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The technique of laparoscopic oocyte aspiration has been increasingly used in animals; however, there are few records of its use in buffaloes. To describe this technique, six suckling Murrah buffaloes aged between 3 and 5 months were used. Three laparoscopic ovum pick-ups were performed in each animal, with intervals of 15 days between surgeries, completing a total of 18 procedures. The technique used three surgical ports with optics and a high-definition video camera. The introduction of the first portal and insufflation of the abdomen was performed through the open technique, with aspiration using a 20 G needle transabdominally and a vacuum pump calibrated at 50 mmHg. The mean complete surgical time from anesthesia to the removal of the animal from the litter was 49 ± 9.8 min. There were 27.8% cases of insufflation on the wrong side of the omentum. The oocyte recovery rate of 60.3% remained within the normal range. However, the rate of viable oocytes recovered was low, with only 40.8% of those recovered undergoing in vitro embryo production (IVEP). These data demonstrate that this simple, minimally invasive technique is an excellent reproductive tool for the genetic improvement of buffalo species.

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The prevalence of disease-driven mass mortality events is increasing, but our understanding of spatial variation in their magnitude, timing and triggers are often poorly resolved. Here, we use a novel range-wide dataset comprised 48 810 surveys to quantify how sea star wasting disease affected Pycnopodia helianthoides, the sunflower sea star, across its range from Baja California, Mexico to the Aleutian Islands, USA. We found that the outbreak occurred more rapidly, killed a greater percentage of the population and left fewer survivors in the southern half of the species's range. Pycnopodia now appears to be functionally extinct (greater than 99.2% declines) from Baja California, Mexico to Cape Flattery, Washington, USA and exhibited severe declines (greater than 87.8%) from the Salish Sea to the Gulf of Alaska. The importance of temperature in predicting Pycnopodia distribution rose more than fourfold after the outbreak, suggesting latitudinal variation in outbreak severity may stem from an interaction between disease severity and warmer waters. We found no evidence of population recovery in the years since the outbreak. Natural recovery in the southern half of the range is unlikely over the short term. Thus, assisted recovery will probably be required to restore the functional role of this predator on ecologically relevant time scales.

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Resumen Introducción Desde su aprobación, la cirugía robótica ha crecido como una técnica útil, prometedora y probablemente superior en muchas cirugías. El objetivo de este estudio es exponer y evaluar los resultados de 6 años de experiencia, en cirugía digestiva asistida por robot, utilizada en diferentes procedimientos gastrointestinales, a lo largo de estos años. Material y Método Realizamos una revisión retrospectiva de todos los pacientes consecutivos sometidos a cirugía asistida por robot, realizada por un cirujano digestivo del Departamento de Cirugía Bariátrica y Departamento de Cirugía Robótica de la Clínica Santa María, de Santiago de Chile, entre septiembre de 2011 y mayo de 2017. Resultados Un total de 290 pacientes fueron sometidos a cirugía digestiva asistida por robot durante 6 años. Todos los pacientes fueron operados por el mismo cirujano digestivo. Los procedimientos primarios realizados fueron bypass gástrico en Y-Roux con anastomosis manual, gastrectomía en manga, cirugía revisional bariátrica y no bariátrica, fundoplicatura de Nissen, colecistectomía con puerto único, miotomía de Heller con fundoplicatura de Dor, hernioplastías, y otros casos excepcionales. La mayoría de los procedimientos secundarios fueron colecistectomías, hernioplastías hiatales y adherenciolisis. La estadía hospitalaria promedio fue de 3 días. Se observaron complicaciones postoperatorias en 27 (9,3%) pacientes. De acuerdo a la clasificación de Clavien Dindo, 4 (1,4%) complicaciones fueron Clavien I, 5 (1,7%) Clavien II, 18 (6,2%) Clavien III, 0 Clavien IV, 0 Clavien V. No hubo mortalidad en este grupo. El tiempo total promedio de los procedimientos fue de 76 min. El tiempo quirúrgico promedio fue de 64 min. Conclusión La cirugía digestiva asistida por robot es una técnica confiable y segura, que se puede utilizar para muchas enfermedades.

Background Since its approval, robotic surgery has been growing as a useful, promising and probably superior technique for many surgeries. The aim of this study is to expose and evaluate the results of a 6-year experience, of a single surgeon, with robotic assisted surgery, used for different gastrointestinal procedures throughout this years. Study Design We conducted a retrospective revision of all consecutive robotic assisted gastrointestinal cases performed by a single gastrointestinal laparoscopic surgeon of the Bariatric Surgery Department and Robotics Surgery Department of Clínica Santa María of Santiago, Chile, between September 2011 and May 2017. Results A total of 290 patients underwent robotic gastrointestinal surgery during 6 years. All cases were performed by the same gastrointestinal surgeon. Primary procedures performed were totally hand sewn Roux-en-Y gastric bypass, sleeve gastrectomy, revisional bariatric and non-bariatric surgery, Nissen fundoplication, single port cholecystectomy, Heller myotomy with Dor fundoplication, hernia repairs, and other exceptional cases. A total of 512 procedures were performed in 290 patients. The majority of secondary procedures were cholecystectomies, hiatal hernia repairs and adhesiolysis. Average length of hospital stay was 3 days. Postoperative complications were observed in 27 (9.3%) patients. According to Clavien Dindo classification of surgical complications, 4 (1.4%) complications were Clavien I, 5 (1.7%) Clavien II, 18 (6.2%) Clavien III, 0 Clavien IV, 0 Clavien V. There were no deaths in this group. Mean operative time was 76 minutes. Mean surgical time was 64 minutes. Conclusion Robot assisted upper gastrointestinal surgery is a reliable and effective technique, that can be used in many diseases.

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Resumen Introducción La cirugía bariátrica robótica es una técnica novedosa y en desarrollo en Chile. Los procedimientos bariátricos revisionales han aumentado durante los últimos años. No existen publicaciones en nuestro país relacionadas con experiencias en cirugía bariátrica revisional robótica. El objetivo de este estudio es describir la experiencia inicial y los resultados a corto plazo con el uso de la cirugía robótica en estos procedimientos. Material y Métodos Realizamos una revisión retrospectiva de todos los pacientes sometidos a cirugía bariátrica revisional asistida por robot, en Clínica Santa María, de Santiago de Chile. Analizamos las características demográficas, resultados quirúrgicos, morbilidad, mortalidad y tiempo de estadía hospitalaria. Resultados Se realizaron un total de 59 cirugías bariátricas revisionales asistidas por robot, 11 remodelamientos de gastrectomía en manga, 34 bypass gástrico en Y-Roux, 1 remodelamiento del pouch gástrico en un bypass gástrico en Y-Roux, 3 extracciones de banda gástrica ajustable, 1 de ellas con gastrectomía en manga simultánea, 5 instalaciones de banda gástrica ajustable en pacientes con bypass gástrico en Y-Roux, 3 gastrectomías totales, 1 resección de fístula gastro-gástrica y una anastomosis gastroyeyunal. La edad promedio fue de 47,8 años. El Índice de Masa Corporal promedio preoperatorio fue de 33,86 kg/m2. El tiempo quirúrgico promedio fue de 101,63 min. Se observaron complicaciones postoperatorias en 3 pacientes (5,08%). En 2 (3,39%) de ellos, se requirió una reoperación. No hubo fallecidos. El tiempo promedio de estadía hospitalaria fue de 3,6 días. conclusión La cirugía bariátrica revisional asistida por robot es una técnica novedosa, que parece ser segura y efectiva.

Background Robotics in bariatric surgery is a novel development in medical institutions in Chile. Revisional bariatric procedures have increased during the last years. There are no publications in our country related to the initial experience and results in robotic revisional bariatric surgery. The aim of this study is to describe the initial experience and short term outcomes with robotic revisional bariatric surgery. Study Design We conducted a retrospective study of all consecutive robotic revisional bariatric surgeries performed by a single surgeon in Clínica Santa María in Santiago, Chile. We analyzed demographic characteristics and surgical outcomes, morbidity, mortality and length of hospital stay. Results 59 revisional bariatric surgeries were performed, 11 reshaping of sleeve gastrectomy, 34 Roux in Y gastric bypass, 1 pouch reshaping of Roux in Y gastric bypass, 3 extractions of laparoscopic adjustable gastric banding, 1 of them with simultaneous sleeve gastrectomy, 5 laparoscopic adjustable gastric banding to patients with previous Roux in Y gastric bypass, 3 total gastrectomy, 1 resection of gastro-gastric fistula and 1 gastro enteral anastomosis. Mean age was 47.8 years. Average preoperative body mass index was 33.86 kg/m2. Mean surgical time was 101.63 minutes. Postoperative complications were observed in 3 patients (5.08%). In 2 (3.39%) of this patient, reoperation was required. There were no deaths in this group. Average length of hospital stay was 3.6 days. Conclusion Robotic revisional bariatric surgery is a novel technique that appears to be safe and effective.

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PURPOSE: Despite advances in the composition of defined embryo culture media, co-culture with somatic cells is still used for bovine in vitro embryo production (IVEP) in many laboratories worldwide. Granulosa cells are most often used for this purpose, although recent work suggests that co-culture with stem cells of adult or embryonic origin or their derived biomaterials may improve mouse, cattle, and pig embryo development. MATERIALS AND METHODS: In experiment 1, in vitro produced bovine embryos were co-cultured in the presence of two concentrations of bovine adipose tissue-derived mesenchymal cells (b-ATMSCs; 103 and 104 cells/mL), in b-ATMSC preconditioned medium (SOF-Cond), or SOF alone (control). In experiment 2, co-culture with 104 b-ATMSCs/mL was compared to the traditional granulosa cell co-culture system (Gran). RESULTS: In experiment 1, co-culture with 104 b-ATMSCs/mL improved blastocyst rates in comparison to conditioned and control media (p < 0.05). Despite that it did not show difference with 103 b-ATMSCs/mL (p = 0.051), group 104 b-ATMSCs/mL yielded higher results of blastocyst production. In experiment 2, when compared to group Gran, co-culture with 104 b-ATMSCs/mL improved not only blastocyst rates but also quality as assessed by increased total cell numbers and mRNA expression levels for POU5F1 and G6PDH (p < 0.05). CONCLUSIONS: Co-culture of bovine embryos with b-ATMSCs was more beneficial than the traditional co-culture system with granulosa cells. We speculate that the microenvironmental modulatory potential of MSCs, by means of soluble substances and exosome secretions, could be responsible for the positive effects observed. Further experiments must be done to evaluate if this beneficial effect in vitro also translates to an increase in offspring following embryo transfer. Moreover, this study provides an interesting platform to study the basic requirements during preimplantation embryo development, which, in turn, may aid the improvement of embryo culture protocols in bovine and other species.

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O desempenho reprodutivo de exemplares selvagens de beijupirá capturados no litoral de Pernambuco e aclimatados ao cativeiro foi avaliado durante 10 meses. Um plantel composto por duas fêmeas (peso de 14 a 16kg) e quatro machos (cerca de 12kg) mantidos em um único tanque de 70t produziu 48,7 milhões de ovos no período de outubro a junho. As fêmeas foram capazes de desovar 21 vezes, com uma frequência média (±DP) de uma desova a cada 11,9 dias (±2,9). Em média, cada desova produziu 2,4 milhões de ovos, com fertilização de 52,4 por cento, o que resultou em aproximadamente 1,0 milhão de larvas por desova. Os resultados demonstram a viabilidade da metodologia empregada na formação do plantel e no manejo de reprodutores e confirmam a relativa facilidade de obtenção de desovas espontâneas do beijupirá em cativeiro. Também foi confirmado que o período reprodutivo dessa espécie em cativeiro se estende além do observado na natureza. Este é o primeiro relato sobre o desempenho reprodutivo do beijupirá em cativeiro no Brasil.(AU)

The reproductive performance of wild cobia caught off the coast of Pernambuco, northeastern Brazil, was assessed. Six breeders (two females with 14-16kg and four males with approximately 12kg each) were maintained in a 70 ton tank from October to June and produced 48.7 million eggs. Females were able to spawn every 11.9 days (±2.9), which resulted in 21 spawns. On average each spawn produced 2.4 million eggs with a fertilization of 52.4 percent, which resulted in approximately 1.0 million larvae per spawn. The present results demonstrate the feasibility of the methodology employed here in the formation and management of a cobia breeding stock and confirm the ease of spawning cobia in captivity. It was also confirmed that the spawning season may be extended under captivity when compared to the wild stock. This is the first report on the reproductive performance of cobia in captivity in Brazil.(AU)

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O desempenho reprodutivo de exemplares selvagens de beijupirá capturados no litoral de Pernambuco e aclimatados ao cativeiro foi avaliado durante 10 meses. Um plantel composto por duas fêmeas (peso de 14 a 16kg) e quatro machos (cerca de 12kg) mantidos em um único tanque de 70t produziu 48,7 milhões de ovos no período de outubro a junho. As fêmeas foram capazes de desovar 21 vezes, com uma frequência média (±DP) de uma desova a cada 11,9 dias (±2,9). Em média, cada desova produziu 2,4 milhões de ovos, com fertilização de 52,4 por cento, o que resultou em aproximadamente 1,0 milhão de larvas por desova. Os resultados demonstram a viabilidade da metodologia empregada na formação do plantel e no manejo de reprodutores e confirmam a relativa facilidade de obtenção de desovas espontâneas do beijupirá em cativeiro. Também foi confirmado que o período reprodutivo dessa espécie em cativeiro se estende além do observado na natureza. Este é o primeiro relato sobre o desempenho reprodutivo do beijupirá em cativeiro no Brasil...

The reproductive performance of wild cobia caught off the coast of Pernambuco, northeastern Brazil, was assessed. Six breeders (two females with 14-16kg and four males with approximately 12kg each) were maintained in a 70 ton tank from October to June and produced 48.7 million eggs. Females were able to spawn every 11.9 days (±2.9), which resulted in 21 spawns. On average each spawn produced 2.4 million eggs with a fertilization of 52.4 percent, which resulted in approximately 1.0 million larvae per spawn. The present results demonstrate the feasibility of the methodology employed here in the formation and management of a cobia breeding stock and confirm the ease of spawning cobia in captivity. It was also confirmed that the spawning season may be extended under captivity when compared to the wild stock. This is the first report on the reproductive performance of cobia in captivity in Brazil...

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The invasive golden mussel, Limnoperna fortunei (Dunker, 1857), was introduced into the La Plata River estuary and quickly expanded upstream to the North, into the Paraguay and Paraná rivers. An ecological niche modeling approach, based on limnological variables, was used to predict the expansion of the golden mussel in the Paraguay River and its tributaries. We used three approaches to predict the geographic distribution: 1) the spatial distribution of calcium concentration and the saturation index for calcium carbonate (calcite); 2) the Genetic Algorithm for Rule-Set Production (GARP) model; and the 3) Maximum Entropy Method (Maxent) model. Other limnological variables such as temperature, dissolved oxygen, pH, and Total Suspended Solids (TSS) were used in the latter two cases. Important tributaries of the Paraguay River such as the Cuiabá and Miranda/Aquidauana rivers exhibit high risk of invasion, while lower risk was observed in the chemically dilute waters of the middle basin where shell calcification may be limited by low calcium concentrations and carbonate mineral undersaturation.

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The objective of this study was to investigate safety and feasibility of autologous bone marrow mononuclear cells (BMMNC) transplantation in ST elevation myocardial infarction (STEMI), comparing anterograde intracoronary artery (ICA) delivery with retrograde intracoronary vein (ICV) approach. An open labeled, randomized controlled trial of 30 patients admitted with STEMI was used. Patients were enrolled if they 1) were successfully reperfused within 24 h from symptoms onset and 2) had infarct size larger than 10% of the left ventricle (LV). One hundred million BMMNC were injected in the infarct-related artery (intra-arterial group) or vein (intravenous group), 1% of which was labeled with Tc(99m)-hexamethylpropylenamineoxime. Cell distribution was evaluated 4 and 24 h after injection. Baseline MRI was performed in order to evaluate microbstruction pattern. Baseline radionuclide ventriculography was performed before cell transfer and after 3 and 6 months. All the treated patients were submitted to repeat coronary angiography after 3 months. Thirty patients (57 +/- 11 years, 70% males) were randomly assigned to ICA (n = 14), ICV (n = 10), or control (n = 6) groups. No serious adverse events related to the procedure were observed. Early and late retention of radiolabeled cells was higher in the ICA than in the ICV group, independently of microcirculation obstruction. An increase of EF was observed in the ICA group (p = 0.02) compared to baseline. Injection procedures through anterograde and retrograde approaches seem to be feasible and safe. BMMNC retention by damaged heart tissue was apparently higher when the anterograde approach was used. Further studies are required to confirm these initial data.

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BACKGROUND: The use of a dye and radiocolloid to detect sentinel lymph nodes in breast cancer increases the detection rates. However the use of either method alone does not modify the false negative rate. Therefore there is no formal contraindication for the exclusive use of dye to detect nodes. AIM: To report a prospective analysis of the exclusive blue dye technique for sentinel node biopsy in patients with early breast cancer. PATIENTS AND METHODS: We analyzed the first 100 women with pathologically proven breast cancer who met the inclusion criteria. Patent blue dye was used as colorant. In the first 25 cases sentinel node was identified using radiocolloid and blue dye an then an axillary dissection performed. In the next 25 women, blue dye was used exclusively for detection and an axillary dissection was performed. In the next 50 cases, blue dye was used and only isolated sentinel node biopsy was performed. RESULTS: In 92 of the 100 women a sentinel node was successfully detected. In the first 50 women, the false negative rate of sentinel lymph node detection was 6.9%. No complications occurred. During follow-up, lasting three to 29 months, no axillary relapse was observed. CONCLUSIONS: Sentinel node biopsy in patients with early breast cancer using exclusively blue dye is feasible and safe.

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Background: The use of a dye and radiocolloid to detect sentinel lymph nodes in breast cáncer increases the detection rates. However the use of either method alone does not modify the false negative rate. Therefore there is no formal contraindication for the exclusive use of dye to detect nodes. Aim: To repon a prospective analysis of the exclusive blue dye technique for sentinel node biopsy in patients with early breast cáncer Patients and methods: We analyzed the first 100 women with pathologically proven breast cáncer who met the inclusión criteria. Patent blue dye was used as colorant. In the first 25 cases sentinel node was identified using radiocolloid and blue dye an then an axillary dissection perfomed. In the next 25 women, blue dye was used exclusively for detection and an axillary dissection was perfomed. In the next 50 cases, blue dye was used and only isolated sentinel node biopsy was perfomed. Results: In 92 of the 100 women a sentinel node was successfully detected. In the first 50 women, the false negative rate of sentinel lymph node detection was 6.9 percent. No complications occurred. During follow-up, lasting three to 29 months, no axillary relapse was observed. Conclusions: Sentinel node biopsy in patients with early breast cáncer using exclusively blue dye is feasible and safe.

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Objetivos: Evaluar la experiencia de nuestro equipo en el tratamiento de la obesidad con la técnica de banda ajustable por vía laparoscópica. Paciente y métodos: Entre noviembre de 2001 y julio de 2003, 70 pacientes con obesidad grave o mórbida, fueron operados con banda gástrica ajustable, rígida o flexible, de acuerdo a un protocolo prospectivo propuesto por nuestro equipo multidisciplinario para el tratamiento de la obesidad. La técnica quirúrgica fue la misma en todos los pacientes. Se realizó un análisis de la morbilidad perioperatoria y un seguimiento a 20 meses de las complicaciones tardías del procedimientos. Se comparó también la tasa de complicaciones según uso de banda rígida o banda flexible. Se evaluó asimismo la variación en el índice de masa corporal de los pacientes. Para este análisis del estudio se efectuó una encuesta telefónica de satisfacción de los pacientes. Resultados: Los 70 pacientes se trataron consecutivamente. Cuarenta y cinco pacientes se trataron con banda rígida y los últimos 25, con banda flexible. No hubo mortalidad operatoria. La reducción del IMC promedio fue de 37,7 a 27, 3 a 20 meses de deslizamiento de banda fue la más frecuente de éstas. Las complicaciones tardías se presentaron exclusivamente en los pacientes con banda gástrica rígida. Una paciente (1,4 por ciento) no tuvo variaciones en el IMC y otra (1,4 por ciento) tuvo una disminución de 4 por ciento en el IMC ambas a los 12 meses de insertada la banda. El 94 por ciento de los pacientes encuestados se manifestó con el procedimiento y sus resultados. Conclusiones: La técnica descrita es altamente eficaz, segura, con baja tasa de complicaciones. La baja en el IMC es comparable a las series publicadas en la literatura internacional. El estudio de las complicaciones sugiere que el uso de banda gástrica flexible puede tener ventajas sobre la rígida. Se requiere de mayor seguimiento para confirmar resultados.

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Insulinoma is the most common neuroendocrine tumor. Its clinical manifestations are frequently confounded with neuropsychiatric symptoms, and definitive diagnosis can be delayed for a long time. These tumors are usually small, of less than 2 cm. Thus, their preoperative localization is difficult. We report two patients with a clinical diagnosis of insulinoma, in whom the preoperative imaging study was negative. Both fulfilled diagnostic criteria, with high serum insulin levels in the presence of a blood glucose of less than 45 mg/dl. The imaging study, including abdominal computed tomography and pancreatic endoscopic ultrasonography did not disclose the location of the tumor. A pancreatic angiography with selective stimulation with intra arterial calcium and venous sampling for insulin measurements, was performed in both patients. This test allowed the exact localization of the tumors and their successful excision. A review of other localization diagnostic tests is done (Rev Méd Chile 2004; 132: 71-5).

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Abstract Inundation patterns in the Pantanal remain in a relatively natural state, yet a number of significant human influences have occurred in the past, and there is potential for more severe human impacts as development of the region continues in the future. The objectives of this paper are 1) to briefly review the linkages between hydrology and ecological structure and function in the Pantanal; 2) to review some documented cases of historical influences of human activities on hydrology in the region; and 3) to consider potential future impacts, particularly in regard to the recently proposed navigation project known as the Paraguay-Parana Waterway (or Hidrovia).

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En Chile sólo el 35 por ciento de las colecistectomías se realizan por vía laparoscópica. Dada la alta prevalencia de colelitiasis, quisimos evaluar un protocolo prospectivo de colecistectomía abierta electiva cuyo objetivo fue lograr una corta estadía hospitalaria. Se realizó con 101 pacientes de lista de espera, seleccionando aquéllos con bajo riesgo quirúrgico y pocas probabilidades de tener coledocolitiasis o cáncer vesicular asociados a colelitiasis. Se evaluaron los resultados clínicos, el dolor postoperatorio inmediato y ambulatorio, y el grado de satisfacción del paciente frente al servicio recibido. El promedio de hospitalización fue 1,12 días, el 96 por ciento de los pacientes refirió estas satisfecho de haber participado de nuestro programa y el 99 por ciento lo recomendaría a un amigo. El dolor postoperatorio fue, en la mayoría, leve y no afectó el juicio del paciente cuando fue adecuadamente tratado. No hubo mortalidad. La morbilidad fue escasa y leve. El 95 por ciento de los pacientes fue dado de alta al día siguiente de su cirugía y sólo el 3 por ciento requirió una hospitalización mayor que 2 días. Pensamos que es posible implementar programas de colecistectomía abierta electiva con tiempos de hospitalización cortos (24 h) con buenos resultados clínicos y alto grado de satisfacción del paciente

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El cáncer gástrico es una enfermedad de alta prevalencia en Chile y su diagnóstico se realiza frecuentemente en etapas avanzadas de la enfermedad. Se presentan los resultados obtenidos en pacientes resecados por un cáncer gástrico con metástasis hepáticas, peritoneales y/o en ganglios de tercera barrera. Se realizaron 34 operaciones en 27 meses: 24 gastrectomías totales y 10 gastrectomías parciales. Hubo dos muertes perioperatorias secundarias a neumonía en pacientes gastrectomizados totales (8,3 por ciento) y una filtración esófago-yeyunal (4,2 por ciento). La mediana de sobrevida fue 10 meses. Los pacientes con diseminación N3 exclusiva tuvieron una sobrevida actuarial a 20 meses de 38 por ciento. La gastrectomía fue un tratamiento efectivo en el alivio de los síntomas y otorgó una buena calidad de vida a los sobrevivientes

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The purpose of this study was to assess the delivery to the lungs and the short-term safety of recombinant human deoxyribonuclease (rhDNase, Pulmozyme) in children with cystic fibrosis younger than 5 years of age compared with older children. Patients between the ages of 3 months and 10 years had bronchoscopic examination with bronchoalveolar lavage (BAL) after administration of an aerosol dose of 2.5 mg of rhDNase. After recovery from the procedure, patients were discharged home for an additional 13 days of rhDNase therapy. During this time adverse events were recorded to assess short-term safety. A total of 98 patients were enrolled, 65 (66%) aged 3 months to 5 years and 33 (34%) aged 5 years to 10 years. Deoxyribonuclease concentrations in BAL fluid were variable (interquartile range, 752 to 3943 micrograms/mL epithelial lining fluid [ELF]) and did not depend on patient age, weight, or height or differ when delivered through a mouthpiece or mask. The median value for the BAL DNA concentration in the younger group was 432 micrograms/mL ELF compared with 703 micrograms/mL ELF in the older patients. This study demonstrates the value of bronchoscopy and BAL for assessing nebulized medication delivery in young children and shows that aerosolized medications can be delivered to and are present in comparable amounts in the lower airways of younger and older children. Exposure to rhDNase appears to be safe over 2 weeks in infants and young children with cystic fibrosis.

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Se presenta una serie de 12 pacientes portadores de acalasia esofágica en los que se realizó miotomía esofágica por medio de videotoracoscopia izquierda. Se describe en detalle la técnica quirúrgica y manejo perioperatorio. Se presentan complicaciones mayores en 2 pacientes y menores en otro. No hubo mortalidad. En 1 0 pacientes la deglución postoperatoria inmediata es excelente a buena. En el postoperatorio alejado se presenta disfagia recurrente en 2 pacientes que se manejan con dilataciones. La miotomía esofágica por videotoracoscopia proporciona resultados similares a otras técnicas abiertas pero con todas las ventajas de una técnica mínimamente invasiva

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Larval flannelmouth sucker (Catostomus latipinnis) were exposed to arsenate, boron, copper, molybdenum, selenate, selenite, uranium, vanadium, and zinc singly, and to five mixtures of five to nine inorganics. The exposures were conducted in reconstituted water representative of the San Juan River near Shiprock, New Mexico. The mixtures simulated environmental ratios reported for sites along the San Juan River (San Juan River backwater, Fruitland marsh, Hogback East Drain, Mancos River, and McElmo Creek). The rank order of the individual inorganics, from most to least toxic, was: copper > zinc > vanadium > selenite > selenate > arsenate > uranium > boron > molybdenum. All five mixtures exhibited additive toxicity to flannelmouth sucker. In a limited number of tests, 44-day-old and 13-day-old larvae exhibited no difference in sensitivity to three mixtures. Copper was the major toxic component in four mixtures (San Juan backwater, Hogback East Drain, Mancos River, and McElmo Creek), whereas zinc was the major toxic component in the Fruitland marsh mixture, which did not contain copper. The Hogback East Drain was the most toxic mixture tested. Comparison of 96-h LC50 values with reported environmental water concentrations from the San Juan River revealed low hazard ratios for arsenic, boron, molybdenum, selenate, selenite, uranium, and vanadium, moderate hazard ratios for zinc and the Fruitland marsh mixture, and high hazard ratios for copper at three sites and four environmental mixtures representing a San Juan backwater, Hogback East Drain, Mancos River, and McElmo Creek. The high hazard ratios suggest that inorganic contaminants could adversely affect larval flannelmouth sucker in the San Juan River at four sites receiving elevated inorganics.

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Apresenta-se revisao da literatura sobre a pé séptico em pacientes com diabetes, enfatizando fisio-patologia, diagnóstico, tratamento clínico e cirúrgico atualmente utilizados no controle da doença. Conclui-se que o pé séptico sem isquemia avançada é uma causa freqüente de amputaçao em membros inferiores nos pacientes diabéticos.

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