Implicaciones clínicas y quirúrgicas de las variaciones anatómicas vasculares del riñón

Introducción: Conocer y diagnosticar las variaciones más frecuentes de la vasculatura renal es de gran importancia para la planificación de la nefrectomía laparoscópica en el donante y para la reconstrucción vascular en el trasplante renal. De igual forma, considerar las variaciones vasculares −especialmente las del sistema venoso− es indispensable en reconstrucción vascular debido a la gran proporción de variaciones venosas asociadas a aneurismas de la aorta abdominal; además, es ideal en el estudio de condiciones clínicas tales como el síndrome de congestión pélvica y la hematuria. Metodología: Se trata de una revisión de la bibliografía sobre la proporción, diagnóstico, procedimientos quirúrgicos y síndromes clínicos asociados a las variaciones de la vasculatura renal, basada en el material encontrado con la siguiente estrategia de búsqueda: “Renal Artery/abnormalities”[Mesh] OR Renal Veins/abnormalities”[Mesh] AND “surgery”[Mesh] OR “transplantation”[Mesh] OR “radiography”[Mesh] “Kidney Pelvis/abnormalities”[Mesh] AND “Kidney Pelvis/blood supply”[Mesh]. Esta estrategia se modificó de acuerdo con las bases de datos: MEDLINE/PubMed, MEDLINE OVID, SCIENCEDIRECT, HINARI y LILACS. Desarrollo: Se revisó el origen y los tipos más frecuentes de variaciones de la vasculatura renal. Se investigó sobre las implicaciones quirúrgicas y los síndromes clínicos asociados.

Consumo de sustancias y noxas prenatales en madres de pacientes con síndrome de Möbius y Möbius Like

Introducción: El síndrome de Möbius y Möbius Like es una entidad poco frecuente caracterizada principalmente por parálisis congénita del VI y VII par craneal. Su etiología es poco conocida aunque se ha asociado a inductores del aborto. El objetivo de este estudio es describir factores anómalos, tóxicos o nocivos que hayan estado presentes en el embarazo de las madres de estos pacientes. Metodología: se realizó una encuesta auto-diligenciable a 15 madres de pacientes con el diagnóstico, indagando sobre condiciones anómalas y/o exposicionales del embarazo, el padre y el ambiente. Resultados: Las madres se encontraban entre los 16 y 34 años al momento de quedar embarazadas, en su mayoría eran solteras, estudiantes y sin planes de embarazo. Once en total usaron algún medicamento y/o sustancias durante la gestación; seis de ellas Misoprostol (40%). Las otras sustancias utilizadas incluyeron: alternativas, cigarrillo, alcohol, ibuprofeno, anticonceptivos, otros. Como anomalías del periodo prenatal se reportaron sangrado activo y/o amenaza de aborto, infección, exposición a químicos ambientales y enfermedad materna activa. Las condiciones paternas descritas fueron alcoholismo y/o drogadicción, enfermedad y edad ≥ 40 años en bajo porcentaje. Conclusión: El síndrome de Möbius y Möbius Like es una patología poco frecuente de la cual aún se debe seguir investigando sobre su etiología, para plantear posibles medidas de prevención.

Incidencia de fibrilación auricular en las primeras 72 horas del post operatorio de revascularización miocárdica

Determinar la incidencia de fibrilación auricular en las primeras 72 horas del post operatorio en pacientes llevados a revascularización miocárdica utilizando dos técnicas de anestésia una convencional (AC) con anestésicos inhalados y opioides y otra con dexmedetomidina (AD.). cohorte retrospectivo, en donde se seleccionarán dos grupos de estudio, un grupo de expuestos, pacientes llevados a revascularización miocárdica con utilización técnica anestésica convencional y un grupo de no expuestos pacientes llevados a revascularización miocárdica con uso de dexmedetomidina como técnica de anestesia; A estos grupos se les hizo seguimiento por 72 horas para determinar la presencia de fibrilación auricular y la terapéutica instaurada.

Secuestro pulmonar

Paciente de 39 años con antecedente de Síndrome de Tolosa Hunt, quien ingresa al servicio de urgencias por disminución de la agudeza visual y cefalea. Dado el antecedente se considera realizar estudios complementarios para descartar enfermedad granulomatosa, como causa del síndrome, encontrando los siguientes hallazgos incidentales en las imágenes del tórax. El secuestro pulmonar es una anomalía congénita caracterizada por tejido pulmonar displásico, sin conexión normal con la vía aérea, irrigado por la circulación arterial sístémica. Hay dos tipos de secuestros, el intralobar y el extralobar. El intralobar (75%), puede ser congénito o adquirido como secuela de infecciones recurrentes localizadas, está cubierto por pleura del pulmón normal adyacente y generalmente su drenaje venoso es a través del sistema venoso pulmonar ipsilateral. El secuestro extralobar (25%), es considerado una anomalía congénita, está revestido por su propia pleura y su drenaje venoso es sistémico. Tanto el secuestro intralobar como extralobar reciben suplencia arterial sistémica. En los estudios de imágenes, el secuestro se puede presentar como consolidación focal, nódulo o masa, de localización paravertebral, contiguo al hemidiafragma, en los lóbulos inferiores (segmento posterior), con mayor frecuencia en el lado izquierdo (98%) y con una suplencia arterial anómala dada por una o múltiples ramas (15%) generalmente de la aorta torácica y su drenaje puede ser al sistema venoso pulmonar y con menor frecuencia a la circulación sistémica.

Capacidad predictiva del euroscore II en una cohorte de pacientes de cirugía cardiovascular en una institución de cuarto nivel de Bogotá

El EuroSCORE II es una de las escalas más empleadas como predictor de riesgo de mortalidad en los servicios de cirugía cardiovascular. Esta ha sido validada en diferentes hospitales alrededor del mundo demostrando una adecuada capacidad de discriminación. El objetivo de este estudio fue evaluar el valor predictivo de la escala de riesgo EuroSCORE II en los pacientes sometidos a Cirugía Cardiovascular en una institución de cuarto nivel de Bogotá. Metodología: Estudio de prueba diagnóstica observacional y retrospectivo de la cohorte de pacientes en una institución de cuarto nivel durante los años 2012 a 2014. Se realizó el cálculo del EuroSCORE II para cada paciente, comparando la mortalidad predicha versus la observada, de forma global y por grupo de riesgo. Resultados: Del total de la población que tuvo intervención cardiaca mayor en una institución de cuarto nivel en la cohorte estudiada se presentaron 58 casos de muerte en los treinta días posteriores a la intervención, que corresponde al 7,46%. La mortalidad esperada calculada con el EuroSCORE II fue del 9,26%, lo cual indica un buen poder de predicción para esta población. Por otro lado, la curva ROC evidencia con un valor de 0.757 del área bajo la curva, que el modelo El EuroSCORE II es un buen modelo predictivo con un adecuado valor de discriminación. Se evidenció que las variables estado crítico preoperatorio y función del ventrículo izquierdo tienen mayor peso estadístico en nuestra población objeto, con una significancia del 0,001, seguido de infarto agudo de miocardio, sexo y peso de la intervención con una significancia del 0,01. Adicionalmente, el Euroscore II tiene mejor valor predictivo cuando se realiza un solo procedimiento o revascularización, en comparación a cuando se realiza procedimientos mixtos. Se recomienda realizar un estudio multicéntrico donde se incluyan pacientes con diferentes características demográficas

Endocarditis infecciosa por Staphylococcus Aureus Meticilino sensible y resistente en la Fundación Cardioinfantil – Instituto de Cardiología

Introducción y objetivos: La endocarditis infecciosa (EI) es una enfermedad grave producida por diversos gérmenes que afectan las válvulas cardiacas y el tejido endomiocárdico. El objetivo fue describir las características epidemiológicas, clínicas, ecocardiográficas y microbiológicas de la endocarditis infecciosa por Staphylococcus aureus (S. aureus) meticilino sensible y resistente de la Fundación Cardioinfantil – Instituto de Cardiología (FCI-IC) en el periodo de tiempo 2010- 2015. Métodos: Cohorte retrospectiva de casos de EI por S. aureus en la FCIIC para el período 2010-2015. Se realizó descripción de las variables generales de la población a estudio utilizando medidas de tendencia central y dispersión. Análisis de desenlaces teniendo cuenta la concentración inhibitoria mínima de vancomicina. Resultados: En el estudio se presentaron 27 casos de EI, con una mayor proporción de pacientes de sexo masculino, con hipertensión, diabetes y hemodiálisis. La fiebre fue la manifestación más frecuente seguida de fenómenos vasculares. La válvula más comprometida fue la mitral, principalmente nativa. Discusión: La presentación clínica de los pacientes con EI por S. aureus es aguda por lo que la fiebre es la principal manifestación clínica presentada, lo anterior favorece un rápido diagnóstico clínico. De las cepas de S. aureus causante de EI no se encontró gérmenes con sensibilidad intermedia ni resistente a la vancomicina según criterios establecidos por CLSI. Se encontró mayor proporción de pacientes con un valor de CMI para vancomicina mayor a 0,5μg/ml lo cual es importante dado que podemos estar enfrentándonos a cepas hetero VISA (hVISA).

Estudio piloto de la relación entre el aumento de la velocidad de onda del pulso en arteria carótida común medida por resonancia magnética y los factores de riesgo vasculares clásicos en sujetos con sospecha de lesión cerebrovascular isquémica

Arterial stiffness assessed by carotid-femoral pulse wave velocity (cfPWV) measurement is now well accepted as an independent predictor of vascular mortality and morbidity. However, the value of cfPWV has been considered to be limited for risk classification in patients with several vascular risk factors. Magnetic resonance (MR) allows measurement of PWV between two points, though to date mainly used to study the aorta. To assess the common carotid artery pulse wave velocity by magnetic resonance, determine their association with classical vascular risk factors and ischemic brain injury burden in patients with suspected ischemic cerebrovascular disease

Laurentide ice streaming on the Canadian Shield: A conflict with the soft-bedded ice stream paradigm?

Elucidating the controls on the location and vigor of ice streams is crucial to understanding the processes that lead to fast disintegration of ice flows and ice sheets. In the former North American Laurentide ice sheet, ice stream occurrence appears to have been governed by topographic troughs or areas of soft-sediment geology. This paper reports robust evidence of a major paleo-ice stream over the northwestern Canadian Shield, an area previously assumed to be incompatible with fast ice flow because of the low relief and relatively hard bedrock. A coherent pattern of subglacial bedforms (drumlins and megascalle glacial lineations) demarcates the ice stream flow set, which exhibits a convergent onset zone, a narrow main trunk with abrupt lateral margins, and a lobate terminus. Variations in bedform elongation ratio within the flow set match theoretical expectations of ice velocity. In the center of the ice stream, extremely parallel megascalle glacial lineations tens of kilometers long with elongation ratios in excess of 40:1 attest to a single episode of rapid ice flow. We conclude that while bed properties are likely to be influential in determining the occurrence and vigor of ice streams, contrary to established views, widespread soft-bed geology is not an essential requirement for those ice streams without topographic control. We speculate that the ice stream acted as a release valve on ice-sheet mass balance and was initiated by the presence of a proglacial lake that destabilized the ice-sheet margin and propagated fast ice flow through a series of thermomechanical feedbacks involving ice flow and temperature.

Ultrastructure of Buddenbrockia allmani n sp (Myxozoa, Malacosporea), a parasite of Lophopus crystallinus (Bryozoa, Phylactolaemata)

Development of a new species of malacosporean myxozoan (Buddenbrockia allmani n. sp.) in the bryozoan Lophopus crystallinus is described. Early stages, represented by isolated cells or small groups, were observed in the host's body wall or body cavity. Multiplication and rearrangement of cells gave an outer cell layer around a central mass. The outer cells made contact by filopodia and established adherens junctions. Sporoplasmosomes were a notable feature of early stages, but these were lost in subsequent development. Typical malacosporean sacs were formed from these groups by attachment of the inner (luminal) cells by a basal lamina to the outer layer (mural cells). Division of luminal cells gave rise to a population of cells that was liberated into the lumen of the sac. Mitotic spindles in open mitosis and prophase stages of meiosis were observed in luminal cells. Centrioles were absent. Detached luminal cells assembled to form spores with four polar capsules and several valve cells surrounding two sporoplasms with secondary cells. Restoration of sporoplasmosomes occurred in primary sporoplasms. A second type of sac was observed with highly irregular mural cells and stellate luminal cells. A radially striated layer and dense granules in the polar capsule wall, and previous data on 18 rDNA sequences enabled assignment of the species to the genus Buddenbrockia, while specific diagnosis relied on the rDNA data and on sac shape and size.

Malacosporean-like spores in urine of rainbow trout react with antibody and DNA probes to Tetracapsuloides bryosalmonae

Tetracapsuloides bryosalmonae is the myxozoan parasite causing proliferative kidney disease (PKD) of salmonid fishes in Europe and North America. The complete life cycle of the parasite remains unknown despite recent discoveries that the stages infectious for fish develop in freshwater bryozoans. During the course of examinations of the urine of rainbow trout (Oncorhynchus mykiss) with or recovering from PKD we identified spores with features similar to those of T. bryosalmonae found in the bryozoan host. Spores found in the urine were subspherical, with a width of 16 mum and height of 14 mum, and possessed two soft valves surrounding two spherical polar capsules (2 mum in diameter) and a single sporoplasm. The absence of hardened valves is a distinguishing characteristic of the newly established class Malacosporea that includes T. bryosalmonae as found in the bryozoan host. The parasite in the urine of rainbow trout possessed only two polar capsules and two valve cells compared to the four polar capsules and four valves observed in the spherical spores of 19 mum in diameter from T. bryosalmonae from the bryozoan host. Despite morphological differences, a relationship between the spores in the urine of rainbow trout and T. bryosalmonae was demonstrated by binding of monoclonal and polyclonal antibodies and DNA probes specific to T. bryosalmonae.

Plumatella geimermassardi, a newly recognized freshwater bryozoan from Britain, Ireland, and continental Europe (Bryozoa : Phylactolaemata)

Plumatella geimermassardi is a newly recognized species of phylactolaemate bryozoan. Its known range extends from Ireland east through southern Norway and south into Italy. Colonies grow close to the substrate with little free branching; the body wall is mostly transparent and without an obvious raphe. Floatoblasts are broadly oval and relatively small, with distinctively large dorsal fenestra and uniformly narrow ventral annulus. The sessoblast basal valve is low and dish-shaped; the annulus bears tubercles which vary in their prominence. This species brings to 14 the number of phylactolaemate bryozoans known in the region.

Physiological and bifidogenic effects of prebiotic supplements in infant formulae

This randomized controlled trial involving 110 healthy neonates studied physiological and bifidogenic effects of galactooligosaccharides (GOS), oligofructose and long-chain inulin (FOS) in formula. Subjects were randomized to Orafti Synergy1 (50 oligofructose: 50 FOS) 0.4g/dl or 0.8g/dl, GOS:FOS (90:10) 0.8g/dl or a standard formula according to Good Clinical Practise (GCP) guidelines. A breast-fed group was included for comparison. Outcome parameters were weight, length, intake, stool characteristics, crying, regurgitation, vomiting, adverse events and fecal bacterial population counts. Statistical analyses used non-parametric tests. During the first month of life weight, length, intake and crying increased significantly in all groups. Regurgitation and vomiting scores were low and similar. Stool frequency decreased significantly and similarly in all formula groups but was lower than in the breast-fed. All prebiotic groups maintained soft stools, only slightly harder than those of breast-fed infants. The standard group had significantly harder stools at wks 2 and 4 compared to 1 (P<0.001 & P=0.0279). The total number of fecal bacteria increased in all prebiotic groups (9.82, 9.73 and 9.91 to 10.34, 10.38 and 10.37, respectively, log10 cells/g feces, P=0.2298) and resembled more the breast-fed pattern. Numbers of lactic acid bacteria, bacteroides and clostridia were comparable. In the SYN1 0.8 g/dl and GOS:FOS groups Bifidobacterium counts were significantly higher at D14 & 28 compared to D3 and comparable to the breast-fed group. Tolerance and growth were normal. In conclusion, stool consistency and bacterial composition of infants taking SYN1 0.8 g/dl or GOS:FOS supplemented formula was closer to the breast-fed pattern. There was no risk for dehydration.

The determinants of competitive success in the interwar British radio industry

This article discusses the sources of competitive advantage in the interwar British radio industry. Specifically, it examines why sections of the industry that reaped substantial monopoly rents from the downstream value chain failed to dominate the industry. During the 1920s Marconi (which controlled the fundamental UK patents) had a key cost advantage, as had other members of the ‘Big Six’ electrical engineering firms which formed the BBC and were granted preferential royalties. Meanwhile the valve manufacturers' cartel was also able to extract high rents from set manufacturers. The vertical integration literature suggests that input monopolists have incentives to control downstream production. Yet—in contrast to the gramophone industry, which became concentrated into two huge companies following market saturation in the 1930s—radio retained a much more competitive structure. The Big Six failed to capitalize fully on their initial cost advantages owing to logistical weaknesses in supplying markets subject to rapid technical and design obsolescence. Subsequently, during the 1930s, marketing innovations are shown to have played a key role in allowing several independents to establish successful brands. This gave them sufficient scale to provide strong bargaining positions with input suppliers, negating most of their initial cost disadvantage.

Objective Assessment of Internal Nasal Dimensions and Speech Resonance in Individuals With Repaired Unilateral Cleft Lip and Palate After Rhinoseptoplasty

The objective of the current study was to analyze the effects of rhinoseptoplasty on internal nasal dimensions and speech resonance of individuals with unilateral cleft lip and palate, estimated by acoustic rhinometry and nasometry, respectively. Twenty-one individuals (aged 15-46 years) with previously repaired unilateral cleft lip and palate were analyzed before (PRE), and 6 to 9 (POST1) and 12 to 18 months (POST2) after surgery. Acoustic rhinometry was used to measure the cross-sectional areas (CSAs) of segments corresponding to the nasal valve (CSA1), anterior portion (CSA2), and posterior portion (CSA3) of the lower turbinate, and the volumes at the nasal valve (V1) and turbinate (V2) regions at cleft and noncleft sides, before and after nasal decongestion with a topical vasoconstrictor. Nasometry was used to evaluate speech nasalance during the reading of a set of sentences containing nasal sounds and other devoid of nasal sounds. At the cleft side, before nasal decongestion, there was a significant increase (P < 0.05) in mean CSA1 and V1 values at POST1 and POST2 compared with PRE. After decongestion, increased values were also observed for CSA2 and V2 at POST2. No significant changes were observed at the noncleft side. Mean nasalance values at PRE, POST1, an POST2 were not different from each other in both oral and nasal sentences. The measurement of CSAs and volumes by acoustic rhinometry revealed that rhinoseptoplasty provided, in most cases analyzed, a significant increase in nasal patency, without concomitant changes in speech resonance, as estimated by nasalance assessment.

Trophallaxis in Dehydrated Leaf Cutting Colonies of Atta sexdens rubropilosa (Hymenoptera: Formicidae)

Trophallaxis, the transfer of liquid among individuals by oral regurgitation or anal deposition, occurs in many insect groups including ants. The first indication that trophallaxis could occur in leaf cutting ants (Atta sexdens rubropilosa) was made by Autuori in 1942. He reported water collection by this ant species, and highlighted what in those days was an undescribed behavior for this species. In 2005, Da-Silva and Ribeiro presented preliminary results suggesting the existence of trophallaxis in A. sexdens rubropilosa. Here we report on a formal test of the hypothesis of trophallaxis in that species. Our approach was to test ant pairs in which only one individual (Group I) had access to blue-dyed water and the other individual (Group II), a nest-mate, came from a colony dehydrated by offering dry crushed corn for fungal growth. Positive results for trophallaxis were obtained in ants from four colonies and accounted for 33%-46% of all tests in which ants from Group I drank dyed water. These results indicate that trophallaxis occurs in this species.