Experiencia en nefrectomía: serie de casos de cuatro años

Introducción: Las indicaciones por las cuales un paciente requiere una nefrectomía son múltiples: las neoplasias, la hidronefrosis y la exclusión funcional son las principales. En manos expertas la nefrectomía es un procedimiento seguro, especialmente porque en la actualidad el abordaje por excelencia es realizar una técnica mínimamente invasiva con conservación de nefronas. Se presenta el análisis de la experiencia en Mederi, Hospital Universitario Mayor en esta intervención. Metodología: Se realizó una serie de casos de pacientes llevados a nefrectomía entre mayo de 2008 y mayo de 2012. Se incluyeron la totalidad de los casos. Resultados: Se analizaron 72 registros, 49 mujeres y 25 hombres; 13 de ellas fueron laparoscópicas. La edad promedio fue de 58,6 años. El tiempo medio operatorio fue 169,23 minutos (118-220 minutos). El sangrado operatorio promedio fue de 680,63 ml (IC95%: 2,83-1358 ml). El tiempo de hospitalización promedio fue de 4,88 días IC95%. La mayoría de los pacientes se distribuyeron en estadios medios de la enfermedad tumoral, con poco compromiso ganglionar y metástasis; el diagnóstico histológico y estadio dominante fueron el carcinoma de células renales grado 3 de Fuhrman respectivamente. Se reportan 13 casos de compromiso de la capsula de Gerota y 11 con compromiso del hilio. Discusión: La experiencia en nefrectomía de la institución es muy positiva por el bajo número de mortalidad y complicaciones. En cuanto a la técnica, es importante promover la técnica laparoscópica

Relación entre la presencia de tiroiditis linfocítica con la gravedad y recurrencia/persistencia del carcinoma diferenciado de tiroides.

Introducción: Para el sistema endocrino la neoplasia más frecuente es el cáncer diferenciado de tiroides, con un claro incremento en su incidencia. Es importante encontrar asociaciones que posteriormente permitan establecer factores de riesgo y/o protectores claves en la estrategia terapéutica futura. Por lo que se investigó la relación entre la presencia de tiroiditis linfocítica con la gravedad y persistencia/recurrencia del carcinoma diferenciado de tiroides Materiales y métodos: se hizo un estudio de casos y controles de pacientes con carcinoma diferenciado de tiroides llevados a cirugía entre enero de 1997 y diciembre de 2012 en la Fundación Cardioinfantil, Bogotá, Colombia. Se evaluó la asociación entre la presencia de factores histopatológicos y la presencia de persistencia/recurrencia usando pruebas chi cuadrado y el OR. Para evaluar la presencia de asociación a nivel multivariado se utilizaron modelos de regresión binaria con enlace log log complementario. Resultados: la tiroiditis linfocítica no se asocia con la presencia de ninguna variable de severidad histopatológica. Sin embargo, la tiroiditis linfocítica se asoció con persistencia/recurrencia en presencia invasión vascular (OR 6.6 IC95% 1.4-32), invasión linfática (OR 5.4 IC95% 1.3-22.1), invasión de tejido peritiroideo (OR 1.0-12.3), vaciamiento central positivo (OR 5.1 IC 95% 1.0-2.6) y el, vaciamiento lateral positivo (OR 11.5 IC95% 1.0-12). Con un OR inclusive mayor respecto del grupo sin tiroiditis linfocítica en presencia de invasión linfática (OR 5.4 IC95% 1.3-22 vs 2.6 IC95% 1.2-5.6) y compromiso ganglionar en el vaciamiento lateral (OR 58 IC95% 7.1-476) independiente de la edad y el sexo. Conclusión: la tiroiditis linfocítica no se relaciona con marcadores de severidad histopatológica pero sí con mayor persistencia/recurrencia de la enfermedad.

Imaginarios, biomedicina y normatividad: una respuesta a los procesos de estigmatización y discriminación por VIH

El tratamiento del VIH/sida, como problemática que ocupa a la salud colectiva, requiere nuevas perspectivas teóricas para su análisis. Objetivo: reconstruir algunas matrices imaginarias, configu- radoras de la infección de VIH, vinculadas con prácticas normativas y con la formación del saber clínico, visibilizar consecuencias de estos procesos y articular estas matrices con las problemáticas de discriminación y estigmatización que pesan sobre el diagnóstico. Materiales y métodos: se efectuaron entrevistas en profundidad a jóvenes entre 18 y 35 años y a profesionales de la salud dedicados al tratamiento del VIH/sida de hospitales públicos de las ciudades de Santa Fe y Paraná (Argentina). Resultados: el discurso biomédico –nodal en tanto exigencia de la norma y garante del ejercicio de normalización de los individuos y de las poblaciones a partir del binomio normal/ patológico– incide en la apropiación de la diagnosis y la convivencia con la infección. Conclusión: a partir de los resultados, es posible comprender los procesos de estigmatización y discrimina- ción como mecanismos privilegiados de estas instancias normativas que median la configuración discursiva del VIH. A su vez, se advierte que el rechazo prevalente en jóvenes a realizarse las pruebas diagnósticas, como las dificultades de acceso a los servicios de salud, es consecuencia de los procesos indicados.

La congruencia en la sentencia anticipada

Una de las tantas preocupaciones es la concerniente a la emisión de fallos en los que se deja de lado la imputación nodal o la calificación provisional que el evento ameritara, esto es, cuando el juez sanciona por delito distinto al determinado

Análisis de los imaginarios y representaciones urbanas de las personas con discapacidad, en relación con la infraestructura urbana: estudio de caso: barrio Horizontes, sector del Codito. Bogotá DC.

La ciudad es la plataforma para la realización de la vida urbana; desde sus componentes físicos e imaginados la ciudad moldea la manera en que las personas son representadas y se representan. Por lo tanto, este estudio de caso indaga por los imaginarios y representaciones de las personas con discapacidad en el barrio Horizontes, ubicado en los cerros nororientales de la ciudad de Bogotá y analiza la relación que existe con la infraestructura urbana. Por lo tanto, se investiga cómo la ciudad física construida, especialmente en materia de espacio público, influye directamente en la manera en que los ciudadanos con discapacidad se imaginan y representan en la ciudad. Para este propósito se utilizaron diferentes herramientas como encuestas, entrevistas, cartografías y fotografías que permitieron el desarrollo del trabajo de campo y la acción participante culminando con una intervención sobre el espacio público de la carrera 4ª en el barrio.

Dificultades en la integración y cooperación de los cuerpos policiales de América Latina en la lucha contra el narcotráfico. Estudio de caso: AMERIPOL

La presente investigación analiza los principales retos que afectan la cooperación e integración de los cuerpos policiales latinoamericanos en la lucha contra el narcotráfico. Para realizar dicho análisis se toma como caso de estudio AMERIPOL, organización creada en el año 2007 y que actualmente constituye el único mecanismo de cooperación policial en el hemisferio americano. Se considera que la cooperación e integración de los cuerpos policiales en la lucha contra el narcotráfico en la región enfrentan dos retos principales: la disparidad de los marcos jurídicos entre los Estados y la descoordinación política. Estos retos suponen la existencia de factores que impiden una política de cooperación conjunta contra las drogas y por tanto, el desarrollo de actitudes aislacionistas que limitan la cooperación en contra de éste flagelo

Capacitaciones autónomas indígenas : respuesta a la política asimiladora nacional : el ejemplo de los Wixaritar de México.

Monográfico con el título: 'Desde la diversidad hacia la desigualdad: ¿destino inexorable de la globalización?'. Resumen basado en el de la publicación

A preliminary investigation of the release of oil from contaminated clays and other fine-grained sediments during consolidation

Fine-grained sediments on land, or in a freshwater or marine environment, may become contaminated with a wide range of pollutants including hydrocarbons. This paper is concerned with preliminary studies of the mobilization and transportation of hydrocarbons, during the process of consolidation, to adjacent sediments or water bodies. A modified Rowe Cell was used to measure the consolidation properties of prepared kaolinite and bentonite clay-water slurries, with and without the addition of oil, along with hydrocarbon-bearing drill-cuttings samples taken from the sea-bed adjacent to two North Sea oil-well platforms. The consolidation properties of the kaolinite and bentonite clay slurries were little altered by the addition of oil, which was present at concentrations of between 8073 and 59 572 mg kg(-1). During each consolidation stage, samples of the expelled pore-fluids were collected and analysed for oil content. These values were very low in comparison with the original oil concentration in the samples and changed little between each consolidation stage. Analysis of the slurry samples both before and after consolidation confirms that, proportionally, little oil is removed as a result of consolidation. The implication of these results is that, for the range of samples tested, the very high hydraulic gradients and particle rearrangements that occur during the process of consolidation are capable of releasing only proportionally small amounts of oil bound to the fine-grained clay and silt particles.

Effects of short-term pH fluctuations on cadmium, nickel, lead, and zinc availability to ryegrass in a sewage sludge-amended field

In this field experiment, sewage sludge was applied at 0, 5, 10, and 50 t ha(-1), and the availability of Cd, Ni, Pb, and Zn was assessed both by ryegrass uptake and by DTPA extractions. The aim was to investigate the role of important soil parameters, particularly pH, on heavy metal availability. It was found that metal uptake and extractability increased significantly in the 50 t ha(-1) treatment. In the 16th week of the experiment there was a significant, although temporary, increase in DTPA-extractable Cd, Ni, and Zn concentrations. Metal concentrations in ryegrass were also significantly elevated in week 20 compared to the subsequent cuttings. These fluctuations in both DTPA and ryegrass uptake occurred only at 50 t ha(-1) and were probably induced by a sudden pH decrease measured in the same treatment in week 16. This suggests that soils which have received high applications of sewage sludge may be prone to fluctuations in metal availability. (c) 2007 Elsevier Ltd. All rights reserved.

A preliminary investigation of the release of oil from contaminated clays and other fine-grained sediments during consolidation

Fine-grained sediments on land, or in a freshwater or marine environment, may become contaminated with a wide range of pollutants including hydrocarbons. This paper is concerned with preliminary studies of the mobilization and transportation of hydrocarbons, during the process of consolidation, to adjacent sediments or water bodies. A modified Rowe Cell was used to measure the consolidation properties of prepared kaolinite and bentonite clay-water slurries, with and without the addition of oil, along with hydrocarbon-bearing drill-cuttings samples taken from the sea-bed adjacent to two North Sea oil-well platforms. The consolidation properties of the kaolinite and bentonite clay slurries were little altered by the addition of oil, which was present at concentrations of between 8073 and 59 572 mg kg(-1). During each consolidation stage, samples of the expelled pore-fluids were collected and analysed for oil content. These values were very low in comparison with the original oil concentration in the samples and changed little between each consolidation stage. Analysis of the slurry samples both before and after consolidation confirms that, proportionally, little oil is removed as a result of consolidation. The implication of these results is that, for the range of samples tested, the very high hydraulic gradients and particle rearrangements that occur during the process of consolidation are capable of releasing only proportionally small amounts of oil bound to the fine-grained clay and silt particles.

The establishment of heathland vegetation on ex-arable land: the response of Calluna vulgaris to soil acidification

The UK Biodiversity Action Plan has identified the creation of lowland heathland as an important objective. Heathland restoration studies have identified soil pH, elevated soil nutrients and large weed seed banks as major problems in the restoration of heathland vegetation on ex-arable land. Heathland vegetation is usually found on nutrient-poor acidic soils. Creating acidic soil conditions on ex-arable sites thus may produce a suitable environment for the establishment of heath vegetation. Soil acidification by the addition of sulphur has been shown to reduce the soil pH and the availability of nutrients in arable soils. A series of experiments was established to investigate the effects of soil acidification using sulphur on the establishment of Calluna vulgaris and the development of weed vegetation. The application of sulphur at 0.24 kg m(-2) to an arable soil was found to increase the survival rate of C. vulgaris cuttings planted in it. The mechanism of increased C. vulgaris survival appeared to be by sulphur application significantly reducing the cover of arable weeds arising from the soil seed bank. Higher rates of sulphur application (0.36 and 0.48 kg m(-2)) resulted in the death of many C. vidgaris plants. However C. vulgaris seedlings were able to establish successfully on these ex-arable soils within 1824 months following the addition of these levels of sulphur. The application of sulphur appears to offer a practical solution to heathland creation on ex-arable land. However, it may be necessary to provide an interval of between 18 and 24 months between the application of sulphur and the addition of C. vulgaris plants or seeds for the successful establishment of heathland vegetation. (C) 2003 Elsevier Ltd. All rights reserved.

Adventitious root formation in anacardium occidentale L. in response to phytohormones and removal of roots

Despite advances in tissue culture techniques, propagation by leafy, softwood cuttings is the preferred, practical system for vegetative reproduction of many tree and shrub species. Species are frequently defined as 'difficult'- or 'easy-to-root' when propagated by conventional cuttings. Speed of rooting is often linked with ease of propagation, and slow-to-root species may be 'difficult' precisely because tissues deteriorate prior to the formation of adventitious roots. Even when roots form, limited development of these may impair the establishment of a cutting. In this study we used softwood cuttings of cashew (Anacardium occidentale), a species considered as 'difficult-to-root'. We aimed to test the hypothesis that speed, and extent of early rooting, is critical in determining success with this species; and that the potential to form adventitious roots will decrease with time in the propagation environment. Using two genotypes, initial rooting rates were examined in the presence or absence of exogenous auxin. In cuttings that formed adventitious roots, either entire roots or root tips were removed, to determine if further root formation/development was feasible. To investigate if subsequent root responses were linked to phytohormone action, a number of cuttings were also treated with either exogenous auxin (indole-3-butyric acid-IBA) or cytokinin (zeatin). Despite the reputation of Anacardium as being 'difficult-to-root', we found high rooting rates in two genotypes (AC 10 and CCP 1001). Removing adventitious roots from cuttings and returning them to the propagation environment, resulted in subsequent re-rooting. Indeed, individual cuttings could develop new adventitious roots on four to five separate occasions over a 9 week period. Data showed that rooting potential increased, not decreased with time in the propagation environment and that cutting viability was unaffected. Root expression was faster (8-15 days) after the removal of previous roots compared to when the cuttings were first stuck (21 days). Exposing cuttings to IBA at the time of preparation, improved initial rooting in AC 10, but not in CCP 1001. Application of IBA once roots had formed had little effect on subsequent development, but zeatin reduced root length and promoted root number and dry matter accumulation. These results challenge our hypothesis, and indicate that rooting potential remains high in Anacardium. The precise mechanisms that regulate the number of adventitious roots expressed, remain to be determined. Nevertheless, results indicate that rooting potential can be high in 'difficult-to-root' species, and suggest that providing supportive environments is the key to expressing this potential. (c) 2006 Elsevier B.V. All rights reserved.

Calcium turns sinister in left-right asymmetry

A major challenge in deciphering the development of left-right asymmetry in vertebrates is uncovering how subtle early differences between the left and right sides are translated into robust differences in gene expression. Recently, Raya and colleagues suggested that asymmetric localization of extracellular calcium ions at the node could differentially modulate Notch signalling, resulting in asymmetric expression of the signalling molecule Nodal on the left side of the node. In this article, I examine the implications of this finding and explore their relevance to the evolution of asymmetry in vertebrates and invertebrates.

In vitro micro-tuber initiation and dormancy in yam

Dormancy is a mechanism that regulates the timing of sprouting (germination) of affected plant parts as well as ensures that the food quality of edible parts is maintained in storage until the following growing season. In yam, however, little is known about the control of tuber initiation or tuber dormancy. The objective of this study was to determine the effects of selected plant growth regulators (PGRs) on tuber initiation and dormancy, using an in vitro system. In two replicated experiments, 2-chloroethylphosphonic acid (ethephon, an ethylene source), abscisic acid (ABA) and gibberellin (GA3) – and their inhibitors silver nitrate, fluridone and 2-chloroethyl-trimethylammonium chloride, respectively – were added at two concentrations to the culture medium prior to explant culture. Dates of micro-tuber initiation and sprouting (end of dormancy) and tuber number were recorded. In the control (no PGR) in Experiment 1, micro-tubers were initiated at the base of the stem after 176 days and sprouted 235 days later, that is 411 days after culturing. Most PGR treatments had only small effects (±30 days) on the duration of dormancy and the time of micro-tuber initiation. However, in GA3 micro-tuber initiation occurred after 76 days, about 100 days earlier than in the control, whereas fluridone affected the position of micro-tubers and duration of dormancy. With fluridone treatments, tubers were found at the base of the stem (normal position) and on lower and upper nodes. Lower node tubers sprouted within 225 days of culturing compared with about 420 days after culturing at other nodal positions and in other PGR treatments. These data suggest an important role for ABA and gibberellic acid in yam micro-tuber initiation and the induction of dormancy.

A simplified mathematical model for urban microclimate simulation

Techniques for modelling urban microclimates and urban block surfaces temperatures are desired by urban planners and architects for strategic urban designs at the early design stages. This paper introduces a simplified mathematical model for urban simulations (UMsim) including urban surfaces temperatures and microclimates. The nodal network model has been developed by integrating coupled thermal and airflow model. Direct solar radiation, diffuse radiation, reflected radiation, long-wave radiation, heat convection in air and heat transfer in the exterior walls and ground within the complex have been taken into account. The relevant equations have been solved using the finite difference method under the Matlab platform. Comparisons have been conducted between the data produced from the simulation and that from an urban experimental study carried out in a real architectural complex on the campus of Chongqing University, China in July 2005 and January 2006. The results show a satisfactory agreement between the two sets of data. The UMsim can be used to simulate the microclimates, in particular the surface temperatures of urban blocks, therefore it can be used to assess the impact of urban surfaces properties on urban microclimates. The UMsim will be able to produce robust data and images of urban environments for sustainable urban design.