no existe consenso en cuanto a número y zonas a biopsiar en este procedimiento. Efectuamos un estudio prospectivo evaluando la sensibilidad de distintos esquemas de punción, con el fin de generar una estrategia óptima en términos de detección y número de muestras. Se incluyeron 35 pacientes sometidos a re-biopsia de próstata. Se aplicó un esquema de 12 muestras incluyendo 2 de la zona de transición. Se calculó el rendimiento de cada foco en forma separada, analizándose diversas combinaciones y comparándose con pruebas no paramétricas. El 28,6 por ciento de los pacientes presentó cáncer en la biopsia. El esquema clásico por sextantes diagnosticó sólo 50 por ciento de los tumores. Los pacientes sometidos previamente a biopsia por sextantes presentaron una mayor tasa de detección (32 por ciento) que aquellos sometidos previamente a biopsia ampliada (20 por ciento). Las muestras de la zona de transición no representaron un aporte. La densidad del APE fue el único parámetro significativamente mayor en pacientes diagnosticados con cáncer (p=0,029). La biopsia ampliada (10-12 muestras) presenta mayor rendimiento que el esquema por sextantes en re-biopsias, siendo más efectivo en pacientes sometidos, previamente, a biopsias por sextantes.

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El esquema clásico de biopsias por sextantes ha demostrado ser insuficiente en el diagnóstico del cáncer de próstata. Sin embargo, aún no existe consenso en cuanto a número y zonas a biopsiar durante este procedimiento, existiendo numerosas propuestas al respecto en la literatura. Los estudios han descrito un mayor rendimiento con biopsias dirigidas hacia la zona lateral. Efectuamos un estudio prospectivo comparando la sensibilidad de los distintos focos en forma individual, evaluándose diversas combinaciones de éstos con el fin de generar una estrategia óptima en términos de detección y número de muestras. Se incluyeron 110 pacientes consecutivos sometidos a biopsia de próstata. Se registró edad, APE, volumen prostático, Gleason, tacto rectal y morbilidad derivada del procedimiento. Además de la biopsia rutinaria por sextantes en ubicación parasagital, se agregaron dos muestras laterales a cada lado, en la base y en la zona media. En próstatas > 50 cc se agregaron dos muestras de la zona de transición. Se calculó el rendimiento de cada foco de biopsia en forma separada, analizándose varios esquemas derivados de distintas combinaciones, comparándose con pruebas no paramétricas. Treinta y nueve (35,5 por ciento) de los pacientes presentó cáncer en la biopsia. Estos pacientes eran de mayor edad (p=0,056), tenían próstatas más pequeñas (p=0,028) y APE más elevados (p=0,0003). El esquema clásico por sextantes detectó sólo el 69,2 por ciento de los cánceres en comparación con el esquema de 10 muestras (p=0,001), este rendimiento se mantuvo al eliminar la muestra de la base de la zona lobular media, obteniéndose de esta manera una combinación óptima compuesta por 8 muestras. Esta tendencia se mantuvo al analizar según APE, volumen prostático y tacto rectal, siendo significativa en próstatas < 50 cc (p=0,008), en pacientes con TR negativo (p=0,003) y con APE < 10 ng/ml (p=0,004). Se constató una morbilidad baja, no diferenciándose significativamente de la publicada en series con 6 muestras. La biopsia ecodirigida debiera incluir al menos 8 muestras, incluyéndose la zona lateral basal y media, el ápex y la media de la zona lobular media. El mayor número de muestras no implica una mayor morbilidad.

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RESUMO

Se presenta un caso clínico de paciente con diagnóstico de cáncer de pene (T2 Nx M0) sometido a linfocintigrafía para identificación de linfonodo centinela. Se analiza el rol de este procedimiento como método de etapificación en esta patología y se revisa la historia y la experiencia de centros internacionales con este método diagnóstico.

Assuntos

RESUMO

La biopsia de próstata guiada por ecografía transrectal ha revolucionado la detección del cáncer de próstata, sin embargo, existen pocos ensayos a nivel nacional del impacto de este procedimiento en la calidad de vida de los pacientes, más aún, si consideramos que estudios recientes han sugerido incrementar el número de muestras para aumentar la sensibilidad de este examen. El objetivo de este trabajo fue determinar el impacto en la calidad de vida de los pacientes sometidos a biopsia de próstata guiada por ecografía transrectal en 6 y 12 muestras y demostrar la utilidad de la sedación durante el examen. Se randomizaron 60 pacientes, del Servicio de Urología del Hospital San José, en dos grupos: 30 pacientes con sedación (Midazolam 2,5 mg endovenoso) y 30 pacientes con placebo. Estos grupos se subdividieron en grupos de 6 y 12 muestras de tejido prostático. Se constató edad, antígeno prostático, tacto rectal, comorbilidad y complicaciones post biopsia. Todos los pacientes contestaron un cuestionario realizado post examen y un segundo cuestionario 4 semanas después. La calidad de vida fue evaluada utilizando 2 escalas (Short form 36 item health survey). La edad promedio de los pacientes fue de 70 años, con valores de antígeno prostático entre 4,6- 281 ng/dl. Al comparar los grupos sometidos a sedación (6 y 12 muestras) versus los grupos sin sedación sometidos a biopsia transrectal guiada por ecografía, se encuentran diferencias estadísticamente significativas (p<0,0005). Las complicaciones de la sedación en el procedimiento fueron 0 por ciento. Se discuten los resultados.

Assuntos