Laparoendoscopic single-site (LESS) sacrocolpopexy: feasibility and efficacy of knotless procedure performed with conventional instruments

The aim of this paper was to report a case of a patient with stage IV vaginal vault prolapse treated by laparoendoscopic single-site (LESS) sacrocolpopexy using an Alexis retractor and a surgical glove attached to three trocars through a 3.5-cm umbilical incision. Only conventional laparoscopic instruments were used for intrabdominal dissection of vagina and peritoneum. The mesh was fixed to the vaginal fornix and to the sacral periosteum from the promontory using running sutures hold in the extremities by polymer clips. The posterior peritoneum was closed over the mesh. LESS sacrocolpopexy performed with conventional instruments is a difficult but feasible and efficient technique to treat vaginal vault prolapse that respects the principles of conventional laparoscopic or open repairs. Alexis retractor associated with knotless sutures are technical options that simplify LESS reconstructive surgical maneuvers

Estudios citogenéticos y mecanismos moleculares en los Síndromes Mielodisplásicos

Las alteraciones genéticas debidas a mutaciones, hallazgos cromosómicos balanceados o no, disomía uniparental adquirida, haploinsuficiencia y los fenómenos epigenéticos estarían involucrados al inicio y en la progresión de los SMD. Entre los genes implicados se encuentran el NRAS, FLT3, TP53, RUNX1, p15INK4b, TET2, ASXL1 y RPS14. Un 30-59% de pacientes con SMD de novo presentan cariotipos alterados y este porcentaje se incrementa según el riego de los subtipos FAB o WHO. Las aberraciones citogenéticas más frecuentes son: -5/del(5q) [2%-11%], -7/del (7q) [2%-5%], +8 [3%-12%], del(20q) [2%-4%], –Y [2%-4%] y cariotipos complejos (≥3 alteraciones) [10-20%]. Un 60-90% de los SMD secundarios presentan cariotipos anormales, un aumento de translocaciones y de cariotipos complejos [50%]. Las alteraciones en los cromosomas 5/7 [80%] se asocian con exposición a agentes alquilantes y los rearreglos 11q23 o 21q22 con exposición a inhibidores de topoisomerasa II. El cariotipo ayuda en el diagnóstico, pronóstico, tratamiento y seguimiento de los pacientes. La categorización del riesgo citogenético del IPSS ha sido comprobada aplicando las clasificaciones FAB y WHO, y validada en el WPSS. Aunque el grupo Intermedio es heterogéneo, el Consenso Internacional en Citogenética de los SMD sugiere la continuidad de su utilización hasta que se realice un nuevo estudio multicéntrico.Fil: Belli, Carolina Bárbara. Consejo Nacional de Investigaciones Científicas y Técnicas; Argentina. Academia Nacional de Medicina de Buenos Aires. Instituto de Investigaciones Hematológicas "Mariano R. Castex". Departamento de Genética; ArgentinaFil: Benasayag, Silvia. Fundagen; ArgentinaFil: Gallino, María Inés. Fundagen; ArgentinaFil: Correa, Walter A. Fundagen; ArgentinaFil: Larripa, Irene Beatriz. Consejo Nacional de Investigaciones Científicas y Técnicas; Argentina. Academia Nacional de Medicina de Buenos Aires. Instituto de Investigaciones Hematológicas "Mariano R. Castex". Departamento de Genética; Argentin

Estudios citogenéticos y mecanismos moleculares en los Síndromes Mielodisplásicos

Las alteraciones genéticas debidas a mutaciones, hallazgos cromosómicos balanceados o no, disomía uniparental adquirida, haploinsuficiencia y los fenómenos epigenéticos estarían involucrados al inicio y en la progresión de los SMD. Entre los genes implicados se encuentran el NRAS, FLT3, TP53, RUNX1, p15INK4b, TET2, ASXL1 y RPS14. Un 30-59% de pacientes con SMD de novo presentan cariotipos alterados y este porcentaje se incrementa según el riego de los subtipos FAB o WHO. Las aberraciones citogenéticas más frecuentes son: -5/del(5q) [2%-11%], -7/del (7q) [2%-5%], +8 [3%-12%], del(20q) [2%-4%], –Y [2%-4%] y cariotipos complejos (≥3 alteraciones) [10-20%]. Un 60-90% de los SMD secundarios presentan cariotipos anormales, un aumento de translocaciones y de cariotipos complejos [50%]. Las alteraciones en los cromosomas 5/7 [80%] se asocian con exposición a agentes alquilantes y los rearreglos 11q23 o 21q22 con exposición a inhibidores de topoisomerasa II. El cariotipo ayuda en el diagnóstico, pronóstico, tratamiento y seguimiento de los pacientes. La categorización del riesgo citogenético del IPSS ha sido comprobada aplicando las clasificaciones FAB y WHO, y validada en el WPSS. Aunque el grupo Intermedio es heterogéneo, el Consenso Internacional en Citogenética de los SMD sugiere la continuidad de su utilización hasta que se realice un nuevo estudio multicéntrico.Fil: Belli, Carolina Bárbara. Consejo Nacional de Investigaciones Científicas y Técnicas; Argentina. Academia Nacional de Medicina de Buenos Aires. Instituto de Investigaciones Hematológicas "Mariano R. Castex". Departamento de Genética; ArgentinaFil: Benasayag, Silvia. Fundagen; ArgentinaFil: Gallino, María Inés. Fundagen; ArgentinaFil: Correa, Walter A. Fundagen; ArgentinaFil: Larripa, Irene Beatriz. Consejo Nacional de Investigaciones Científicas y Técnicas; Argentina. Academia Nacional de Medicina de Buenos Aires. Instituto de Investigaciones Hematológicas "Mariano R. Castex". Departamento de Genética; Argentin

Compliance with Antibiotic Prophylaxis in Obstetric and Gynecological Surgeries in Two Peruvian Hospitals

Introduction: Surgical site infections (SSI) can be as high in gynecology and obstetrics surgeries compared to other areas. Antimicrobial prophylaxis is an effective tool in the prevention of SSIs; however, it is often not adequately administered, so this study aimed to understand the compliance and factors associated with the use of the clinical practice guidelines for antibiotic prophylaxis in gynecological surgeries in two hospitals in the city of Huanuco, Peru. Methods: An analytical cross-sectional study of all gynecologic surgeries performed during 2019 was performed. Compliance was determined based on the antibiotic chosen, dose, administration time, redosing, and prophylaxis duration. Age, hospital of origin, presence of comorbidities, surgery performed, as well as its duration, types of surgery, and anesthesia were considered as related factors. Results: We collected 529 medical records of patients undergoing gynecological surgery with a median age of 33 years. The prophylactic antibiotic was correctly indicated in 55.5% of cases, and the dose was correct in 31.2%. Total compliance with the five variables evaluated was only 3.9%. Cefazolin was the most commonly used antibiotic. Conclusion: Low compliance with the institutional clinical practice guidelines for antibiotic prophylaxis was identified, showing that antimicrobial prophylaxis in the hospitals studied was inadequate

Comparative effect of ALA derivatives on protoporphyrin IX production in human and rat skin organ cultures

Samples of human and rat skin in short-term organ culture exposed to ALA or a range of hydrophobic derivatives were examined for their effect on the accumulation of protoporphyrin IX (PpIX) measured using fluorescence spectroscopy. With the exception of carbobenzoyloxy-D-phenylalanyl-5-ALA-ethyl ester the data presented indicate that, in normal tissues, ALA derivatives generate protoporphyrin IX more slowly than ALA, suggesting that they are less rapidly taken up and/or converted to free ALA. However, the resultant depot effect may lead to the enhanced accumulation of porphyrin over long exposure periods, particularly in the case of ALA-methyl ester or ALA-hexyl ester, depending on the applied concentration and the exposed tissue. Addition of the iron chelator, CP94, greatly increased PpIX accumulation in human skin exposed to ALA, ALA-methyl ester and ALA-hexyl ester. The effect in rat skin was less marked.</p

Diagnostic accuracy of cyst fluid amphiregulin in pancreatic cysts

<p>Abstract</p> <p>Background</p> <p>Accurate tests to diagnose adenocarcinoma and high-grade dysplasia among mucinous pancreatic cysts are clinically needed. This study evaluated the diagnostic utility of amphiregulin (AREG) as a pancreatic cyst fluid biomarker to differentiate non-mucinous, benign mucinous, and malignant mucinous cysts.</p> <p>Methods</p> <p>A single-center retrospective study to evaluate AREG levels in pancreatic cyst fluid by ELISA from 33 patients with a histological gold standard was performed.</p> <p>Results</p> <p>Among the cyst fluid samples, the median (IQR) AREG levels for non-mucinous (n = 6), benign mucinous (n = 15), and cancerous cysts (n = 15) were 85 pg/ml (47-168), 63 pg/ml (30-847), and 986 pg/ml (417-3160), respectively. A significant difference between benign mucinous and malignant mucinous cysts was observed (<it>p </it>= 0.025). AREG levels greater than 300 pg/ml possessed a diagnostic accuracy for cancer or high-grade dysplasia of 78% (sensitivity 83%, specificity 73%).</p> <p>Conclusion</p> <p>Cyst fluid AREG levels are significantly higher in cancerous and high-grade dysplastic cysts compared to benign mucinous cysts. Thus AREG exhibits potential clinical utility in the evaluation of pancreatic cysts.</p