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Sample records for fosa supraclavicular izquierda

  1. Ultrasound guided supraclavicular block.

    LENUS (Irish Health Repository)

    Hanumanthaiah, Deepak

    2013-09-01

    Ultrasound guided regional anaesthesia is becoming increasingly popular. The supraclavicular block has been transformed by ultrasound guidance into a potentially safe superficial block. We reviewed the techniques of performing supraclavicular block with special focus on ultrasound guidance.

  2. Revista Izquierdas, N° 21, Octubre 2014

    OpenAIRE

    Pérez, Aníbal; Bortolotti, Mariana; Figueroa, Noelia; Grimaldi, Nicolás; Aiziczón, Fernando; Ponce, José Ignacio; Serra, María Loreto; Corvalán, Luis; Garrido, Pablo; Díaz, Francisco; Chaia De Bellis, Jonás; Samaniego, Augusto

    2015-01-01

    Revista Izquierdas, publicación científica dedicada a la historiografía sobre el socialismo latinoamericano, http://www.izquierdas.cl/ Publicada por el Instituto de Estudios Avanzados de la Universidad de Santiago de Chile

  3. An unexpected supraclavicular swelling

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    Wilson Eliie

    2007-08-01

    Full Text Available Abstract Background Colorectal cancer is the third commonest cause of cancer death in UK. It commonly metastasises to the liver but rarely to small bones. Case presentation We describe a case of a patient with adenocarcinoma of the descending colon who presented preoperatively with a right supraclavicular swelling. Subsequent imaging and cytology of the lesion revealed this to be a metastasis to the right clavicle resulting in a pathological fracture. Conclusion This report describes the rare occurrence of a colorectal metastasis to the clavicle. It emphasises that although bone metastases from primary colorectal tumours are rare events, they tend to metastasise to small, non-weight bearing bones. It also discusses the utility of isotope bone scanning and that on certain occasions this imaging method may prove to be equivocal. In such circumstances, biopsy or magnetic resonance imaging is more sensitive for the detection of bone metastases.

  4. La izquierda chilena contemparánea

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    Manuel Antonio Garretón

    2006-01-01

    Full Text Available En este artículo, el autor examina las particularidades de la izquierda chilena para entender su papel en los gobiernos democráticos desde los años 70. El autor parte de la premisa de la existencia, durante los años 90, de dos izquierdas: una, el socialismo dentro de la coalición; la otra, el comunismo fuera de ella. En el trabajo se sostiene que la izquierda socialista ha sido el principal motor de la coalición y su papel específico se ha concentrado en los temas socio-económicos ligados a la igualdad, a la justicia, a los derechos humanos y a las propuestas culturales de tipo progresista. Asimismo, se analizan las particularidades esenciales de los gobiernos democráticos chilenos y se examinan los temas y las tareas pendientes. El artículo concluye con un balance del papel de la izquierda y de los retos que aún tiene por delante.

  5. La izquierda Argentina: nuevamente el fracaso

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    Ángel Rodríguez Kauth

    2004-01-01

    Full Text Available A partir de los acontecimientos políticos y sociales ocurridos en Argentina desde finales de 2001, se estudia el papel protagónico que tuvieron las diversas organizaciones en que se ha atomizado la izquierda vernácula. Esto es no sólo en el plano electoral, sino también en el de las movilizaciones junto a la participación popular que reclamaba su presencia.

  6. Left Supraclavicular Spindle Cell Lipoma

    OpenAIRE

    Oladejo Olaleye; Bertram Fu; Ram Moorthy; Charles Lawson; Myles Black; David Mitchell

    2010-01-01

    Background. Spindle cell lipoma (SCL) is a benign lipomatous tumour, typically occurring in the posterior neck, shoulder or upper back of elderly males. They compose of fat, CD34 positive spindle cells, and ropey collagen on a myxoid matrix. This case highlights a rare presentation of SCL and the need for pre-operative diagnosis. Case Report. A 63-year-old gentleman presented with a pre-existing left supraclavicular mass that had recently increased in size. FNA and CT Scans were performed and...

  7. TUMORES DE LA FOSA POSTERIOR EN PEDIATRÍA

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    Dr. Felipe Otayza

    2017-05-01

    En esta revisión se analizarán aspectos epidemiológicos, patogenia y biología molecular clínicos y neuroradiológicos en general de los tumores de fosa posterior y en particular se revisarán los avances en biología molecular y tratamiento de los tumores más frecuentes de la zona; méduloblastoma, ependimoma, astrocitoma de bajo grado y los tumores de tronco cerebral.

  8. Left supraclavicular spindle cell lipoma.

    Science.gov (United States)

    Olaleye, Oladejo; Fu, Bertram; Moorthy, Ram; Lawson, Charles; Black, Myles; Mitchell, David

    2010-01-01

    Background. Spindle cell lipoma (SCL) is a benign lipomatous tumour, typically occurring in the posterior neck, shoulder or upper back of elderly males. They compose of fat, CD34 positive spindle cells, and ropey collagen on a myxoid matrix. This case highlights a rare presentation of SCL and the need for pre-operative diagnosis. Case Report. A 63-year-old gentleman presented with a pre-existing left supraclavicular mass that had recently increased in size. FNA and CT Scans were performed and results discussed in the mutidisciplinary team meeting. Excisional biopsy was recommended. Radiology. CT neck showed a left supraclavicular mass of fatty density with fine internal septations. A low-grade liposarcoma could not be excluded. Histopathology. FNA was indeterminate. Histology of specimen showed bland spindle cells with no evidence of malignancy. Immuno-histochemistry showed SCL with CD34 positivity and negative staining on CDK4 and p16. Management. Excision biopsy of the mass was performed which was technically difficult as the mass invaginated around the brachial plexus. The patient recovered well post-operatively with no neurological deficits. Conclusion. Spindle cell lipoma is a rare benign tumour and a pre-operative diagnosis based on the clinical context, imaging and immuno-histochemistry is crucial to management.

  9. Left Supraclavicular Spindle Cell Lipoma

    Directory of Open Access Journals (Sweden)

    Oladejo Olaleye

    2010-01-01

    This case highlights a rare presentation of SCL and the need for pre-operative diagnosis. Case Report. A 63-year-old gentleman presented with a pre-existing left supraclavicular mass that had recently increased in size. FNA and CT Scans were performed and results discussed in the mutidisciplinary team meeting. Excisional biopsy was recommended. Radiology. CT neck showed a left supraclavicular mass of fatty density with fine internal septations. A low-grade liposarcoma could not be excluded. Histopathology. FNA was indeterminate. Histology of specimen showed bland spindle cells with no evidence of malignancy. Immuno-histochemistry showed SCL with CD34 positivity and negative staining on CDK4 and p16. Management. Excision biopsy of the mass was performed which was technically difficult as the mass invaginated around the brachial plexus. The patient recovered well post-operatively with no neurological deficits. Conclusion. Spindle cell lipoma is a rare benign tumour and a pre-operative diagnosis based on the clinical context, imaging and immuno-histochemistry is crucial to management.

  10. La izquierda y los derechos humanos en el siglo XXI

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    Manuel Alcaraz Ramos

    2000-01-01

    Full Text Available El artículo trata de ofrecer una visión general de las relaciones históricas entre la izquierda, en sus diversas tradiciones, y los problemas políticos planteados por la emergencia y desarrollo conceptual y práctico de los Derechos Humanos. Se resalta que la relación entre izquierdas y Derechos Humanos ha estado marcada, en muchas ocasiones, por la contradicción cuando no por determinadas incompresiones y desencuentros. Sin embargo, el fin de la Guerra Fría y las convulsiones producidas en la izquierda por los cambios experimentados abren un nuevo curso ideológico a la relación izquierda - Derechos humanos, hasta el punto de que el autor considera inevitable que la defensa radical de éstos debe comvertirse en un eje central de la recuperación de la identidad perdida de las izquierdas.

  11. The partition behavior of perfluorooctanesulfonate (PFOS) and perfluorooctanesulfonamide (FOSA) on microplastics.

    Science.gov (United States)

    Wang, Fei; Shih, Kai Min; Li, Xiao Yan

    2015-01-01

    Microplastics have been recognized as transport vectors for heavy metals and organic pollutants to marine animals. Thus, the sorption behavior of contaminant on microplastic is crucial to their transport in marine system. In this study, the sorption behavior of PFOS and FOSA (two perfluorochemicals) on three kinds of microplastics (PE, PS, and PVC) are reported. The isotherm study showed that the sorption of PFOS and FOSA on microplastics is highly linear, and it indicated that partition by hydrophobic interaction is the predominant sorption mechanism. The Kd values of FOSA on three kinds of microplastics are all higher than those of PFOS, and the reason is attributed to their different functional groups. The Kd value of FOSA on three types of microplastics followed the order as: PE>PVC>PS. Such finding may indicate that the molecule composition and structure of microplastics play important roles in their sorption processes of organic pollutants. The PFOS sorption levels on PE and PS particles were increased with the increase of NaCl and CaCl2 concentrations, while the ion concentrations have no effect on FOSA sorption. The study on the pH effects on PFOS and FOSA sorption indicated FOSA could partition under various pH conditions on three types of microplastics while PFOS sorption on PE and PS were favored with lower pH.

  12. A case of lymphangioleiomyomatosis affecting the supraclavicular lymph nodes.

    Science.gov (United States)

    Kamitani, Takeshi; Yabuuchi, Hidetake; Soeda, Hiroyasu; Matsuo, Yoshio; Okafuji, Takashi; Sakai, Shuji; Hatakenaka, Masamitsu; Minami, Takahiro; Inoue, Hiromasa; Tanaka, Atsuo; Kohno, Hiroyuki; Tanaka, Michiko; Nakashima, Yutaka; Honda, Hiroshi

    2006-01-01

    The case of a 46-year-old woman with lymphangioleiomyomatosis (LAM) involving the supraclavicular, mediastinal, and pelvic lymph nodes in addition to the lungs is reported. Computed tomography incidentally revealed multiple thin-walled pulmonary cysts and low-attenuating masses in the supraclavicular, mediastinal, and retroperitoneal lymph nodes. A biopsy of the supraclavicular mass was performed and diagnosed as LAM histopathologically. The common sites of extrapulmonary LAM include retroperitoneal and mediastinal lymph nodes; however, supraclavicular lymph node involvement is extremely rare.

  13. Silvio Frondizi y el surgimiento de la nueva izquierda

    OpenAIRE

    Amaral, Samuel, dir.

    2005-01-01

    Silvio Frondizi fue uno de los teóricos que dio origen a la nueva izquierda de los sesenta. Aunque ésta surgió alrededor de 1960. Las raíces teóricas de la nueva izquierda se hunden en los debates del marxismo de las décadas anteriores. El papel de Silvio Frondizi, sin embargo, fue más de partero que de guía teórico. Su principal contribución fue la creación, a mediados de la década del cincuenta, del primer grupo de izquierda que no reconocía sus antecedentes en el Partido Comunista (PC) ni ...

  14. Delineation of Supraclavicular Target Volumes in Breast Cancer Radiation Therapy

    Energy Technology Data Exchange (ETDEWEB)

    Brown, Lindsay C. [Department of Radiation Oncology, Mayo Clinic, Rochester, Minnesota (United States); Diehn, Felix E. [Department of Radiology, Mayo Clinic, Rochester, Minnesota (United States); Boughey, Judy C. [Department of Surgery, Mayo Clinic, Rochester, Minnesota (United States); Childs, Stephanie K.; Park, Sean S.; Yan, Elizabeth S.; Petersen, Ivy A. [Department of Radiation Oncology, Mayo Clinic, Rochester, Minnesota (United States); Mutter, Robert W., E-mail: mutter.robert@mayo.edu [Department of Radiation Oncology, Mayo Clinic, Rochester, Minnesota (United States)

    2015-07-01

    Purpose: To map the location of gross supraclavicular metastases in patients with breast cancer, in order to determine areas at highest risk of harboring subclinical disease. Methods and Materials: Patients with axial imaging of gross supraclavicular disease were identified from an institutional breast cancer registry. Locations of the metastatic lymph nodes were transferred onto representative axial computed tomography images of the supraclavicular region and compared with the Radiation Therapy Oncology Group (RTOG) breast cancer atlas for radiation therapy planning. Results: Sixty-two patients with 161 supraclavicular nodal metastases were eligible for study inclusion. At the time of diagnosis, 117 nodal metastases were present in 44 patients. Forty-four nodal metastases in 18 patients were detected at disease recurrence, 4 of whom had received prior radiation to the supraclavicular fossa. Of the 161 nodal metastases, 95 (59%) were within the RTOG consensus volume, 4 nodal metastases (2%) in 3 patients were marginally within the volume, and 62 nodal metastases (39%) in 30 patients were outside the volume. Supraclavicular disease outside the RTOG consensus volume was located in 3 regions: at the level of the cricoid and thyroid cartilage (superior to the RTOG volume), in the posterolateral supraclavicular fossa (posterolateral to the RTOG volume), and in the lateral low supraclavicular fossa (lateral to the RTOG volume). Only women with multiple supraclavicular metastases had nodal disease that extended superiorly to the level of the thyroid cartilage. Conclusions: For women with risk of harboring subclinical supraclavicular disease warranting the addition of supraclavicular radiation, coverage of the posterior triangle and the lateral low supraclavicular region should be considered. For women with known supraclavicular disease, extension of neck coverage superior to the cricoid cartilage may be warranted.

  15. Delineation of Supraclavicular Target Volumes in Breast Cancer Radiation Therapy.

    Science.gov (United States)

    Brown, Lindsay C; Diehn, Felix E; Boughey, Judy C; Childs, Stephanie K; Park, Sean S; Yan, Elizabeth S; Petersen, Ivy A; Mutter, Robert W

    2015-07-01

    To map the location of gross supraclavicular metastases in patients with breast cancer, in order to determine areas at highest risk of harboring subclinical disease. Patients with axial imaging of gross supraclavicular disease were identified from an institutional breast cancer registry. Locations of the metastatic lymph nodes were transferred onto representative axial computed tomography images of the supraclavicular region and compared with the Radiation Therapy Oncology Group (RTOG) breast cancer atlas for radiation therapy planning. Sixty-two patients with 161 supraclavicular nodal metastases were eligible for study inclusion. At the time of diagnosis, 117 nodal metastases were present in 44 patients. Forty-four nodal metastases in 18 patients were detected at disease recurrence, 4 of whom had received prior radiation to the supraclavicular fossa. Of the 161 nodal metastases, 95 (59%) were within the RTOG consensus volume, 4 nodal metastases (2%) in 3 patients were marginally within the volume, and 62 nodal metastases (39%) in 30 patients were outside the volume. Supraclavicular disease outside the RTOG consensus volume was located in 3 regions: at the level of the cricoid and thyroid cartilage (superior to the RTOG volume), in the posterolateral supraclavicular fossa (posterolateral to the RTOG volume), and in the lateral low supraclavicular fossa (lateral to the RTOG volume). Only women with multiple supraclavicular metastases had nodal disease that extended superiorly to the level of the thyroid cartilage. For women with risk of harboring subclinical supraclavicular disease warranting the addition of supraclavicular radiation, coverage of the posterior triangle and the lateral low supraclavicular region should be considered. For women with known supraclavicular disease, extension of neck coverage superior to the cricoid cartilage may be warranted. Copyright © 2015 Elsevier Inc. All rights reserved.

  16. Una fosa común en el interior de Argentina: el Cementerio de San Vicente

    OpenAIRE

    Darío Olmo; Mercedes Salado Puerto

    2008-01-01

    ResumenLa Antropología Forense ha tenido un papel fundamental en las investigaciones sobre el terrorismode estado en Argentina durante el último siglo, y todavía lo tiene: La exhumación de los cadáveres noidentificados enterrados en fosas comunes y tumbas individuales y el análisis de los restos recuperadospara su identificación y determinación de la causa de muerte. En el caso aquí descrito, las técnicasforenses y arqueológicas son esenciales para la localización de las fosas comunes en San ...

  17. Clavicle fractures - incidence of supraclavicular nerve injury

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    Pedro Jose Labronici

    2013-08-01

    Full Text Available OBJECTIVE: To analyze retrospectively 309 fractures in the clavicle and the relation with injury of the supraclavicular nerve after trauma. METHODS: It was analyzed 309 patients with 312 clavicle fractures. The Edinburgh classification was used. Four patients had fractures in the medial aspect of the clavicle, 33 in the lateral aspect and 272 in the diaphyseal aspect and three bilateral fractures. RESULTS: 255 patients were analyzed and five had paresthesia in the anterior aspect of the thorax. Four patients had type 2 B2 fracture and one type 2 B1 fracture. All patients showed spontaneous improvement, in the mean average of 3 months after the trauma. CONCLUSION: Clavicle fractures and/ or shoulder surgeries can injure the lateral, intermediary or medial branches of the supraclavicular nerve and cause alteration of sensibility in the anterior aspect of the thorax. Knowledge of the anatomy of the nerve branches helps avoid problems in this region.

  18. La izquierda colombiana, un caso particular en el escenario latinoamericano

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    Jeisson Oswaldo Martínez Leguízamo

    2015-04-01

    Full Text Available En los últimos 25 años en el panorama político de Latinoamérica se pueden apreciar dos fenómenos evidentes. Primero, la crisis del modelo neoliberal instaurado en el continente a partir del Consenso de Washington y, segundo, la respuesta popular que condujo al ascenso de movimientos pertenecientes a un amplio espectro de la izquierda. Colombia, a pesar de mantener una activa movilización social, no ha logrado sumarse a esta tendencia regional. La intervención permanente de los EE.UU., la violencia usada como instrumento político por parte de las élites colombianas y la dispersión de la izquierda aparecen entre las principales explicaciones de este hecho. Como respuesta a la violencia estatal y ante el cierre de los espacios democráticos, una parte de la izquierda se alzó en armas impugnando la legitimidad del régimen, mientras que otra se mantuvo dentro de la institucionalidad a pesar de los riesgos que ello conllevaba. El Estado, decidido a terminar por la fuerza con el alzamiento armado, adoptó una tendencia militarista encaminada a la persecución de las guerrillas, pero que se extendió al conjunto de la izquierda democrática y del movimiento social. Sin embargo, los Diálogos de Paz han abierto la posibilidad de superar la confrontación. Ante la eventual firma de un acuerdo de paz, vuelve a cobrar vigencia el debate sobre la unidad de la izquierda, pero esta vez con un elemento adicional: la posibilidad de que los movimientos políticos que resulten del acuerdo puedan sumarse a la tan anhelada convergencia.

  19. ¿América Latina: giro a la izquierda?

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    Pierre Gilhodes

    2008-11-01

    Full Text Available Se discute la aparición en América Latina, desde la primera elección de Chávez en Venezuela, de las características de un neo populismo o un giro hacia una nueva izquierda; algunos hablan de varias izquierdas. Se debe a la fuerte personalización del poder, a la falta de partidos políticos que representen a esta izquierda. Sus gobiernos, además de ser expresión de fuerzas sociales hasta hoy, alejadas del poder, parecen estar inventando su programa de gobierno día tras día. Les favorece, coyunturalmente, una buena situación económica mundial, ¿qué será de ellos en caso de dificultades?, ¿representan algo distinto frente a la hasta hoy alineación mundial de fuerzas, frente a la opción exclusiva por políticas liberales?, ¿en caso de responder positivamente, cuáles son sus ineludibles tareas?

  20. Fine needle aspiration cytology of palpable supraclavicular lymph nodes

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    RC Adhikari

    2011-03-01

    Full Text Available Background: Fine needle aspiration cytology as a first line of investigation has assumed importance in diagnosing a variety of disease process. The aim of this study was to assess the diagnostic value of fine needle aspiration cytology in the evaluation of palpable supraclavicular lymph nodes. Materials and methods: This was a retrospective study of fine needle aspiration cytology of palpable supraclavicular lymph node done between January 1, 2007 and December 31, 2009. Fine needle aspiration cytology was performed on 149 patients (49 cases at Om Hospital & Research Centre and 100 cases at Tribhuvan University Teaching Hospital. Results: The right supraclavicular lymph node was enlarged in 55% cases, while the left supraclavicular lymph node alone was palpable in 40.3% cases and in 7 of 149 (4.7% cases, bilateral supraclavicular lymph nodes were palpable. Cytological diagnoses were categorized as reactive (8.7%, tuberculosis (41.6%, lymphoma (4.8% and metastasis (44.9%. Of a total of 74 cases of malignancy, 90.5% were non-lymphoid and 9.5% were lymphoid (5 Non-Hodgkin lymphoma and 2 Hodgkin lymphoma. Of the 67 cases of metastatic disease, three major types of malignancy found in supraclavicular lymph nodes were Squamous cell carcinoma (28 cases, adenocarcinoma (21 cases and others (small cell carcinoma, papillary thyroid carcinoma etc. Adenocarcinoma tended to metastasize to the left supraclavicular lymph node. Lung was the most common primary site (43.3%, followed by stomach, ovary, breast and larynx. However, in 28.4% cases, no primary site was found. Conclusion: The fine needle aspiration cytology can be used as a first line investigation in the evaluation of supraclavicular lymphadenopathy due to its low cost, simplicity and minimal invasiveness. Keywords: Supraclavicular lymph node; Fine needle aspiration cytology; Metastasis DOI: 10.3126/jpn.v1i1.4441 Journal of Pathology of Nepal (2011 Vol.1, 8-12  

  1. [Patterns of mediastinal and supraclavicular metastases in apical invasive lung cancer--importance of supraclavicular lymph node dissection].

    Science.gov (United States)

    Niwa, H; Yamakawa, Y; Fuka, I; Kiriyama, M; Katayama, Y; Tanamura, O; Ninoyu, K; Yokochi, T; Masaoka, A; Satake, A

    1994-08-01

    Thirty-one patients with apical invasive lung cancer, who underwent surgical therapy were analyzed. In the patients with palpable nodal metastases in the supraclavicular region, the lymph nodes were dissected through a collar incision in supine position after thoracotomy. In the patients without palpable nodes, the supraclavicular nodes were dissected through the same wound and in the same position after the tumor was resected by the hook or anterior approach. N factor was N0 in eighteen patients, N1 in two patients, N2 in seven patients, and N3 in four patients. The ratio of supraclavicular metastasis was 33.3%. Patterns of mediastinal and supraclavicular metastases were classified into three types. Type I (supraclavicular type): metastasized directly to the supraclavicular nodes via the chest wall, Type II (mediastinal type): metastasized via a common route from hilum to mediastinum, Type III (mixed type): combination of Type I and Type II. Of the nine patients who had N2 or N3 disease uncovered by supraclavicular lymph node dissection, one patient was Type I, six were Type II, and two were Type III. Of the four patients with supraclavicular node metastasis, two had palpable nodes and two histological metastasis. The nodes were metastasized via the chest wall in three patients. Two patients with N3 disease are still alive without recurrence, one patient for eighty-six months and another for twenty months after the operation. Since supraclavicular lymph nodes are local and very near from involved structures of apical invasive lung cancer, dissection of these nodes will provide improved prognosis.

  2. Supraclavicular Lymphadenopathy: Initial Manifestation of Metastasis in Carcinoma of Cervix

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    Mutahir A. Tunio

    2013-01-01

    Full Text Available Introduction. Carcinoma of cervix rarely metastasizes to cervical lymph nodes and is associated with poor prognosis. To date, only few case reports have been reported in the medical literature. Here, we report a case of this unusual manifestation of carcinoma of cervix. Case Presentation. A 39-year-old Saudi woman who was treated three years ago for bulky IB stage carcinoma of cervix with total abdominal hysterectomy and bilateral salpingo-oophorectomy and adjuvant chemoradiation presented to us during her routine follow-up visit with left supraclavicular lymphadenopathy. Staging workup revealed additional para-aortic nodal and osseous metastases. The biopsy of left supraclavicular mass confirmed the diagnosis of carcinoma of the cervix. Patient was started on chemotherapy and bisphosphonates. Conclusion. Supraclavicular lymph nodes are a rare site of metastasis in carcinoma of cervix, and this can be explained by outlining the drainage of the lymphatic system from the cervix. Supraclavicular lymphadenopathy is associated with variable prognosis.

  3. Supraclavicular versus Infraclavicular Subclavian Vein Catheterization in Infants

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    Wen-Hsien Lu

    2006-04-01

    Conclusion: In our study, we found that there was no statistically significant difference among the 4 SVC locations in effectiveness of operation or in risk of complication. There was a tendency to damage the subclavian arteries through the supraclavicular route.

  4. La izquierda en América Latina

    OpenAIRE

    Paramio, Ludolfo, 1948-

    2009-01-01

    La frustración de las expectativas creadas por las reformas estructurales, tras la nueva crisis de finales de los años noventa, ha llevado al electorado en muchos países a castigar a los partidos que se habían identificado con ellas. En algunos casos, un descrédito generalizado de los partidos anteriores ha conducido a la aparición de liderazgos «populistas». Pero, con pocas excepciones, el problema de la izquierda latinoamericana sigue siendo la dificultad de crear partidos con identidade...

  5. Anatomic distribution of supraclavicular lymph node in patients with esophageal cancer

    National Research Council Canada - National Science Library

    Xing, Jun; Luo, Yijun; Wang, Xiaoli; Gao, Min; Sun, Mingping; Ding, Xiuping; Fan, Tingyong; Yu, Jinming

    2016-01-01

    ...), especially for lower cervical lymph nodes. This study aimed to map the location of metastatic supraclavicular lymph nodes in thoracic esophageal carcinoma patients with supraclavicular node involvement and generate an atlas to delineate...

  6. Supraclavicular Lymph Node Excision Biopsy in Patients with Suspected Supraclavicular Lymph Node Metastasis of Lung Cancer: Experience in a Tertiary Hospital

    Science.gov (United States)

    Lee, Dong Hoon; Yoon, Tae Mi; Lim, Sang Chul

    2017-01-01

    The aim of this study was to evaluate the usefulness and accuracy of supraclavicular lymph node excision biopsy in the diagnosis of suspected supraclavicular lymph node metastasis of lung cancer. A retrospective review was performed to evaluate patients with suspected supraclavicular lymph node metastasis of lung cancer who underwent supraclavicular lymph node excision biopsy from January 2011 to July 2014. Forty-six patients with suspected supraclavicular lymph node metastasis of lung cancer underwent supraclavicular lymph node excision biopsy, which diagnosed benign diseases in 6 patients and malignant diseases in 40 patients. Supraclavicular lymph node excision biopsy was usually performed on patients during their first clinical visit under local anesthesia. For diagnosing suspected lung cancer, supraclavicular lymph node excision biopsy had a diagnostic sensitivity of 100%, specificity of 97.6%, positive-predictive value of 83.3%, negative-predictive value of 100%, and accuracy of 97.8%. No major complication resulted from surgical intervention. Supraclavicular lymph node excision biopsy is a useful and accurate adjunct for the evaluation of suspected supraclavicular lymph node metastasis of lung cancer in a tertiary hospital. PMID:28184341

  7. Una fosa común en el interior de Argentina: el Cementerio de San Vicente

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    Darío Olmo

    2009-04-01

    Full Text Available ResumenLa Antropología Forense ha tenido un papel fundamental en las investigaciones sobre el terrorismode estado en Argentina durante el último siglo, y todavía lo tiene: La exhumación de los cadáveres noidentificados enterrados en fosas comunes y tumbas individuales y el análisis de los restos recuperadospara su identificación y determinación de la causa de muerte. En el caso aquí descrito, las técnicasforenses y arqueológicas son esenciales para la localización de las fosas comunes en San Vicente,Córdoba, distinguiendo entre los desaparecidos y otros muertos allí enterrados, la determinación de laidentidad y la reconstrucción de la forma en que fueron asesinados.AbstractForensic anthropology had a fundamental role to play in the process of investigations about StateTerrorism in Argentina during the last century, and still does: that of exhuming the unidentified bodiesstill buried in common and individual graves and of analyzing the recovered remains towards theiridentification and determination of the cause of death. In the case described here, forensicanthropological and archaeological skills were essential in locating the mass graves at San Vicente,Córdoba, distinguishing among disappeared and non-disappeared dead, determining identity, andreconstructing the manner in which the disappeared were killed.

  8. Supraclavicular recurrence after early breast cancer: a curable condition?

    DEFF Research Database (Denmark)

    Pedersen, Anders N; Møller, Susanne; Dahl Steffensen, Karina

    2011-01-01

    The prognosis of ipsilateral supraclavicular lymph node recurrence after early breast cancer appears to be worse than for other loco-regional recurrences, but better than for distant metastases. The purpose of the present study was to investigate the relationship between different types of salvage...... treatment and primary patient characteristics, treatment response, and survival after supraclavicular recurrence (SR) in a large patient population. From the Danish Breast Cancer Cooperative Group treatment database 1977-2003, 305 patients were identified with SR without distant disease as site of first...

  9. ¿Quién apoya a la izquierda ‘populista’ latinoamericana?

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    Paolo Moncagatta

    2013-01-01

    Full Text Available A inicios del siglo XXI, América Latina se ve gobernada en su mayor parte por gobiernos de izquierda. Varios autores han diferenciado entre una izquierda ‘pragmática’, por un lado, y una ‘populista’ por otro. Usando datos de las encuestas AmericasBarometer del 2012, indagamos sobre el perfil socio-demográfico de quién apoya a la izquierda ‘populista’ en cuatro naciones: Argentina, Bolivia, Ecuador y Venezuela. Mediante modelos de regresión logística, analizamos las probabilidades de expresar intención de voto por el candidato o partido del actual presidente de ciudadanos pertenecientes a distintos niveles de educación, riqueza, y otras variables socio-demográficas. Los resultados permiten concluir que no todos los gobiernos calificados como pertenecientes a la izquierda ‘populista’ latinoamericana reciben el apoyo del mismo tipo de individuos.

  10. Nietzsche y las izquierdas. Su recepción en las revistas de Abelardo Castillo

    OpenAIRE

    Noelia Billi

    2007-01-01

    Este artículo estudia la recepción del pensamiento de Nietzsche en las revistas literarias y de izquierdas dirigidas por Abelardo Castillo: El grillo de papel, El escarabajo de oro y El ornitorrinco.

  11. El giro latinoamericano: del malestar neoliberal a gobiernos reivindicados de izquierda

    OpenAIRE

    Tobón, Maria Juliana; Pontificia Universidad Javeriana Cali

    2013-01-01

    Este artículo busca destacar la viabilidad de la izquierda en tanto alternativa de poder. Lo anterior a partir de poner de manifiesto el cambio que se ha venido presenciando en América Latina, desde 1998, en la forma de conducir sus gobiernos. El descontento social, producto de las reformas neoliberales de los noventa, ha evocado un “renacer” de la izquierda, bajo tres enfoques diferentes.

  12. La izquierda de la izquierda. Un estudio de antropología política en España y Portugal

    Directory of Open Access Journals (Sweden)

    Josepa Cucó i Giner

    2007-03-01

    Full Text Available El nombre de extrema izquierda, izquierda radical o izquierda revolucionaria agrupa a una serie de organizaciones y partidos que surgen a mediados de los años sesenta del pasado siglo en oposición a la rígida hegemonía que sobre el movimiento comunista internacional ejercía el PCUS. Identificadas como New Left, estas formaciones se distinguen por fijar en el marxismo—leninismo las fuentes revolucionarias de su ideología, su mitificación de la clase obrera y las realidades lejanas, su estructura organizativa marcadamente jerarquizada y centralizada, y su acusada beligerancia hacia la ortodoxia soviética. Las condiciones de represión, clandestinidad y aislamiento propias de las dictaduras que padecen, agudizan las similitudes de las izquierdas revolucionarias de Portugal y España, sobre las que también se deja sentir la impronta de sus procesos específicos. En su evolución también se observan numerosos paralelismos: una pérdida generalizada de protagonismo a medida que avanza el proceso de transición hacia la democracia parlamentaria, cuya instauración acarreará la crisis y rápido declive de la mayor parte de sus formaciones partidarias. No obstante, en la década de los noventa, una vez descartada la opción de la lucha armada y sorteado el peligro de la sectarización, algunas organizaciones de la antigua izquierda radical peninsular experimentan unos cambios tan profundos que llegan a dibujar dos perfiles alternativos de otra nueva izquierda: en uno los revolucionarios se convierten en alternativos, en el otro los radicales se transforman en parlamentarios con éxito.

  13. Trombo libre en aurícula izquierda.

    Directory of Open Access Journals (Sweden)

    Rubén Gómez

    2005-09-01

    Full Text Available Se presenta el caso de una mujer de 81 años de edad con antecedentes de valvulopatía mitral reumática y fibrilación auricular diagnosticada 10 años antes, que ingresó por un accidente isquémico transitorio carotídeo derecho y un episodio coronario agudo sin elevación del segmento ST en territorio de la arteria coronaria descendente anterior (troponina T elevada y ondas T negativas anterolaterales. En los últimos años había mantenido un adecuado nivel de anticoagulación (INR entre 2,5 y 3,5 con acenocumarol, a excepción del último mes en el que presentó un INR de 1,8. El ecocardiograma transtorácico evidenció una hipocinesia anteroapical y una masa de 2x4 cm, hiperecoica y de contornos redondeados sugestiva de trombo que flotaba libremente en una aurícula izquierda muy dilatada (A, B y C y que, ocasionalmente, protruía en el ventrículo izquierdo (D ocluyendo la válvula mitral que presentaba una estenosis reumática importante (área de 1,0 cm². Debido al alto riesgo de muerte súbita por oclusión del orificio mitral y de embolismos sistémicos, como los que probablemente presentó esta paciente, está indicada la cirugía cardiaca urgente para realizar trombectomía y recambio valvular mitral. La paciente rechazó esta indicación y cinco días más tarde falleció de muerte súbita. Este caso clínico enfatiza la importancia de mantener un adecuado rango de anticoagulación (INR entre 2,5 y 3,5 en pacientes con estenosis mitral reumática y fibrilación auricular crónica debido al alto riesgo de tromboembolismo, así como la indicación de cirugía urgente ante el hallazgo de un trombo que flote libremente en la aurícula izquierda.

  14. Internal Mammary and Medial Supraclavicular Irradiation in Breast Cancer

    NARCIS (Netherlands)

    Poortmans, P.M.P.; Collette, S.; Kirkove, C.; Limbergen, E. van; Budach, V.; Struikmans, H.; Collette, L.; Fourquet, A.; Maingon, P.; Valli, M.; Winter, K. De; Marnitz, S.; Barillot, I.; Scandolaro, L.; Vonk, E.; Rodenhuis, C.; Marsiglia, H.; Weidner, N.; Tienhoven, G. van; Glanzmann, C.; Kuten, A.; Arriagada, R.; Bartelink, H.; Bogaert, W. Van den

    2015-01-01

    BACKGROUND: The effect of internal mammary and medial supraclavicular lymph-node irradiation (regional nodal irradiation) added to whole-breast or thoracic-wall irradiation after surgery on survival among women with early-stage breast cancer is unknown. METHODS: We randomly assigned women who had a

  15. PHRENIC NERVE PALSY AFTER SUPRACLAVICULAR BRACHIAL PLEXUS BLOCK

    Directory of Open Access Journals (Sweden)

    Gupta A K

    2009-09-01

    Full Text Available A 67 year old male patient was scheduled for implant removal from right upper limb under supraclavicular block. During procedure patient develops right phrenic nerve palsy & complains of dyspnea which was managed conservatively and no intervention done except chest x-ray for confirming the diagnosis. Surgeons completed the implant removal without any invasive intervention or interruption.

  16. Supraclavicular lymph node: incidence of unsuspected metastatic prostate cancer.

    Science.gov (United States)

    Hematpour, Khashayar; Bennett, Carol J; Rogers, David; Head, Christian S

    2006-09-01

    An uncommon presentation of prostate carcinoma to the supraclavicular lymph nodes is herein reviewed. With prompt diagnosis and treatment, patient survival can be extended. A high index of suspicion is necessary to make the diagnosis. The clinical features of four cases involving metastatic prostate carcinoma will be discussed.

  17. Historia de vida de un militante mexicano de izquierda

    Directory of Open Access Journals (Sweden)

    María Patricia Pensado Leglise

    2013-01-01

    Full Text Available Este texto plantea una reflexión teórico- metodológica sobre la historia de vida en el marco conceptual de la Historia oral, señalando los aportes a los estudios históricos contemporáneos. Se presenta la historia de vida de un socialista mexicano, Adolfo Sánchez Rebolledo, cuya praxis ha sido significativa para comprender el desarrollo de la política de izquierda en México y su intervención en las principales movilizaciones sociales que tuvieron lugar durante la segunda mitad del siglo xx. También da cuenta de los cambios ylas organizaciones políticas, desde las rupturas con el estalinismo, la influencia de la revolución cubana, los movimientos por los derechos civiles y contra la guerra de Vietnam hasta llegar a la revaloración de la democracia formal y el abandono de la militancia partidaria para formar parte del movimiento social. Los testimonios que aparecen a lo largo del artículo se seleccionaron y editaron de las once sesiones de entrevistas que se hicieron con Sánchez Rebolledo en el lapso de tres años (2005-2008.

  18. Supraclavicular failure after breast-conserving therapy in patients with four or more positive axillary lymph nodes when prophylactic supraclavicular irradiation is omitted.

    Science.gov (United States)

    Hamamoto, Yasushi; Kataoka, Masaaki; Semba, Takatoshi; Uwatsu, Kotaro; Sugawara, Yoshifumi; Inoue, Takeshi; Sakai, Shinya; Aono, Shoji; Takahashi, Tadaaki; Oda, Shogo

    2009-06-01

    The incidence of supraclavicular metastasis as the initial failure and the failure patterns in patients with four or more positive axillary lymph nodes (PALNs) after breast-conserving therapy (BCT) without prophylactic supraclavicular irradiation were investigated. Between 1991 and 2002, a total of 48 women with four or more PALNs underwent BCT without prophylactic supraclavicular irradiation (33 patients with 4-9 PALNs; 15 patients with > or =10 PALNs). The median follow-up time was 50 months. Among the patients with 4-9 PALNs, 3% had isolated supraclavicular metastasis as the initial failure, and 30% had distant metastasis as the initial failure. Among patients with > or =10 PALNs, 7% had isolated supraclavicular metastasis as the initial failure, and 40% had distant metastasis as the initial failure. The 4-year isolated supraclavicular failure rates were 5% for all patients, 3% for patients with 4-9 PALNs, and 8% for patients with >/=10 PALNs. In patients who had undergone BCT and had had four or more PALNs, the major failure pattern was distant failure with or without locoregional failure; isolated supraclavicular failure as the initial failure comprised a less common failure pattern. Omission of prophylactic supraclavicular irradiation may be acceptable for this subset of patients.

  19. La reemergencia del discurso nacional-popular en la nueva izquierda latinoamericana

    DEFF Research Database (Denmark)

    Cancino, Hugo

    2012-01-01

    En este artículo analizamos la reemergencia del discurso nacional-popular. Los movimientos nacional-populares son un fenómeno recurrente en la historia de América Latina. Las revoluciones y los movimientos sociales más significativos del siglo XX fueron los movimientos nacional-populares. Para...... nosotros, los movimientos nacional-populares que conducen Hugo Chaves y Evo Morales representan una nueva izquierda en comparación a la izquierda tradicional y el nuevo llamado a la izquierda. Estos movimientos se desarrollaron con el pueblo como sujeto histórico y de las luchas para la construcción de un...

  20. Detection and diagnosis of nonpalpable supraclavicular lymph nodes in lung cancer at CT and US.

    Science.gov (United States)

    Fultz, Patrick J; Feins, Richard H; Strang, John G; Wandtke, John C; Johnstone, David W; Watson, Thomas J; Gottlieb, Ronald H; Voci, Susan L; Rubens, Deborah J

    2002-01-01

    To assess frequency and significance of enlarged nonpalpable supraclavicular lymph nodes by using chest computed tomography (CT) and supraclavicular ultrasonography (US) in patients at initial diagnosis of lung cancer. Fifty-five patients with no prior malignancy who presented with suspected and subsequently proven lung cancer of any stage or a proven but potentially resectable lung cancer were prospectively selected after chest CT. Chest CT and other radiologic findings were reviewed and tabulated. Standardized US technique was used to identify and guide needle biopsy of enlarged supraclavicular lymph nodes (> or =0.5 cm short axis). Twenty-two (40%) of 55 patients had supraclavicular abnormalities detected at CT and/or US. In 18 (82%) of the 22 patients, supraclavicular abnormalities were recognizable at CT. Seventeen of 22 patients had malignant nodes, and five patients had benign nodes (n = 3), a cyst (n = 1), or an indeterminate lesion (n = 1) at US-guided supraclavicular needle sampling. There were no complications. Supraclavicular metastases (31% of patients) were about as common as the combined number of patients with indeterminate (n = 13) and probably or proven malignant (n = 6) adrenal nodules (35% of patients). Supraclavicular metastases were often associated with mediastinal adenopathy or suspected extrapulmonary nonnodal metastases (P supraclavicular lymph nodes is a simple and safe method for simultaneously establishing a tissue diagnosis and tumor nonresectability.

  1. Supraclavicular scalenectomy for thoracic outlet syndrome--functional outcomes assessed using the DASH scoring system.

    LENUS (Irish Health Repository)

    Glynn, Ronan W

    2012-02-01

    To evaluate supraclavicular scalenectomy ± cervical rib excision for thoracic outlet syndrome (TOS), employing Disability of Arm, Shoulder, and Hand (DASH) scoring for functional assessment post-decompression.

  2. Los jiráfidos del Neogeno de la fosa de Teruel

    Directory of Open Access Journals (Sweden)

    Montoya, P.

    1994-04-01

    Full Text Available Giraffid remains from several Neogene localities from the Temel Basin (Spain are studied. The material belongs to the following sites: Masía de la Roma and Masía del Barbo (Vallesian; Masada del Valle 2 (Turolian; La Gloria 4 and La Calera (Alfambrian. Fossils recently obtained are described, with special emphasis on the Pliocene taxa that were previously unrecorded in this basin. The presence of Decennatherium pachecoi in the Vallesian and Birgerbohlinia schaubi in the Turolian is specified here. In order to make a distinction between both species two characteristics can be pointed out among the rest: the postcranial skeleton of Decennatherium is more slender than the one of Birgerbohlinia while the latter has a wider upper cheek-teeth than the former. The Pliocene material (only postcranial remains is assigned to Sivatheriinae indet d. Birgerbohlinia. No upper Turolian (NM 13 giraffids have been found yet although many rich localities have already been reviewed in Temel area.Se estudian los restos de jiráfidos procedentes de los yacimientos neógenos de Masía de La Roma y Masía del Barbo (Vallesiense, Masada del Valle 2 (Turoliense y La Gloria 4 y La Calera (Alfambriense, todos ellos de la fosa de Teme!. Se describe el material encontrado en recientes excavaciones, destacando el perteneciente al Plioceno, muy poco conocido con anterioridad. Se ha determinado la presencia de Decennatherium pachecoi en los yacimientos vallesienses y Birgerbohlinia schaubi en las localidades turolienses. Entre los caracteres empleados para diferenciar estos dos taxones podemos destacar la menor robustez del esqueleto postcraneal de Decennatherium y la dentición superior proporcionalmente más ancha en Birgerbohlinia. Los restos del Plioceno, todos ellos pertenecientes al esqueleto postcraneal, se han clasificado como Sivatheriinae indet. cf Birgerbohlinia sp. En la fosa de Temel no se han registrado jiráfidos en el Turoliense superior (MN 13, pese a la

  3. El "viejo" Partido Socialista y los orígenes de la "nueva izquierda"

    OpenAIRE

    Tortti, María Cristina

    2007-01-01

    Con la reconstrucción de la trayectoria de la izquierda socialista, se espera contribuir a mostrar, desde otro ángulo, el conflictivo cuadro en el que por aquellos años se debatían la sociedad y la política argentinas, y en particular, la profundidad de las grietas que comenzaban a abrirse en el pensamiento y en la práctica de la izquierda. Dentro de ese panorama -y en respuesta a él-, se harán visibles tanto las expectativas de la joven generación como la suerte corrida por las empresas en l...

  4. Hipertrofia ventricular izquierda como factor de riesgo cardiovascular en el paciente hipertenso

    OpenAIRE

    Marcelo, Llancaqueo V.

    2012-01-01

    La hipertrofia ventricular izquierda es una respuesta maladaptativa a la sobrecarga de presión crónica y un factor de riesgo importante para la fibrilación auricular, insuficiencia cardíaca diastólica, insuficiencia cardíaca sistólica, y la muerte súbita en pacientes con hipertensión. Dado que no todos los pacientes con hipertensión desarrollan hipertrofia ventricular izquierda, hay hallazgos clínicos que se deben tener en cuenta que puede alertar al médico sobre la presencia de hipertrofia v...

  5. Muerte violenta en 1822: una fosa común en Ocio (Zambrana, Álava

    Directory of Open Access Journals (Sweden)

    Berjón, M.A.

    2012-01-01

    Full Text Available En la excavación llevada a cabo en el suelo de la Ermita de Nuestra Señora de Asunción en Ocio (Zambrana, Álava en 2010, se expusieron un total de 48 enterramientos individuales y uno de tipo colectivo. Este último corresponde a una fosa común en la que se hallaban 13 individuos de sexo masculino que murieron en un mismo episodio de carácter violento. Todos los individuos presentan lesiones en cráneo o/y en el cuerpo compatibles con el paso de proyectil de arma de fuego de plomo, así como heridas incisas provocadas por arma cortante, además de traumas directos. En la investigación histórica realizada se ha podido saber que en un enfrentamiento bélico en 1822 se produjo la muerte simultánea de 13 vecinos de la localidad de Brinas (próxima a Ocio. Este suceso estaría relacionado con las luchas entre absolutistas o realistas y liberales o constitucionalistas, en los prolegómenos de la Primera Guerra Carlista.

  6. Dissemination of a clone carrying a fosA3-harbouring plasmid mediates high fosfomycin resistance rate of KPC-producing Klebsiella pneumoniae in China.

    Science.gov (United States)

    Jiang, Yan; Shen, Ping; Wei, Zeqing; Liu, Lilin; He, Fang; Shi, Keren; Wang, Yanfei; Wang, Haiping; Yu, Yunsong

    2015-01-01

    Fosfomycin has been proposed as an adjunct to other active agents for treating KPC-producing Klebsiella pneumoniae infections. This study aimed to investigate the prevalence of fosfomycin resistance and plasmid-mediated resistance determinants among KPC-producing K. pneumoniae isolates from clinical samples in China. In total, 278 KPC-producing and 80 extended-spectrum β-lactamase (ESBL)-producing (non-KPC-producing) clinical K. pneumoniae isolates were collected in 12 hospitals from 2010 to 2013. Fosfomycin susceptibility testing was carried out using the agar dilution method. Phylogenetic clonal patterns were revealed by pulsed-field gel electrophoresis (PFGE). Isolates were screened for plasmid-mediated fosfomycin resistance genes (fosA, fosA3 and fosC2) by PCR amplification. A plasmid was completely sequenced by next-generation sequencing. The fosfomycin resistance rate in KPC-producers (60.8%; 169/278) was significantly higher than in ESBL-producers (12.5%; 10/80). In addition, 94 KPC-producing isolates were positive for fosA3 and most of them were clonally related. A 23939-bp plasmid (pFOS18) co-harbouring fosA3 and bla(KPC-2) was completely sequenced, revealing that the fosA3 gene was flanked by two copies of IS26; however, bla(KPC-2) was located on a Tn3-Tn4401 integration structure. Although the fosA3 and blaKPC-2 genes are located on different transposon systems, they are able to spread together worldwide through plasmid transfer. Dissemination of the clone carrying the fosA3-harbouring plasmid mediates the high fosfomycin resistance rate of KPC-producing K. pneumoniae in China. Fosfomycin as an alternative option for treating infections caused by KPC-producing K. pneumoniae should not be recommended in hospitals in which fosfomycin-resistant clonal dissemination is emerging.

  7. Catheter malposition following supraclavicular approach for subclavian vein catheterisation--case reports.

    Science.gov (United States)

    Singh, Prem K; Ali, Zulfiquar; Rath, Girija P; Prabhakar, Hemanshu

    2008-10-01

    The supraclavicular approach of subclavian vein catheterization is associated with the lowest incidence of malposition. We report two cases of unusual malpositions seen during central venous cathelerization of subclavian vein via supraclavicular approach. Literature search did not reveal such malpositions. The possible cause for the malposition and method to prevent it is discussed.

  8. Mauricio Archila et al. Una historia inconclusa. Izquierdas políticas y sociales en Colombia

    Directory of Open Access Journals (Sweden)

    Ricardo Sánchez Ángel

    2011-02-01

    Full Text Available La distinción entre izquierdas y derechas depende de los momentos históricos, que son cualitativos; concentra significados y crea imaginarios. Los imaginarios de la igualdad y de la libertad son creaciones de la Revolución Francesa, en 1789, pero especialmente de la república jacobina, entre 1791-1793.

  9. La melancolía de izquierda y el utopismo espectral

    Directory of Open Access Journals (Sweden)

    Christian Retamal

    2016-08-01

    Full Text Available A partir de un escrito de Walter Benjamin se examina I la noción de «melancolía de izquierda » para describir el estado emocional de los herederos del marxismo. Para ello II se explora cómo la melancolía del romanticismo es sublimada en el marxismo y emerge luego de su crisis opacando su impulso utópico. III Posteriormente se analizan las paradojas presentes en algunas representaciones de la melancolía para mostrar las tensiones religiosas presentes en el utopismo y cómo estas se trasladan a la visión de mundo de las izquierdas. IV Este análisis nos muestra —desde un punto de vista psicoanalítico— la necesidad de considerar la muerte de las abstracciones equivalentes propia de la melancolía para averiguar que es aquello que ha muerto en el pensamiento de izquierdas. Finalmente V se plantea que el modo en que se concibe y desarrolla la subjetivad fuerte en la cultura moderna es la base de la melancolía de izquierda y por ello es la puerta de salida de tal condición.

  10. Mauricio Archila et al. Una historia inconclusa. Izquierdas políticas y sociales en Colombia

    Directory of Open Access Journals (Sweden)

    Ricardo Sánchez Ángel

    2010-07-01

    Full Text Available La distinción entre izquierdas y derechas depende de los momentos históricos, que son cualitativos; concentra significados y crea imaginarios. Los imaginarios de la igualdad y de la libertad son creaciones de la Revolución Francesa, en 1789, pero especialmente de la república jacobina, entre 1791-1793.

  11. Chromosomal location of the fosA3 and blaCTX-M genes in Proteus mirabilis and clonal spread of Escherichia coli ST117 carrying fosA3-positive IncHI2/ST3 or F2:A-:B- plasmids in a chicken farm.

    Science.gov (United States)

    He, Dandan; Liu, Lanping; Guo, Baowei; Wu, Shengjun; Chen, Xiaojie; Wang, Jing; Zeng, Zhenling; Liu, Jian-Hua

    2017-04-01

    The aim of this study was to investigate the spread and location of the fosA3 gene among Enterobacteriaceae from diseased broiler chickens. Twenty-nine Escherichia coli and seven Proteus mirabilis isolates recovered from one chicken farm were screened for the presence of plasmid-mediated fosfomycin resistance genes by PCR. The clonal relatedness of fosA3-positive isolates, the transferability and location of fosA3, and the genetic context of the fosA3 gene were determined. Seven P. mirabilis isolates with three different pulsed-field gel electrophoresis (PFGE) patterns and five E. coli isolates belonging to sequence type 117 (ST117) and phylogenetic group D were positive for fosA3 and all carried the blaCTX-M gene. In E. coli, the genetic structures IS26-ISEcp1-blaCTX-M-65-IS26-fosA3-1758 bp-IS26 and IS26-ISEcp1-blaCTX-M-3-blaTEM-1-IS26-fosA3-1758 bp-IS26 were present on transferable IncHI2/ST3 and F2:A-:B- plasmids, respectively. However, fosA3 was located on the chromosome of the seven P. mirabilis isolates. IS26-ISEcp1-blaCTX-M-65-IS26-fosA3-1758 bp-IS26 and IS26-blaCTX-M-14-611 bp-fosA3-1222 bp-IS26 were detected in three and four P. mirabilis isolates, respectively. Minicircles that contained both fosA3 and blaCTX-M-65 were shared between E. coli and P. mirabilis. This is the first report of the fosA3 gene integrated into the chromosome of P. mirabilis isolates with the blaCTX-M gene. The emergence and clonal spread of avian pathogenic E. coli ST117 with the feature of multidrug resistance and high virulence are a serious problem.

  12. Massive hemothorax: A rare complication after supraclavicular brachial plexus block.

    Science.gov (United States)

    Singh, Shiv Kumar; Katyal, Surabhi; Kumar, Amit; Kumar, Pawan

    2014-01-01

    Plexus block is the preferred anesthesia plan for upper limb surgeries. Among the known complications, hematoma formation following the vascular trauma is often occur but this complication is frequently underreported. We present a case where a massive hemothorax developed post operatively in a patient who underwent resection of giant cell tumor of the right hand radius bone followed by arthroplasty under brachial plexus block using supraclavicular approach. This case report attempts to highlight the essence of remaining vigilant postoperatively for first initial days after brachial plexus block, especially after failed or multiple attempts. Ultrasound guided technique in combination with nerve stimulator has proven to be more reliable and safer than traditional techniques.

  13. [The Role of Supraclavicular lymph node dissection in Breast Cancer Patients with Synchronous Ipsilateral Supraclavicular Lymph Node Metastasis].

    Science.gov (United States)

    Zhang, W; Qi, X M; Chen, A X; Zhang, P; Cao, X C; Xiao, C H

    2017-05-23

    Objective: In this study, we evaluated the effect of supraclavicular lymph node dissection in breast cancer patients who presented with ipsilateral supraclavicular lymph node metastasis (ISLM) without distant metastasis. Methods: A total of 90 patients with synchronous ISLM without distant metastasis between 2000 and 2009 were retrospectively analyzed. Patients were retrospectively divided into two groups, namely supraclavicular lymph node dissection group(34 patients) and non-dissection group(56 patients), according to whether they underwentsupraclavicular lymph node dissection or not.The Kaplan-Meier method was applied to analyze the locoregional relapse free survival (LRFS) and overall survival(OS). Results: Median follow-upwas 85 months(range, 6 to 11 months). Local recurrence in 32 cases, 47 cases of distant metastasis, of which 25 patients were accompanied by both locoregional relapse and distant metastasis. Of the 32 patients with locoregional relapse, 11 patients were in the lymph node dissection group and 21 patients in the control group. Of the 47 patients with distant metastases, 17 were treated with lymph node dissection, 30 in the control group. Thirty-two patients died in the whole group and 16 patients underwentlymph node dissection and 16 patients didn't. There was no significant difference between the rate of 5-year LRFS and 5-year OS (P=0.359, P=0.246). For patients of ER negative, the 5-year loco-regional relapse free survival rates were 63.7% and 43.3% in supraclavicular lymph node dissection group and control group, respectively. The 5-year overall survival rates were 52.1% and 52.3%, respectively, and there were no statistically significant differences (P=0.118, P=0.951). For patients of PR negative, the 5-yearloco-regional relapse free rates were 59.8% and 46.2%, respectively, and the 5-year overall survival rates were 50.6% and 43.2%, respectively, and there was no significant difference between the two groups (P=0.317, P=0.973). The 5-year

  14. Regional lymph node radiotherapy in breast cancer: single anterior supraclavicular field vs. two anterior and posterior opposed supraclavicular fields.

    Science.gov (United States)

    Houshyari, Mohammad; Kashi, Amir Shahram Yousefi; Varaki, Sakineh Soleimani; Rakhsha, Afshin; Blookat, Eftekhar Rajab

    2015-01-01

    The treatment of lymph nodes engaged in breast cancer with radiotherapy leads to improved locoregional control and enhanced survival rates in patients after surgery. The aim of this study was to compare two treatment techniques, namely single anterior posterior (AP) supraclavicular field with plan depth and two anterior and posterior opposed (AP/PA) supraclavicular fields. In the study, we also examined the relationships between the depth of supraclavicular lymph nodes (SCLNs) and the diameter of the wall of the chest and body mass index (BMI). Forty patients with breast cancer were analyzed using computed tomography (CT) scans. In planning target volume (PTV), the SCLNs and axillary lymph nodes (AXLNs) were contoured, and, with the attention to PTV, supraclavicular (SC) depth was measured. The dosage that reached the aforementioned lymph nodes and the level of hot spots were investigated using two treatment methods, i.e., 1) AP/PA and 2) AP with three-dimensional (3D) planning. Each of these methods was analyzed using the program Isogray for the 6 MV compact accelerator, and the diameter of the wall of the chest was measured using the CT scan at the center of the SC field. Placing the plan such that 95% of the target volume with 95% or greater of the prescribed dose of 50 Gy (V95) had ≥95% concordance in both treatment techniques. According to the PTV, the depth of SCLNs and the diameter of the wall of the chest were 3-7 and 12-21cm, respectively. Regression analysis showed that the mean SC depth (the mean Plan depth) and the mean diameter of the wall of the chest were related directly to BMI (p<0.0001, adjusted R(2)=0.67) and (p<0.0001, adjusted R(2)=0.71), respectively. The AP/PA treatment technique was a more suitable choice of treatment than the AP field, especially for overweight and obese breast cancer patients. However, in the AP/PA technique, the use of a single-photon, low energy (6 MV) caused more hot spots than usual.

  15. Surgical treatment of thoracic outlet syndrome; by supraclavicular approach

    Directory of Open Access Journals (Sweden)

    Osman Abd Ellah Mohamed

    2012-01-01

    Full Text Available Background: Thoracic outlet syndrome comprises a wide spectrum of disorders with different compressive pathologies attributed to the neurovascular bundle passing from the root of the neck to supply the upper extremity. New concepts and advances in diagnosis and treatment are emerging. This study evaluates effectiveness and safety of the supraclavicular approach in management of neurovascular compression at the thoracic outlet. Materials and Methods: Twenty patients (15 females and 5 males with mean age of 20 years (ranging from 18 to 40 years underwent anterior neurovascular decompression procedures because of symptoms of lower plexus compression (C8 - T1. Preoperative plain radiography, MRI and nerve conduction velocity studies confirmed the clinical diagnosis. Nine patients had neck pain, all had sensory deficit and eight had motor deficit. Results: After 35 months of follow-up, 17 patients showed excellent results, two cases had good results and one case had fair results according to the visual analog scale, and nerve conduction velocities. Conclusions: We recommend nerve conduction velocity studies beside clinical assessment for diagnosis and follow-up, and supraclavicular approach in neurogenic decompression which is relatively safe and effective.

  16. Teoria critica, izquierda y politicas publicas de comunicacion: el caso de America Latina y los gobiernos progresistas

    National Research Council Canada - National Science Library

    Badillo, Angel; Mastrini, Guillermo; Marenghi, Patricia

    2015-01-01

    .... Se focaliza en el estudio de paises cuyos gobiernos se han proclamado a si mismos como de izquierda o progresistas, en un intento por encontrar tendencias comunes en los procesos de implementacion...

  17. Hemangioblastomas de fosa posterior: Reporte de 16 casos y revisión de la literatura

    Science.gov (United States)

    Campero, Alvaro; Ajler, Pablo; Fernandez, Julio; Isolan, Gustavo; Paiz, Martin; Rivadeneira, Conrado

    2016-01-01

    Resumen Objetivo: El propósito del presente trabajo es presentar los resultados de 16 pacientes con diagnóstico de hemangioblastoma de fosa posterior (HBFP), operados con técnicas microquirúrgicas. Método: Desde junio de 2005 a diciembre de 2015, 16 pacientes con diagnóstico de HBFP fueron intervenidos quirúrgicamente. Se evaluó: sexo, edad, tipo de lesión (quística con nódulo, quística sin nódulo, sólida y sólida-quística), sintomatología y resultados postoperatorios. Resultados: De los 16 pacientes intervenidos, 11 fueron varones y 5 mujeres. La edad promedio fue de 44 años. La forma más frecuente fue quística con nódulo (57%), seguida por forma sólida (31%). Un solo caso presentó la forma quística sin nódulo (6%), y uno solo la forma sólido-quística (6%). La sintomatología más frecuente fue cefalea acompañada de síndrome cerebeloso (43%), seguido de síndrome de hipertensión endocraneana (25%). En todos los casos la resección fue completa, siendo necesario en un caso una embolización previa. Como complicaciones postoperatorias, 2 pacientes presentaron ataxia (mejoró al cabo de 3 meses), y 1 paciente presentó una fístula de LCR (se solucionó con un drenaje espinal externo). Se registró un óbito por complicaciones postoperatorias. Conclusión: Lo más frecuente de ver en pacientes con HBFP es la forma quística con nódulo, siendo su sintomatología predominante la cefalea acompañada de síndrome cerebeloso. La resección quirúrgica completa es posible, con una baja tasa de morbimortalidad. PMID:27999708

  18. Colgajo de perforantes de la arteria colateral cubital inferior para defectos por quemadura eléctrica en fosa cubital

    Directory of Open Access Journals (Sweden)

    I. González-Alaña

    2014-09-01

    Full Text Available Las quemaduras eléctricas producen lesiones profundas, especialmente las debidas a la entrada y salida de la corriente y al arco voltaico, que pueden dejar expuestas estructuras nobles y afectar áreas de flexo-extensión, como la fosa antecubital. Los defectos resultantes pueden cubrirse mediante colgajos libres o pediculados de brazo y antebrazo. Entre las distintas opciones quirúrgicas, el colgajo medial del brazo evita la interrupción de los ejes vasculares mayores y la secuela en la zona donante es discreta. Sin embargo, su uso está poco extendido por considerarse un colgajo de difícil disección debido a la variabilidad anatómica de las arterias colaterales cubitales superior e inferior que lo irrigan. Presentamos la cobertura para un defecto secundario a quemadura eléctrica en la fosa antecubital mediante un colgajo medial del brazo basado en las ramas perforantes de la arteria colateral cubital inferior. Aunque confirmamos en este caso la variabilidad vascular, la disección resultó sencilla y el resultado estético y funcional fue excelente.

  19. Recurrent ovarian cancer presenting in the right supraclavicular lymph node with isolated metastasis: a case report.

    Science.gov (United States)

    Tanaka, Tomohito; Ohmichi, Masahide

    2012-07-02

    The majority of ovarian cancer recurrences are in the abdomen. However, some cases relapse as isolated lymph node metastases, mostly in pelvic or para-aortic nodes. Peripheral isolated lymph node metastasis is rare. A 69-year-old Japanese woman had recurrent ovarian cancer presenting with isolated right supraclavicular lymph node metastasis. After surgical resection and combination chemotherapy with carboplatin and paclitaxel, her right supraclavicular lymph node completely regressed. Peripheral isolated lymph nodes, including right supraclavicular lymph node, can recur without a macroscopic abdominal lesion. Clinicians should carefully examine peripheral lymph nodes for recurrence.

  20. Recurrent ovarian cancer presenting in the right supraclavicular lymph node with isolated metastasis: a case report

    Directory of Open Access Journals (Sweden)

    Tanaka Tomohito

    2012-07-01

    Full Text Available Abstract Introduction The majority of ovarian cancer recurrences are in the abdomen. However, some cases relapse as isolated lymph node metastases, mostly in pelvic or para-aortic nodes. Peripheral isolated lymph node metastasis is rare. Case presentation A 69-year-old Japanese woman had recurrent ovarian cancer presenting with isolated right supraclavicular lymph node metastasis. After surgical resection and combination chemotherapy with carboplatin and paclitaxel, her right supraclavicular lymph node completely regressed. Conclusions Peripheral isolated lymph nodes, including right supraclavicular lymph node, can recur without a macroscopic abdominal lesion. Clinicians should carefully examine peripheral lymph nodes for recurrence.

  1. De revolucionarios, partidos y utopismos. Algunas reflexiones en torno a la izquierda mexicana

    Directory of Open Access Journals (Sweden)

    Alejandro González Gutiérrez

    2015-01-01

    Full Text Available En este ensayo se hace un análisis histórico sobre la política, la ideología y la postura de la izquierda comunista mexicana frente al Estado a lo largo del siglo XX. A partir de la experiencia del Partido Comunista Mexicano, el objetivo es arrojar una luz sobre la naturaleza histórica del sistema político mexicano a fin de comprender que la contención de las oposiciones políticas se logró mediante un complejo mecanismo de concesión y coerción. Fue gracias al empleo de ese mecanismo dual que el régimen logró afianzar su proyecto político en detrimento de otras propuestas como fue el caso de la izquierda. Frente a la imposición del neoliberalismo, este ensayo busca abrir espacios de reflexión sobre los retos, límites y alcances de la izquierda en el pasado y el presente.

  2. Supraclavicular lymph node metastasis as the initial presentation of primary fallopian tube carcinoma.

    Science.gov (United States)

    Sakurai, Nobuyuki; Tateoka, Kazuhiro; Fukaya, Kazumasa; Terada, Tadashi; Kubushiro, Kaneyuki

    2010-06-01

    Supraclavicular lymph node metastasis is a rare presentation of primary fallopian tube carcinoma. A 76-year-old woman presented with an enlarged supraclavicular lymph node. A biopsy was performed, and its findings confirmed metastatic adenocarcinoma. Subsequent exploratory laparotomy revealed right fallopian tube carcinoma as the primary lesion; consequently, right salpingo-oophorectomy was performed. After adjuvant chemotherapy, she underwent a laparotomy with total abdominal hysterectomy, left salpingo-oophorectomy, pelvic and para-aortic lymph node sampling, and omentectomy. Supraclavicular lymph node metastasis was thought to be, although rarely, the first manifestation of primary fallopian tube carcinoma (PFTC). When supraclavicular lymph node metastasis of an unknown origin is encountered, the possibility of PFTC should be considered.

  3. Peritoneal malignant mesothelioma metastatic to supraclavicular lymph nodes.

    Science.gov (United States)

    Zannella, Stefano; Testi, Maria Adele; Cattoretti, Giorgio; Pelosi, Giuseppe; Zucchini, Nicola

    2014-09-01

    Distinguishing between malignant mesothelioma and reactive mesothelial hyperplasia is often inestimable, but may be a challenging gauntlet for pathologists. A 62-year-old man underwent appendectomy after the identification of a peritoneal mass and the histological examination showed mesothelial proliferation along the appendix surface with no clear images of infiltration. After a few months the patient developed mediastinal and supraclavicular lymphadenopathies, and a nodal biopsy showed mesothelial cell proliferation invading lymphatic sinuses, consistent with the cells seen in the abdominal cavity. Since overt morphologic criteria for malignancy were lacking and reactive mesothelial cell deposits have been documented in lymph nodes, a molecular investigation of the CDKN2A (henceforth simply p16) gene status via fluorescence in situ hybridization was performed, which showed homozygous deletion in 100% tumor cells. These data ruled out the hypothesis of reactive mesothelial cells inclusion in lymph nodes, thus confirming the diagnosis of epithelioid malignant mesothelioma. © The Author(s) 2014.

  4. Regional hyperthermia combined with radiotherapy for esophageal squamous cell carcinoma with supraclavicular lymph node metastasis

    Science.gov (United States)

    Liming, Sheng; Yongling, Ji; Qiner, Wu; Xianghui, Du

    2017-01-01

    To assess the efficacy and toxicity of Intensity-modulated radiotherapy (IMRT) and hyperthermia for upper and middle thoracic esophageal squamous cell carcinoma (UMT-ESCC) with supraclavicular lymph node metastasis. A total of 50 patients with UMT-ESCC with supraclavicular lymph node metastasis were evaluated in this retrospective study. All patients received IMRT. Hyperthermia was delivered simultaneously with irradiation, in 45 minutes twice a week for 5-6 weeks. Hyperthermia included supraclavicular lymph node metastasis. Forty-four patients (88.0%) received concurrent chemoradiotherapy based on cisplatin regimens. The most common types of hematological toxicities were anemia (62.0%) and leukopenia (60.0%). Most of these events were grade 1-2 and transient. The 3-year progression-free survival (PFS) rate and overall survival (OS) rate were 34.9% and 42.5%, respectively. Cox regression revealed that tumor length and number of supraclavicular lymph node metastasis were two independent predictors of OS (tumor length: HR=3.65, p=0.008; nodal stage: HR=8.07, p=0.019). The IMRT combined with supraclavicular regional hyperthermia has low toxicity and well tolerated with excellent local control in UMT-ESCC with supraclavicular lymph node metastasis. PMID:28029663

  5. Misdiagnosis of left supraclavicular lymph node metastasis of hepatocellular carcinoma: a case report.

    Science.gov (United States)

    Liu, Tao; Gao, Jun-Fang; Yi, Yong-Xiang; Ding, Hai; Liu, Wei

    2013-02-14

    Left supraclavicular lymph node metastasis is a rare presentation of hepatocellular carcinoma (HCC). This phenomenon is easily neglected in the clinic. A 56-year-old man presented with HCC. On examination, a 1cm long left supraclavicular lymph node was palpated. Auxiliary examination indicated a lesion located in the right lobe of the liver. Fine needle aspiration cytology (FNAC) of the enlarged lymph node was performed; however, only necrosis was found. Hepatectomy was performed and HCC was confirmed by Hematoxylin-Eosin staining. However, 14 d after surgery, significantly enlarged left supraclavicular lymph nodes, a new intrahepatic lesion, and pulmonary and mediastinal metastasis appeared. An excisional biopsy of the left supraclavicular lymph node was performed, and its findings confirmed metastatic HCC. The patient's HCC rapidly progressed and he died one month later. It is possible for HCC to metastasize to the left supraclavicular lymph node. Surgeons should always consider an overall physical examination. When left supraclavicular lymphadenopathy of unknown origin is encountered, FNAC should be performed initially. If the results are negative, an excisional biopsy and subsequent Positron emission tomography - computed tomography scanning should be performed. These are very important for making the correct diagnosis and for selecting reasonable therapies.

  6. A strategy for supraclavicular lymph node dissection using recurrent laryngeal nerve lymph node status in thoracic esophageal squamous cell carcinoma.

    Science.gov (United States)

    Taniyama, Yusuke; Nakamura, Takanobu; Mitamura, Atsushi; Teshima, Jin; Katsura, Kazunori; Abe, Shigeo; Nakano, Toru; Kamei, Takashi; Miyata, Go; Ouchi, Noriaki

    2013-06-01

    The desirability of supraclavicular lymph node (LN) dissection, which is the cervical part of three-field LN dissection, has been discussed for a long time. In this study, we examine the pattern of supraclavicular LN metastasis in esophageal cancer, with a particular focus on the correlation between recurrent laryngeal nerve (RLN) LN and supraclavicular LN metastasis. In all, 220 cases of R0 resected T1 to T3 squamous cell carcinomas were retrospectively examined. All of these patients underwent bilateral RLN LNs dissection; none received cancer treatment before surgery. Of 21 upper esophageal cancer cases, 33.3% of the patients had metastasis in the supraclavicular LN. Every patient in whom supraclavicular LN metastasis developed had metastasis in the RLN LN. Of 141 cases of middle esophageal cancer, 19.1% had metastasis in the supraclavicular LN. Among the patients whose RLN LN metastasized, 38.3% had metastasis in the supraclavicular LN. A similar correlation between RLN LN and supraclavicular LN metastasis was observed in lower esophageal cancer cases, especially in T3 cases. When considering cancers of the esophagus and patients who had metastasis in the supraclavicular LN, our data demonstrated that RLN LN metastasis did not always lead to metastasis on the same side of the supraclavicular LN. The status of the RLN LN can be an indicator of supraclavicular LN dissection in upper esophageal cancer patients and advanced cases of middle and lower esophageal cancer patients. Bilateral supraclavicular LN dissection should be recommended even when only unilateral RLN LN metastasis occurs. Copyright © 2013 The Society of Thoracic Surgeons. Published by Elsevier Inc. All rights reserved.

  7. Una fosa-vertedero de época vettona en el Cerro de la Mesa (Alcolea de Tajo, Toledo

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    Chapa Brunet, Teresa

    2013-06-01

    Full Text Available The existence of pits filled with earth, ashes, pottery fragments and fauna, usually known as ash pits, rubbish pits or dumps, has been recognized on many Second Iron Age settlements of the Spanish Northern Plateau, generally linked with Vaccean and Vettonian groups. However, its distribution should be extended to the west of the Southern Plateau and eastern Extremadura, as evidenced by the example of the Cerro de la Mesa village and indications coming from other western sites. We offer here a detailed study of part of a rubbish pit where certain domestic remains were withdrawn in connection with a new project of urbanisation of the Vettonian village held on the transition from the 3rd to the 2nd centuries BC.La existencia de fosas rellenas con tierra, cenizas, fragmentos cerámicos y fauna denominadas genéricamente como cenizales, basureros o vertederos, es un hecho bien conocido en la Meseta Norte durante la Segunda Edad del Hierro, vinculándose con los grupos Vacceos y Vettones. Sin embargo, su distribución debe ampliarse al occidente de la Meseta Sur y oriente extremeño, como se evidencia tanto en el Cerro de la Mesa como a través de indicios documentados en otros yacimientos más occidentales. Se presenta aquí un detallado estudio de un sector de la fosa que actuó como vertedero para la retirada de ciertos restos domésticos con ocasión de la reurbanización en profundidad del poblado vettón que tuvo lugar en la transición del siglo III al II a.C.

  8. A new method to deliver supraclavicular radiation in breast radiotherapy for lung sparing.

    Science.gov (United States)

    Yang, Bo; Dong, Zhang; Lin, Mu-Han; Ma, C-M

    2011-04-18

    Due to the angulation of the breast board used for tangential breast irradiation, additional normal lung tissues are included in the supraclavicular field. This work investigates a method to reduce the lung volume and dose delivered during supraclavicular irradiation for breast cancer. Ten patients included for this retrospective study received chest wall and supraclavicular irradiation following radical surgery or breast-conserving surgery. Three-dimensional conformal radiation therapy plans were generated using the CMS XiO treatment planning system. The clinical target volume (CTV) of the supraclavicular irradiation is defined as the subcutaneous tissues from 0.5 cm under the anterior skin surface to a 3 cm depth. Only the ipsilateral lung is defined as the organ at risk. In the new method, the couch is rotated 90° and the supraclavicular field is tilted to maintain a normal incident angle to the breast board rather than the couch surface to spare more normal lung tissues. The absolute volume of the ipsilateral lung irradiated, and the volumes of lung tissues receiving 5 Gy and 20 Gy (V5 and V20) are analyzed. The new method can reduce the lung volume irradiated by the supraclavicular field significantly. For the ten patients investigated, only 5.3% of the ipsilateral lung is irradiated with the new method, while 14.9% of the ipsilateral lung is irradiated using the conventional method. Compared with the conventional method, the new method reduces V5 by 53.6% and V20 by 59.0%. Our new method does not alter the patient positioning for breast treatment but rotates the couch to deliver a tilted supraclavicular field to maintain adequate CTV coverage and spare more normal lung tissues. The results of this study demonstrated that our new method is effective, and that the reduction of normal lung tissue volume in the field is significant.

  9. Implante de un cardiodesfibrilador bicameral vía vena cava superior izquierda persistente

    OpenAIRE

    Daniel Bagattin; Bruno Strada; Adrián Carlessi; Oscar Didio; Atilio Abud; Raúl Goyeneche

    2009-01-01

    La vena cava superior izquierda persistente (VCSIP) es la anomalía congénita venosa deltórax más frecuente. Se encuentra en el 0,3% de la población general y en el 5-10% de lospacientes con cardiopatías congénitas. Generalmente evoluciona en forma asintomática yno genera trastornos hemodinámicos, pero su reconocimiento es importante, ya que puededificultar la introducción de catéteres para mediciones hemodinámicas, los implantes demarcapasos cardíacos (MCP) y de cardiodesfibriladores automáti...

  10. Evolución y situación actual de la izquierda mexicana

    OpenAIRE

    JOSÉ WOLDENBERG

    2008-01-01

    En el texto se documenta el avance electoral de la izquierda mexicana en los últimos 25 años, pero se subrayan las paradojas en las que se encuentra su principal partido, el de la Revolución Democrática, así como la coexistencia en su seno de dos racionalidades, una democrática y otra revolucionaria. También se ilustran las dificultades que tiene en su trato con otros actores sociales y la tensión, nunca resuelta, entre sus «formas de lucha»: la electoral y las movilizaciones.

  11. Referentes internacionales para el giro reformista de la izquierda chilena (1975-1990

    Directory of Open Access Journals (Sweden)

    Marcelo Mella Polanco

    2011-01-01

    Full Text Available El presente artículo analiza el giro reformista de la izquierda chilena durante el régimen autoritario de Pinochet. Para lograrlo, se expone cómo la penetración de ideas provenientes del marxismo analítico homogeneizó un importante sector de intelectuales y expertos opositores de Pinochet, constituyendo, de esta forma, un nuevo mainstream político-académico capaz de renovar los marcos epistémicos de las ciencias sociales y diseñar la transición a la democracia.

  12. Nociones sobre “democracia obrera” y “burocracia sindical” en la izquierda de los años 70. Una comparación entre la izquierda peronista y la izquierda marxista

    Directory of Open Access Journals (Sweden)

    Rafael FARACE

    2016-02-01

    Full Text Available Este trabajo estudia las nociones sobre democracia obrera y burocracia sindical utilizadas por las organizaciones de izquierda durante la década de 1970 a partir del análisis de fuentes documentales como volantes, boletines, prensa y documentos partidarios. Se examinará en particular los casos de dos organizaciones peronistas (Montoneros y Peronismo de Base y una organización marxista (Partido Revolucionario de los Trabajadores – Ejército Revolucionario del Pueblo, estableciéndose comparaciones que den cuenta de la importancia de la adscripción ideológica y la estrategia política como condicionantes de los sentidos otorgados a la burocracia y democracia sindical. Por otra parte, se focalizará el estudio de publicaciones realizadas en el año 1975 debido a que en el marco de las jornadas de lucha obrera desarrolladas ese año se concentraron y profundizaron debates y concepciones al calor de la experiencia inédita de la clase trabajadora.

  13. Anatomic distribution of supraclavicular lymph node in patients with esophageal cancer.

    Science.gov (United States)

    Xing, Jun; Luo, Yijun; Wang, Xiaoli; Gao, Min; Sun, Mingping; Ding, Xiuping; Fan, Tingyong; Yu, Jinming

    2016-01-01

    Definitive chemoradiation therapy remains the standard of care for patients with localized esophageal carcinoma who choose nonsurgical management. However, there is no consensus regarding delineation of the nodal clinical target volume (CTVn), especially for lower cervical lymph nodes. This study aimed to map the location of metastatic supraclavicular lymph nodes in thoracic esophageal carcinoma patients with supraclavicular node involvement and generate an atlas to delineate the CTVn for elective nodal radiation of esophageal squamous cell carcinoma. In this study, the supraclavicular regional lymph node was further divided into four subgroups. The locations of the involved supraclavicular nodes for all patients were then transferred onto a template computed tomography (CT) image. A volume probability map was then generated with nodal volumes, and was displayed on the template CT to provide a visual impression of nodal frequencies and anatomic distribution. We identified 154 supraclavicular nodal metastases based on CT image in 96 patients. Of these, 29.2% were located in group I region, 59.7% in group II region, 10.4% in group III region, and 0.7% in group IV region. On the basis of our study, we suggest that the appropriate radiation field of CTVn should include the group I and II regions and the CTVn exterior margin along the lateral side of the internal jugular vein may be suitable.

  14. Metastatic renal cell carcinoma in a supraclavicular lymph node with no known primary: a case report.

    Science.gov (United States)

    Choi, Young-Rak; Han, Hye-Suk; Lee, Ok-Jun; Lim, Sung-Nam; Kim, Mi-Jin; Yeon, Myeong-Ho; Jeon, Hyun-Jung; Lee, Ki Hyeong; Kim, Seung Taik

    2012-09-01

    Although metastasis is relatively frequent in cases of renal cell carcinoma (RCC), metastasis in the cervical or supraclavicular lymph node (LN) is relatively rare. Moreover, cases of metastatic RCC with a non-identifiable kidney mass are extremely rare. Here, the authors report a case of metastatic RCC in a supraclavicular LN without a primary kidney lesion. A 69-year-old man presented with a progressively enlarging right supraclavicular mass. Incisional biopsy of the affected supraclavicular LN was performed, and histological examination revealed metastatic RCC. However, no tumor was found in either kidney, despite various examinations. The patient was treated with radiotherapy followed by sunitinib. After three months on sunitinib, a follow-up computed tomography scan revealed that the supraclavicular LN had markedly decreased, and after 20 months, the disease had not progressed. This case suggests that, even when there is no primary kidney lesion, clinicians must consider the possibility of metastatic RCC when evaluating patients with clear cell carcinoma with an unknown primary site.

  15. Curso sobre la izquierda en España, 1931- 1939, en la universidad de Salamanca

    Directory of Open Access Journals (Sweden)

    Valentín del ARCO LÓPEZ

    2010-02-01

    Full Text Available El Departamento de Historia Contemporánea que dirige la Dra. Gómez Moueda organizó durante los días 2 al 6 de Julio pasado, dentro de los Cursos Internacionales de Verano, el Segundo Curso Superior de Historia Contemporánea con el tema monográfico «La izquierda en España, 1931-1939» en el que distintos especialistas abordaron, por una parte, el pensamiento político de la izquierda con respecto a los grandes temas del momento. Autonomías, Iglesia y Reforma agraria, que estuvieron a cargo de los profesores González Casanova,García de Cortázar y López y López y por otra su dinámica política y de alianzas explicada desde distintos ángulos por los profesores Paul Preston, Santos Julia, López Santamaría, Xavier Paniagua, Gabriel Cardona y M. Alonso Baquer para concluir con un acercamiento a la financiación de la Guerra Civil por el profesor Ángel Viñas y una mesa redonda sobre la estrategia militar en la guerra que contó con la presencia de Patrick Laurean, Ramón Salas Larrazábal, Ricardo Cerezo y M. Alonso Baquer.

  16. La segunda república: un discurso esquivo en la izquierda colombiana

    Directory of Open Access Journals (Sweden)

    Miguel Antonio Espinosa Rico

    2013-01-01

    Full Text Available El artículo trata sobre el estado actual de la realidad de la izquierda colombiana y su relación con la crisis del estado moderno colombiano. Se argumenta con FalsBorda (2001 y otros, que la globalización constituye un tema central para la consolidación del capitalismo colombiano, considerando con los autores revisados que el Estado Moderno representa la estructura sobre la cual se yergue el capitalismo en Occidente, pero que en Latinoamérica, y en especial, en la República Neogranadina, sienta las bases para la perpetuación del sistema. Analiza el sistema de división territorial colombiano para establecer premisas de dominio del régimen capitalista sobre el ciudadano común. Se concluye que el nuevo país solo es posible con sueño de la izquierda de la Segunda República, que reivindica las regiones como pilar fundamental para la dignidad del pueblo colombiano.

  17. Izquierda y derecha: formas de definirlas, el caso latinoamericano y sus implicaciones

    Directory of Open Access Journals (Sweden)

    Luis Eduardo GONZÁLEZ FERRER

    2014-01-01

    Full Text Available Izquierda y derecha (o liberales y conservadores son conceptos usados ampliamente para estudiar partidos y otros objetos políticos, pero tienen al menos dos problemas. Primero, no es claro que sean útiles fuera de las democracias prósperas. Segundo, no se los define de una única manera: hay dos grandes familias de enfoques. Por un lado, una tradición histórico-analítica y, por otro, un enfoque basado en las teorías espaciales de la competencia entre partidos. Este artículo compara dos clasificaciones de los partidos políticos de América Latina en la escala izquierda-derecha basadas en esos enfoques y muestra que son muy diferentes. En segundo lugar, sugiere una explicación para esas diferencias basada en pautas sistemáticas observadas en los datos, explicación que conduce a varias hipótesis que pueden ser verificadas empíricamente. Finalmente, muestra que la evidencia y la literatura disponibles apoyan esas hipótesis, y por lo tanto la explicación en sí misma.

  18. Aneurisma congénito de la orejuela izquierda. Caso clínico

    Directory of Open Access Journals (Sweden)

    Johanna T. Otero

    2008-04-01

    Full Text Available El aneurisma auricular congénito es una enfermedad muy rara y su localización más frecuente es la orejuela de la aurícula izquierda con 51 casos comunicados en la literatura. La mayoría son asintomáticos, por lo que su diagnóstico es por hallazgo en técnicas de imagen. Presentamos el caso de un lactante de 4 meses, de género masculino, portador de un síndrome de Treacher-Collins o disostosis mandibulofacial y síndrome bronquial obstructivo cuyo estudio de técnicas de imagen diagnostica un aneurisma de la orejuela izquierda.Se realiza resección quirúrgica del aneurisma bajo circulación extracorpórea sin incidentes. En el seguimiento a 12 meses el paciente se encuentra asintomático y sin videncia ecocardiográfica de recurrencia.

  19. Exhumación y análisis de los restos humanos recuperados en una fosa común del cementerio de Tudela (Navarra

    Directory of Open Access Journals (Sweden)

    Jimenez, J.

    2010-01-01

    Full Text Available Se presentan los resultados de la exhumación y análisis de los restos humanos de una fosa común perteneciente a la Guerra Civil en la localidad de Tudela (Navarra, en donde fueron recuperados dos esqueletos completos que han sido identificados mediante las correspondientes pruebas genéticas, confirmando la hipótesis de trabajo.

  20. Exhumación, identificación y causa de muerte en la fosa común de Aibar-Oibar (Navarra

    Directory of Open Access Journals (Sweden)

    Nuñez, C.,

    2012-01-01

    Full Text Available Se presentan los resultados de la investigación llevada a cabo en una fosa común situada en la localidad de Aibar (Navarra, en donde fueron inhumadas cuatro personas que fueron asesinadas en 1936. De conformidad a las fuentes documentales existentes así como al estudio antropológico y genético, se establece la identidad y la causa de la muerte relacionada con disparos por arma de fuego.

  1. Supraclavicular nodal failure in patients with one to three positive axillary lymph nodes treated with breast conserving surgery and breast irradiation, without supraclavicular node radiation.

    Science.gov (United States)

    Reddy, Shruthi G; Kiel, Krystyna D

    2007-01-01

    The purpose of this study was to evaluate the risk factors associated with supraclavicular nodal failure (SCF) in patients with one to three positive axillary nodes treated with breast conserving surgery and axillary dissection without supraclavicular node radiation (S/C RT) to aid in the selection of patients for S/C RT. Two hundred two breast conservation patients with one to three positive axillary nodes on axillary dissection treated with breast irradiation without S/C RT and 20 patients with S/C RT between August 1985 and May 2002 were identified and retrospectively evaluated. The Kaplan-Meier method was used to determine SCF-free and overall survival curves. Risk factors for SCF were examined. The median follow-up from surgery was 72 months (range: 4-195). Nine of 202 patients (4%) failed in the ipsilateral breast, 4 (2%) in the ipsilateral supraclavicular lymph nodes, 4 (2%) in the ipsilateral axillary and/or internal mammary nodes and 30 (15%) distantly. The 5- and 10-year SCF-free survival was 97.92%. The overall survival at 5, 10, and 15 years was 91.35%, 75.58%, and 67.18%, respectively. SCFs were associated with high grade or ER negative cancers, but not with number of positive nodes. Two of the four SCFs were associated with distant metastases, and two with local failures. One patient with a SCF was salvaged and is disease-free at 134 months. The overall low incidence of SCF in patients with one to three positive nodes treated with breast radiation alone after breast conserving surgery and adequate axillary dissection suggests that additional S/C RT is unnecessary in this cohort. When it occurs, supraclavicular nodal failure is often associated with distant metastases.

  2. La simetría izquierda-derecha en la naturaleza

    OpenAIRE

    Morones I., Rubén

    2002-01-01

    El concepto de simetría ocupa un lugar importante en la vida del ser humano. La simetría la encontramos en la naturaleza, en la arquitectura, en el arte y en la ciencia. La importancia que tiene la simetría en la física proviene de su estrecha relación con conceptos fundamentales de la física y sus leyes de conservaci ón. Las simetrías que esperamos que cumpla una teoría son una guía excelente para elaborar la estructura matemática de la misma. La simetría izquierda- ...

  3. Pseudo-aneurisma post-traumático de tronco de arteria coronaria izquierda

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    Melina M. Gallo

    2011-08-01

    Full Text Available El pseudo-aneurisma de arteria coronaria es extremadamente raro. Su historia natural es poco conocida y su tratamiento discutido. Se presenta el caso de un paciente con pseudo-aneurisma de tronco de la coronaria izquierda e infarto antero-apical del ventrículo izquierdo cinco años después de un paro cardíaco secundario a un traumatismo no penetrante de tórax. Se consideró entonces que la lesión no era pasible de corrección percutánea o quirúrgica por lo que se optó por tratamiento médico conservador. Una angiografía coronaria por tomografía computarizada multicorte realizada 10 años después del evento inicial mostró ausencia de progresión de la lesión.

  4. Sexualidad y participación política femenina en la izquierda costarricense

    OpenAIRE

    Alvarenga Venutolo, Patricia

    2012-01-01

    Análisis de las  políticas sexuales del Partido Comunista y de su incidencia en la construcción de la imagen de la mujer como activista.  En diálogo con los cambios acaecidos en el proceso de construcción del Estado soviético así como con la cultura hegemónica costarricense, el artículo dibuja el proceso de creación de una moralidad de izquierda. Si bien esta no desafía los cánones establecidos, abre espacios para vincular las identidades genéricas con las luchas políticas y  redireccionar la...

  5. [Metastatic characteristics of lymph node in supraclavicular zone and radiotherapy target volume for limited-stage small cell lung cancer].

    Science.gov (United States)

    Feng, Zhen-xing; Zhao, Lu-jun; Guan, Yong; Sun, Yao; Ji, Kai; Wang, Ping

    2013-05-21

    To explore the reasonable radiotherapy range by analyzing the characteristics of supraclavicular lymph node metastasis in limited-stage small cell lung cancer (LS-SCLC). From January 2005 to December 2011, patients of LS-SCLC were reviewed. Supraclavicular zone was further divided into five subgroups including para-recurrent laryngeal nerve (region I and region II ), para-internal jugular vein (region III ), supraclavicular region (region IV), as well as the other regions except for the mentioned above (region V). The characteristics of the lymph nodes in each region were analyzed. The supraclavicular lymph node metastasis was found in 60 patients, with a positive rate of 34.5%. In multivariate Logistic regression analysis,intra-thoracic lymph node metastasis in the lymph node stations of level 2 and 3 were found to be the risk factors of supraclavicular lymph node metastasis (P = 0.006,P = 0.000). Our data suggests that the frequencies of metastasis in region I and III were much higher than those in the other areas.Among the sixty patients with supraclavicular lymph node metastasis, 95.0% were found at region I or III while the incidence of skip metastasis was only 5.0%. It is advisable to contain the bilateral supraclavicular nodes in patients with mediastinal lymph nodes metastasis to the level 2 or 3 for elective radiation target volume.The clinical target volume (CTV) exterior margin containing the outer margin of internal jugular vein may be suitable.

  6. [Des]igualdad y anarquismo. Derecha e izquierda en el ideario anarquista

    Directory of Open Access Journals (Sweden)

    Garaventa, Carlos A.

    2011-12-01

    Full Text Available Dentro del ideario anarquista podemos encontrar muchísimas vertientes ideológicas diferentes que nos hacen imposible dar una definición unívoca de esta corriente de pensamiento o, mejor dicho, de vida. Podemos señalar, sin embargo, una característica común a todo ideal ácrata: la oposición al Estado. Es posible señalar también, en un anarquismo puro, el respeto de los tres pilares fundadores de la Revolución Francesa, pero con una dinámica diferente: en lugar de considerarlos aisladamente, para el anarquismo puro, el trinomio debe funcionar como un todo único. Esto da lugar al triángulo virtuoso de libertad, igualdad y fraternidad; sin embargo, no todos los anarquistas defienden íntegramente este triángulo. Hay autores que, por ejemplo, no prestan atención a la igualdad. Siguiendo el esquema de distinción política que da Norberto Bobbio en Derecha e izquierda podemos realizar una diferenciación entre los anarquistas de ambos lados del abanico político. Esta diferencia la marca, según Bobbio, la aspiración, o no, a una sociedad igualitaria. En consecuencia, serán de izquierda aquellos anarquistas que defiendan la igualdad y, por ende, el triángulo virtuoso. Serán anarquistas de derecha, en cambio, aquellos que deseen la abolición del Estado pero haciendo caso omiso de si la sociedad se vuelve o no igualitaria.

  7. Efficiency of levobupivacaine and bupivacaine for supraclavicular block: a randomized double-blind comparative study

    Directory of Open Access Journals (Sweden)

    Cenk Ilham

    2014-06-01

    Full Text Available Background and objectives: Success rate of catheter applications is low in supraclavicular block. Thus, bupivacaine and levobupivacaine become important with their long effect time in single injection practices. In this study, we aimed to compare the effectiveness, side effects and complications of bupivacaine and levobupivacaine in supraclavicular block. Methods: Sixty patients aged between 20 and 65, with body weight between 50 and 100 kg, in the ASA I-II-III group who were scheduled for hand, forearm and arm surgery using supraclavicular block were randomized into two groups of 30. The patients received 30 ml 0.5% bupivacaine (Group B or 30 ml 0.5% levobupivacaine (Group L. Motor and sensory blocks were evaluated. Motor and sensory block onset times, total block durations, postoperative pain, amount of postoperative analgesic used and patient satisfaction were recorded. Results: Demographic data, distribution of surgical area and hemodynamic data were similar between the two groups. Surgery, motor and sensory block durations of Group B and L patients did not vary statistically significantly. However, motor and sensory block onset times in Group B were significantly shorter than Group L (p 0.05. Conclusion: 30 ml 0.5% bupivacaine and levobupivacaine provide similar block characteristics for supraclavicular block. Bupivacaine leads to faster motor and sensory block onset compared to levobupivacaine however similar duration of postoperative analgesia.

  8. EFFICACY OF DEXAMETHASONE AS AN ADJUVANT TO BUPIVACAINE IN SUPRACLAVICULAR BRACHIAL PLEXUS BLOCK

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    Rakesh

    2015-08-01

    Full Text Available AIMS: Brachial plexus nerve blocks have analgesic and opioid sparing benefits for upper extremity surgery. Single - injection techniques are limited by duration of local anaesthetic agents, however Continuous block techniques can be used for prolonged anaesthesia and analgesia but it presents management challenges. The study was designed to compare the effects of dexamethasone administered as an adjunct to bupivacaine in supraclavicular brachial plexus block on the onset , duration and postoperative analgesia following upper limb surgeries. METHODS AND MATERIAL: A prospective, double - blind study was undertaken in patients scheduled for upper limb surgeries under supraclavicular brachial plexus block. Sixty patients were randomly divided into two groups, Group B and BD . Group B received 30 ml of 0.375% bupivacaine with 2 ml normal saline while Group BD received 30 ml of 0.375% bupivacain with 2ml(8mg dexamethasone for supraclavicular brachial plexus block. The groups were compared regarding quality of sensory and motor blockade, duration of post operative analgesia and intra and postoperative complications. RESULTS: There was a significant increase in duration of motor and sensory block and analgesia in Group BD as compared to Group B patients ( P < 0.0001. No significant side effects were noted. CONCLUSIONS: The addition of 8 mg of dexamethasone to bupivac a ine in supraclavicular brachial plexus block prolongs the duration of motor and sensory block and extends the analgesia period. KEYWORDS: A naesthesia adjuvants; D examethasone; B rachial plexus block .

  9. Measurement of Thyroid Dose by TLD arising from Radiotherapy of Breast Cancer Patients from Supraclavicular Field.

    Science.gov (United States)

    Farhood, B; Bahreyni Toossi, M T; Vosoughi, H; Khademi, S; Knaup, C

    2016-09-01

    Breast cancer is the most frequently diagnosed cancer and the leading global cause of cancer death among women worldwide. Radiotherapy plays a significant role in treatment of breast cancer and reduces locoregional recurrence and eventually improves survival. The treatment fields applied for breast cancer treatment include: tangential, axillary, supraclavicular and internal mammary fields. In the present study, due to the presence of sensitive organ such as thyroid inside the supraclavicular field, thyroid dose and its effective factors were investigated. Thyroid dose of 31 female patients of breast cancer with involved supraclavicular lymph nodes which had undergone radiotherapy were measured. For each patient, three TLD-100 chips were placed on their thyroid gland surface, and thyroid doses of patients were measured. The variables of the study include shield shape, the time of patient's setup, the technologists' experience and qualification. Finally, the results were analyzed by ANOVA test using SPSS 11.5 software. The average age of the patients was 46±10 years. The average of thyroid dose of the patients was 140±45 mGy (ranged 288.2 and 80.8) in single fraction. There was a significant relationship between the thyroid dose and shield shape. There was also a significant relationship between the thyroid dose and the patient's setup time. Beside organ at risk such as thyroid which is in the supraclavicular field, thyroid dose possibility should be reduced. For solving this problem, an appropriate shield shape, the appropriate time of the patient's setup, etc. could be considered.

  10. Comparison of vascularized supraclavicular lymph node transfer and lymphaticovenular anastomosis for advanced stage lower extremity lymphedema.

    Science.gov (United States)

    Akita, Shinsuke; Mitsukawa, Nobuyuki; Kuriyama, Motone; Kubota, Yoshitaka; Hasegawa, Masakazu; Tokumoto, Hideki; Ishigaki, Tatsuya; Togawa, Takashi; Kuyama, Junpei; Satoh, Kaneshige

    2015-05-01

    Vascularized lymph node transfer has become a popular surgical option to improve lower extremity lymphedema (LEL), although potential donor sites are limited. The free supraclavicular flap with deep cervical lymph nodes has been recently associated with a minimal risk of secondary lymphedema caused by donor site dissection. However, the effectiveness of this procedure has not yet been evaluated. Vascularized supraclavicular lymph node transfer (VSLNT) was performed for patients with International Society of Lymphology late stage II or more severe LEL. The results were compared with lymphaticovenular anastomosis (LVA) performed for patients with the same stages of severity. To evaluate improvement in lymphatic function, indocyanine green lymphography and lymphoscintigraphy were performed. Vascularized supraclavicular lymph node transfer was performed in 13 limbs of 13 patients. The results were compared with 43 limbs of 33 patients who underwent multiple LVA. No severe complications were observed in either group. Improvement in lymphatic function, as measured by the LEL index, was 26.5 ± 4.4 and 21.2 ± 2.0 in the VSLNT and LVA groups, respectively. Lymphatic function was improved in 7 cases in the VSLNT group and 10 cases in the LVA group. Vascularized supraclavicular lymph node transfer is an effective technique for the treatment of advanced stage LEL. Lymphaticovenular anastomosis is also effective, but to a lesser degree than VSLNT. However, LVA is less invasive and requires a shorter hospital stay.

  11. COMPARISON BETWEEN INTERSCALENE AND SUPRACLAVICULAR BRACHIAL PLEXUS BLOCK: A CADAVERIC STUDY

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    Suvalagna

    2014-07-01

    Full Text Available INTRODUCTION: Without mastery of the anatomy, luck rather than skill becomes the primary determinant of successful neural blockade. In this educational study our intent was to compare the level of nerve roots blocked by these two techniques of peripheral nerve block, widely used in clinical anesthesia practice. AIMS: To have a three dimensional view of nerve plexus involvement in inter scalene and supraclavicular techniques of brachial plexus block and compare in between them. MATERIAL AND METHOD: 6 recently deceased cadavers preserved in formalin were used. In both the techniques the classical methods usually pursued in daily clinical practice were followed. Dyes used were methylene blue and tartrazine of same dilution. RESULTS: Careful dissection showed that in all cases of inter scalene approach the dye was more concentrated in upper and middle trunk than in lower trunk of brachial plexus. In contrast in supraclavicular approach dye concentration was more in lower and middle trunk and less in upper trunk. DISCUSSION: After reviewing the anatomy it can be concluded that injection of local anesthetic at the interscalene level tends to produce a block that is most intense at the C5-C7 distribution and injection at supraclavicular level provide more compact anesthesia in C8-T1 distribution. CONCLUSION: Supraclavicular block is preferable for operations on the elbow, forearm, and hand and inter scalene block for shoulder.

  12. Bilateral Ultrasound Guided Supraclavicular Block in a Patient on Antiplatelet Drugs

    Directory of Open Access Journals (Sweden)

    Lokesh Kumar KS

    2015-04-01

    Full Text Available A 63 year old male hypertensive and diabetic patient, with coronary artery and chronic obstructive pulmonary disease, presented with bilateral both bone forearm fracture. Open reduction and internal fixation was done successfully with bilateral ultrasound guided supraclavicular block. The problems associated with peripheral nerve block in an Ischemic Heart Disease (IHD patient on antiplatelet therapy are discussed.

  13. Glomus vagale presenting as a supraclavicular mass: Magnetic resonance imaging findings

    Energy Technology Data Exchange (ETDEWEB)

    Puvaneswary, M.; Gani, J. [John Hunter Hospital, New Lambton Heights, Newcastle, NSW (Australia). Departments of Medical Imaging and Surgery; Kalnins, I.K. [Westmead Hospital, Westmead, Sydney NSW (Australia)

    1998-11-01

    Glomus vagale are rare vascular tumours of the paraganglion cells of the vagus nerve, and they usually occur in the carotid space. Tumours can be familial, multicentric, malignant but rarely hormonally active. A rare case is reported of glomus vagale presenting as a supraclavicular mass. Copyright (1998) Blackwell Science Pty Ltd 12 refs., 3 figs.

  14. The use of the pedicled supraclavicular flap in noma reconstructive surgery.

    NARCIS (Netherlands)

    Hartman, E.H.M.; Damme, P.A. van; Sauter, H.; Suominen, S.H.

    2006-01-01

    Three noma patients with large unilateral facial defects were reconstructed using the pedicled supraclavicular flap technique in the Noma Children Hospital in Sokoto, Nigeria. The results are-although not completely perfect-encouraging enough to report and to repeat the technique in future reconstru

  15. A comparison of ultrasound-guided supraclavicular and infraclavicular blocks for upper extremity surgery

    DEFF Research Database (Denmark)

    Koscielniak-Nielsen, Z J; Frederiksen, B S; Rasmussen, H

    2009-01-01

    : supraclavicular (S) and infraclavicular (I). Each patient received a mixture containing equal volumes of ropivacaine 7.5 mg/ml and mepivacaine 20 mg/ml with adrenaline 5 microg/ml, 0.5 ml/kg body weight (minimum 30 ml, maximum 50 ml). The sensory score (anaesthesia--2 points, analgesia--1 point and pain--0 point...

  16. Benign schwannoma in supraclavicular region: a false-positive lymph node recurrence of breast cancer suspected by PET scan.

    Science.gov (United States)

    Perniola, Giorgia; Tomao, Federica; Fischetti, Margherita; Lio, Stephanie; Pecorella, Irene; Benedetti Panici, Pierluigi

    2014-09-01

    Positron emission tomography (PET) is the most accurate imaging modalities to detect malignancies. And it helps to take decisions regarding diagnosis, staging, recurrence, and therapeutical management. We report a case of a suspected supraclavicular lymph node relapse, diagnosed by PET-CT in a breast cancer patient. The lymph node was surgically removed in outpatient with local anesthesia. Histological findings diagnosed a benign Schwannoma. In this patient PET-CT failed to distinguish benign tumors from metastatic supraclavicular lymph nodes. This case confirms the need to investigate histologically suspected supraclavicular lesions, during breast cancer follow up.

  17. [Long-term survival of a patient with lung cancer with skip metastasis to supraclavicular lymph nodes].

    Science.gov (United States)

    Ohta, Y; Nakaizumi, H; Furukawa, S; Ushijima, S; Mori, Y; Sato, H; Kurumaya, H

    1995-04-01

    A case of lung cancer with skip metastasis to supraclavicular lymph nodes is described. The patient had undergone radical resection for gastric cancer about nine years ago. For about one year, chemotherapy had been done by Tegafur (600 mg/day) after operation. Radical resection for lung cancer (p/d squamous cell carcinoma) was performed about seven years ago. Pathologically, mediastinal lymph node metastasis could not be detected. The needle aspiration biopsy of supraclavicular lymph node revealed metastasis. Then, radical neck lymph nodes dissection involving supraclavicular lymph nodes and radiation therapy were added. There has been no sign of recurrence so far.

  18. Anatomic distribution of supraclavicular lymph node in patients with esophageal cancer

    Directory of Open Access Journals (Sweden)

    Xing J

    2016-09-01

    Full Text Available Jun Xing,1 Yijun Luo,1,2 Xiaoli Wang,1,2 Min Gao,1 Mingping Sun,1 Xiuping Ding,1 Tingyong Fan,1 Jinming Yu1 1Department of Radiation Oncology and Radiology, Shandong Cancer Hospital Affiliated to Shandong University, 2School of Medical and Life Sciences, Shandong Academy of Medical Sciences, University of Jinan, Jinan, People’s Republic of China Purpose: Definitive chemoradiation therapy remains the standard of care for patients with localized esophageal carcinoma who choose nonsurgical management. However, there is no consensus regarding delineation of the nodal clinical target volume (CTVn, especially for lower cervical lymph nodes. This study aimed to map the location of metastatic supraclavicular lymph nodes in thoracic esophageal carcinoma patients with supraclavicular node involvement and generate an atlas to delineate the CTVn for elective nodal radiation of esophageal squamous cell carcinoma. Patients and methods: In this study, the supraclavicular regional lymph node was further divided into four subgroups. The locations of the involved supraclavicular nodes for all patients were then transferred onto a template computed tomography (CT image. A volume probability map was then generated with nodal volumes, and was displayed on the template CT to provide a visual impression of nodal frequencies and anatomic distribution. Results: We identified 154 supraclavicular nodal metastases based on CT image in 96 patients. Of these, 29.2% were located in group I region, 59.7% in group II region, 10.4% in group III region, and 0.7% in group IV region. Conclusion: On the basis of our study, we suggest that the appropriate radiation field of CTVn should include the group I and II regions and the CTVn exterior margin along the lateral side of the internal jugular vein may be suitable. Keywords: esophageal carcinoma, lymph node metastasis, clinical target volume, cervical lymph node

  19. Risk of subclinical micrometastatic disease in the supraclavicular nodal bed according to the anatomic distribution in patients with advanced breast cancer.

    Science.gov (United States)

    Reed, Valerie K; Cavalcanti, Jose L; Strom, Eric A; Perkins, George H; Oh, Julia L; Tereffe, Welela; Yu, Tse-Kuan; Yeung, Henry; Whitman, Gary J; Bedrosian, Isabelle; Macapinlac, Homer A; Buchholz, Thomas A; Woodward, Wendy A

    2008-06-01

    To determine the anatomic distribution of gross supraclavicular nodes within the supraclavicular fossa using 2-deoxy-2-[F-18] fluoro-d-glucose (FDG) positron emission tomography/computed tomography (PET/CT) scans, and to evaluate likely coverage of specific regions of the supraclavicular fossa using standard radiation fields. We identified 33 patients with advanced or metastatic breast cancer who had a PET/CT scan demonstrating hypermetabolic supraclavicular lymph nodes in 2005. The locations of the involved lymph nodes were mapped onto a single CT set of images of the supraclavicular fossa. These lymph nodes were also mapped onto the treatment-planning CT dataset of 4 patients treated in our institution (2 patients with biopsy-proven supraclavicular nodes and 2 patients with clinically negative supraclavicular nodes). We were able to determine the distribution of 52 supraclavicular lymph nodes in 32 patients. Of 32 patients, 28 (87%) had a history of metastatic disease, and 2 patients had isolated nodal recurrences. Five patients had supraclavicular nodes posterior to the vertebral body transverse process, and several lymph nodes were in close proximity to the medial field border, raising the possibility of geographic miss in these areas. In patients with locally advanced disease, increased coverage of the supraclavicular fossa medially and posteriorly may be warranted.

  20. La visibilidad arqueológica de un conflicto inconcluso : la exhumación de fosas comunes de la Guerra Civil española a debate

    Directory of Open Access Journals (Sweden)

    Montero Gutiérrez, Juan

    2009-01-01

    Full Text Available El objeto de este trabajo es introducir algunas reflexiones metodológicas sobre el proceso de análisis que conllevan las tareas exhumatorias de las fosas comunes de la Guerra Civil española, reconociendo las particularidades del contexto social en el que han surgido, estrechamente vinculados con el fenómeno de la llamada recuperación de la memoria histórica. De hecho, las labores de excavación de estos registros arqueológicos son el resultado de una demanda social planteada por los familiares de las víctimas de la represión franquista cuyo objetivo principal ha sido y es la recuperación de los cuerpos de sus deudos, su identificación y posterior re-enterramiento, al tiempo que su reconocimiento moral. Pero la irrupción del las exhumaciones de fosas comunes debe, también, ponerse en relación con los profundos cambios operados en la gestión del patrimonio arqueológico de nuestro pasado más reciente y, sobre todo, con la importancia que comienza a adquirir el estudio de los conflictos bélicos y sociales desde la perspectiva no sólo histórica y antropológica, sino también arqueológica. Las fosas son vistas así como parte integrante del registro arqueológico que generó la Guerra Civil y la posterior dictadura de Franco, al igual que otros escenarios y vestigios como son todas aquellas estructuras asociadas a líneas defensivas, maquinaria bélica y centros de internamiento.

  1. Sonographic assessment of predictors of depth of the corner pocket for ultrasound-guided supraclavicular brachial plexus block

    Directory of Open Access Journals (Sweden)

    Naveen Yadav

    2016-01-01

    Conclusion: Prescanning of supraclavicular region for estimating depth of corner pocket should be done before choosing an appropriate size needle. Furthermore, the needle should not be advanced more than the predicted corner pocket depth.

  2. Estudio evolutivo de la eficacia de materiales de resina autograbadores usados como selladores de fosas y fisuras en niños portadores de aparatos de ortodoncia

    OpenAIRE

    Sotoca Tobarra, Aitor

    2016-01-01

    El objetivo de esta tesis doctoral es comparar la eficacia in vivo como sellador de fosas y fisuras, en niños portadores de aparatos de ortodoncia, entre los materiales autograbadores de resina compuesta y los selladores tradicionales de resina. Hemos estudiado 225 selladores realizados a 51 niños, de entre 6 y 16 años de edad, portadores de aparatología fija de ortodoncia. Los selladores se colocaron en 81 molares (primeros y segundos molares) y 144 premolares (primeros y segundos premola...

  3. Molecular Characterization of Escherichia coli Isolates Carrying mcr-1, fosA3, and Extended-Spectrum-β-Lactamase Genes from Food Samples in China.

    Science.gov (United States)

    Liu, Xiaobo; Li, Ruichao; Zheng, Zhiwei; Chen, Kaichao; Xie, Miaomiao; Chan, Edward Wai-Chi; Geng, Shu; Chen, Sheng

    2017-06-01

    This study surveyed the prevalence of mcr-1 in extended-spectrum-β-lactamase (ESBL)-producing Escherichia coli strains of food origin in China and identified strains that carried mcr-1, fosA3, and ESBL genes, which were carried in various plasmids. The mcr-1 and ESBL genes could be cotransferred by one or more types of plasmids. The presence of these multidrug-resistant E. coli strains in food products might pose a huge threat to public health. Copyright © 2017 American Society for Microbiology.

  4. Bypass coronario en un paciente con oclusión de la arteria iliaca izquierda: Precauciones a tomar en cuenta.

    OpenAIRE

    2015-01-01

    Se presenta el caso de un paciente varón de 82 años con Insuficiencia Cardiaca Congestiva (Fracción de Eyección de 20%) y Edema Agudo de Pulmón secundarios a Infarto Agudo de Miocardio extenso que requería cirugía de Bypass Coronario. Además, presentaba Enfermedad Oclusiva Aortoiliaca crónica con  oclusión total de la Arteria Iliaca Izquierda dependiente de circulación colateral a través de la Arteria Mamaria Interna Izquierda. Se decidió realizar la cirugía de bypass coronario sin utilizar di...

  5. Nonpalpable supraclavicular lymph nodes in lung cancer patients: preoperative characterization with 18F-FDG PET/CT.

    Science.gov (United States)

    Sung, Yon Mi; Lee, Kyung Soo; Kim, Byung-Tae; Kim, Seonwoo; Kwon, O Jung; Choi, Joon Young; Yang, Seoung-Oh

    2008-01-01

    Our purpose was to evaluate the usefulness of integrated 18F-FDG PET/CT in the detection and characterization of nonpalpable supraclavicular lymph node metastasis in patients with the initial diagnosis of lung cancer. This study was conducted from May 2005 to May 2006 and included 32 consecutively registered lung cancer patients in whom supraclavicular lymph nodes were not palpable but were identified on contrast-enhanced CT or exhibited increased FDG uptake on integrated PET/CT. Three patients had bilateral nodes, for a total of 35 nodes in the 32 patients. Results of cytologic analysis of a specimen obtained with sonographically guided fine-needle aspiration (n = 27), normal initial and follow-up sonographic findings (n = 3), and no change in the size of supraclavicular lymph nodes on follow-up sonography (n = 2) were the reference standards. The presence of supraclavicular lymph node metastasis was determined with integrated PET/CT (uptake greater than that of surrounding tissue) and contrast-enhanced CT (node short-axis diameter of 5 mm or more). The diagnostic efficacies of these methods in the detection of supraclavicular lymph node metastasis were compared. Supraclavicular lymph node metastasis was diagnosed cytologically in 12 (34%) of 35 lesions. The diagnostic accuracies of integrated PET/CT and contrast-enhanced CT in the detection of supraclavicular lymph node metastasis were 71% and 66%, respectively; the difference was not statistically significant. Although the difference was not statistically significant, the sensitivity (92%) and negative predictive value (93%) of integrated PET/CT were higher than those of contrast-enhanced CT. Because of its high sensitivity and negative predictive value, integrated PET/CT is useful in the detection and characterization of nonpalpable supraclavicular lymph nodes in lung cancer patients.

  6. Dosimetric evaluation of integrated IMRT treatment of the chest wall and supraclavicular region for breast cancer after modified radical mastectomy.

    Science.gov (United States)

    Yang, Bo; Wei, Xian-Ding; Zhao, Yu-Tian; Ma, Chang-Ming

    2014-01-01

    To investigate the dosimetric characteristics of irradiation of the chest wall and supraclavicular region as an integrated volume with intensity-modulated radiation therapy (IMRT) after modified radical mastectomy. This study included 246 patients who received modified radical mastectomy. The patients were scanned with computed tomography, and the chest wall (with or without the internal mammary lymph nodes) and supraclavicular region were delineated. For 143 patients, the chest wall and supraclavicular region were combined as an integrated planning volume and treated with IMRT. For 103 patients, conventional treatments were employed with 2 tangential fields for the chest wall, abutting a mixed field of 6-MV x-rays (16Gy) and 9-MeV electrons (34Gy) for the upper supraclavicular region. The common prescription dose was 50Gy/25Fx/5W to 90% of the target volume. The dosimetric characteristics of the chest wall, the supraclavicular region, and normal organs were compared. For the chest wall target, compared with conventional treatments, the integrated IMRT plans lowered the maximum dose, increased the minimum dose, and resulted in better conformity and uniformity of the target volume. There was an increase in minimum, average, and 95% prescription dose for the integrated IMRT plans in the supraclavicular region, and conformity and uniformity were improved. The V30 of the ipsilateral lung and V10, V30, and mean dose of the heart on the integrated IMRT plans were lower than those of the conventional plans. The V5 and V10 of the ipsilateral lung and V5 of the heart were higher on the integrated IMRT plans (p supraclavicular region and showed better dose conformity and uniformity of the integrated target volume of the chest wall and supraclavicular region. Copyright © 2014 American Association of Medical Dosimetrists. Published by Elsevier Inc. All rights reserved.

  7. Supraclavicular lymph node metastases from malignant gastrointestinal stromal tumor of the jejunum: A case report with review of the literature.

    Science.gov (United States)

    Ma, Chi; Hao, Shao-Long; Liu, Xin-Cheng; Nin, Jin-Yao; Wu, Guo-Chang; Jiang, Li-Xin; Fancellu, Alessandro; Porcu, Alberto; Zheng, Hai-Tao

    2017-03-14

    Gastrointestinal stromal tumors (GISTs) represent the most common mesenchymal tumors of the alimentary tract. These tumors may have different clinical and biological behaviors. Malignant forms usually spread via a hematogenous route, and lymph node metastases rarely occur. Herein, we report a patient with a jejunal GIST who developed supraclavicular lymph node metastasis. We conclude that lymphatic diffusion via the mediastinal lymphatic station to the supraclavicular lymph nodes can be a potential metastatic route for GISTs.

  8. Dosimetric evaluation of integrated IMRT treatment of the chest wall and supraclavicular region for breast cancer after modified radical mastectomy

    Energy Technology Data Exchange (ETDEWEB)

    Yang, Bo; Wei, Xian-ding; Zhao, Yu-tian [Department of Radiation Oncology, the Fourth Affiliated Hospital of Suzhou University, Wuxi (China); Ma, Chang-Ming, E-mail: charlie.ma@fccc.edu [Department of Radiation Oncology, Fox Chase Cancer Center, Philadelphia, PA (United States)

    2014-07-01

    To investigate the dosimetric characteristics of irradiation of the chest wall and supraclavicular region as an integrated volume with intensity-modulated radiation therapy (IMRT) after modified radical mastectomy. This study included 246 patients who received modified radical mastectomy. The patients were scanned with computed tomography, and the chest wall (with or without the internal mammary lymph nodes) and supraclavicular region were delineated. For 143 patients, the chest wall and supraclavicular region were combined as an integrated planning volume and treated with IMRT. For 103 patients, conventional treatments were employed with 2 tangential fields for the chest wall, abutting a mixed field of 6-MV x-rays (16 Gy) and 9-MeV electrons (34 Gy) for the upper supraclavicular region. The common prescription dose was 50 Gy/25 Fx/5 W to 90% of the target volume. The dosimetric characteristics of the chest wall, the supraclavicular region, and normal organs were compared. For the chest wall target, compared with conventional treatments, the integrated IMRT plans lowered the maximum dose, increased the minimum dose, and resulted in better conformity and uniformity of the target volume. There was an increase in minimum, average, and 95% prescription dose for the integrated IMRT plans in the supraclavicular region, and conformity and uniformity were improved. The V{sub 30} of the ipsilateral lung and V{sub 10}, V{sub 30}, and mean dose of the heart on the integrated IMRT plans were lower than those of the conventional plans. The V{sub 5} and V{sub 10} of the ipsilateral lung and V{sub 5} of the heart were higher on the integrated IMRT plans (p < 0.05) than on conventional plans. Without an increase in the radiation dose to organs at risk, the integrated IMRT treatment plans improved the dose distribution of the supraclavicular region and showed better dose conformity and uniformity of the integrated target volume of the chest wall and supraclavicular region.

  9. ANOMALOUS ORIGIN OF THE LEFT VERTEBRAL ARTERY. Origen anómalo de la arteria vertebral izquierda

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    Divya Premchandran

    2016-03-01

    Full Text Available Las variaciones de los principales vasos arteriales son de importancia clínica. La arteria vertebral (VA normalmente surge de la arteria subclavia. El presente informe describe un origen anómalo de la arteria vertebral izquierda (LVA desde el arco aórtico entre el origen de la subclavia izquierda y la arteria carótida común izquierda. Esta arteria cruzó superficialmente de medial a lateral el tronco simpático izquierdo. La VA izquierda y derecha entraban en los agujeros transversos de la quinta vértebra cervical. Aunque el origen anómalo de la VA es bien conocida, su origen y la entrada a través del foramen transversal y sus relaciones con tronco simpático son de importancia clínica y durante los procedimientos vasculares en la región de cabeza y cuello tales como los stent de arteria carótida o vertebral y las intervenciones intracraneales. Variations of major arterial vessels are of clinical significance. The vertebral artery (VA normally arises from the subclavian artery. The present report describes an anomalous origin of the left vertebral artery (LVA from the aortic arch between the origin of the left subclavian and the left common carotid arteries. This artery was crossed superficially from medial to lateral by the left sympathetic trunk. The left and right VA entered the foramen on the transverse process of the fifth cervical vertebra. Though the anomalous origin of the VA is known, its origin and entry through the transverse foramen and its relations with sympathetic trunk are of importance during clinical and vascular procedures in the head and neck region like carotid artery stents, VA stents and intracranial interventions.

  10. Entre el humanismo cívico y el liberalismo de izquierda

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    Daguerre, Martín

    2005-12-01

    Full Text Available I shall begin by exposing the «humanist» criticism of leftwing liberalism and analizing W. Kymlicka's left liberal response to it, while highlighting its coincidences with classical republicanism. I shall then argue that, even if we accept Kymlicka's response, leftwing liberalism is still problematic due to its difficulty in generating political participation. Liberal separation of ethics and politics renders political participation in unjust societies pointless. In order to surmount this problem, we need to resort to the intrinsic value of participation, as humanists do, while avoiding a defense of participation for its own sake, that would carry counter intuitive consequences, as shown by Kymlicka in his defense of liberalism. With a view to avoiding the problems of both liberalism and humanism, I shall draw an analogy between friendship and political relationships and propose a definition of the latter that will show we need not incur the dangers of appealing to religious or national identities or the like in order make political participation intrinsicly valuable.

    Comenzaré exponiendo la crítica «humanista» al liberalismo de izquierda y analizando la respuesta a la misma que, desde esta última postura, ofrece W. Kymlicka, y destacaré sus coincidencias con el republicanismo clásico. Argumentaré luego que, aun aceptando la respuesta de Kymlicka, el liberalismo de izquierda no deja de tener dificultades a la hora de generar participación ciudadana. La diferenciación que hace entre ética y política hace que carezca de sentido la participación política en sociedades injustas. Para superar este problema, es necesario apelar --como los humanistas- al valor intrínseco de la participación, pero evitando una defensa de la participación por la participación misma, que acarrearía -como señala Kymlicka en su defensa del liberalismo- consecuencias contraintuitivas. A fin de evitar tanto los problemas del liberalismo como los

  11. A retrospective study of different local treatments in breast cancer patients with synchronous ipsilateral supraclavicular lymph node metastasis.

    Science.gov (United States)

    Chang, Xin-Zhong; Yin, Jian; Sun, Jinyan; Zhang, Xue-Hui; Cao, Xu-Chen

    2013-11-01

    To evaluate the local treatment outcome and efficacy of supraclavicular lymph node dissection and radical radiotherapy for breast cancer patients with synchronous ipsilateral supraclavicular lymph node metastasis (ISLM). A total of 29 patients with ISLM in the absence of distant metastases were retrospectively analyzed. All patients received radical or modified radical mastectomy and systemic therapy. Thirteen patients received supraclavicular lymph node dissection surgery and the other patients were treated with radical radiotherapy. At the median follow-up of 47 months, 23 patients had developed distant metastases. The 3-year distant metastasis-free survival (DMFS) rates were 46.2% for the supraclavicular lymph node dissection group and 31.3% for the radical radiotherapy group. The 5-year overall survival rates were 46.2% for the supraclavicular lymph node dissection group and 37.5% for the radical radiotherapy group. Breast cancer with ISLM should be considered as a locoregional disease. Besides systemic therapy, local therapy may be helpful in enhancing local control and correspondingly reducing distant metastasis. In some individual patients, supraclavicular lymph node dissection might get a good prognosis.

  12. El giro a la izquierda frustrado en Perú: el caso de Ollanta Humala

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    Maxwell A. Cameron

    2009-01-01

    Full Text Available En Perú, la campaña de elecciones de 2006 fue perturbada por el levantamiento inesperado del candidato nacionalista radical, Ollanta Humala. A pesar de ganar una pluralidad de 31% del voto en la primera vuelta, Humala perdió en la segunda votación, con un margen de 47 a 53%, frente a Alan García Pérez de la Alianza Popular Revolucionaria Americana (apra. Perú no sólo decidió no elegir a un presidente de izquierda, sino que fue el único país en los Andes que votó en elecciones nacionales en los últimos años por un líder que venía del sistema de partidos establecidos. Este trabajo analiza el origen y la naturaleza de la candidatura de Humala, evalúa hasta qué punto su campaña reflejó la debilidad del sistema de partidos, y determina si su candidatura reflejó un repudio a las políticas neoliberales y el descontento con el estado de la democracia o el rendimiento de los gobiernos elegidos.

  13. Infancia, dictadura y resistencia: hijos e hijas de la izquierda chilena (1973-1989

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    Patricia Eliana Castillo-Gallardo

    2015-01-01

    Full Text Available En este artículo de investigación recuperamos la voz de los hijos-niñose hijas-niñas de la gente militante de la izquierda de Chile, a partir del análisis de sus produccionessimbólicas y registros de la vida cotidiana tales como cartas, dibujos, objetos realizados entre 1973y 1989, y entrevistas registradas en documentales de la época que se encuentran actualmente en elMuseo de la Memoria y los Derechos Humanos de Santiago de Chile, analizadas desde la perspectivade los nuevos estudios de la infancia. Reflexionamos respecto al modo en que los niños y niñaselaboran su juicio y sentido de la realidad y construyen un sentido ético que dialoga con la herenciaintergeneracional, pero la excede, reflejando su activa participación en la construcción de unacomunidad afectiva que trasciende los vínculos consanguíneos.

  14. Infancia, dictadura y resistencia: hijos e hijas de la izquierda chilena (1973-1989

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    Patricia Eliana Castillo-Gallardo, Chile

    2015-07-01

    Full Text Available (Descriptivo En este artículo de investigación recuperamos la voz de los hijos-niños e hijas-niñas de la gente militante de la izquierda de Chile, a partir del análisis de sus producciones simbólicas y registros de la vida cotidiana tales como cartas, dibujos, objetos realizados entre 1973 y 1989, y entrevistas registradas en documentales de la época que se encuentran actualmente en el Museo de la Memoria y los Derechos Humanos de Santiago de Chile, analizadas desde la perspectiva de los nuevos estudios de la infancia. Reflexionamos respecto al modo en que los niños y niñas elaboran su juicio y sentido de la realidad y construyen un sentido ético que dialoga con la herencia intergeneracional, pero la excede, reflejando su activa participación en la construcción de una comunidad afectiva que trasciende los vínculos consanguíneos.

  15. Imágenes y representaciones en el periodismo de izquierda en México

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    Maricruz Castro Ricalde

    2006-01-01

    Full Text Available El artículo presenta los resultados de una investigación acerca de los imaginarios de la cinematografía dirigida por mujeres, creados por la prensa de izquierda en México durante la década de los ochenta. El modelo de análisis aplicado parte de la propuesta de Michel Pêcheux sobre las formaciones imaginarias, pero tomando en cuenta las condiciones de producción, circulación y recepción del discurso, y no sólo el estudio de los elementos intradiscursivos, de manera acorde con los presupuestos de la Escuela Francesa del Discurso. La de los ochenta fue una época en la cual el movimiento feminista en México parecía haberse consolidado y, como consecuencia, podría suponerse el interés de los medios de comunicación hacia los problemas de género, el quehacer femenino y sus ámbitos de acción, especialmente en aquellos medios que acababan de surgir como alternativa a las tendencias oficiales.

  16. The use of the pedicled supraclavicular flap in noma reconstructive surgery.

    Science.gov (United States)

    Hartman, Ed H M; Van Damme, Philip A; Sauter, Hartwig; Suominen, Sinikka H H

    2006-01-01

    Three noma patients with large unilateral facial defects were reconstructed using the pedicled supraclavicular flap technique in the Noma Children Hospital in Sokoto, Nigeria. The results are-although not completely perfect-encouraging enough to report and to repeat the technique in future reconstructive noma surgery after moderate modifications. It is advised not to tunnel the pedicle in the neck, but instead to open the neck. Then, the flap can be inset in a Z-plasty fashion to close the neck without the chance of compression of the pedicle of the flap. In this way flap necrosis can be prevented, without the risk of a scar contracture of the neck. Another technique, which can prevent partial flap necrosis and loss of tissue, with the need for secondary stage interventions, is a delay procedure of the flap. Incorporation of the fascia in the pedicled supraclavicular flap can be another option to fulfil the abovementioned requirements.

  17. Supraclavicular node metastasis from thoracic esophageal carcinoma: A surgical series from a Japanese multi-institutional nationwide registry of esophageal cancer.

    Science.gov (United States)

    Tachimori, Yuji; Ozawa, Soji; Numasaki, Hodaka; Matsubara, Hisahiro; Shinoda, Masayuki; Toh, Yasushi; Udagawa, Harushi

    2014-10-01

    In the present TNM classification, involvement of supraclavicular nodes is defined as distant metastases. However, the therapeutic value of supraclavicular node dissection remains controversial. The purpose of this study was to evaluate the survival benefit of dissection of metastases to the supraclavicular lymph nodes in patients with thoracic esophageal carcinoma by using a large nationwide registry of esophageal cancer maintained by the Japanese Esophageal Society. The study group comprised 1309 patients with thoracic esophageal carcinoma treated in 2001, 2002, and 2003, who underwent esophagectomy with 3-field dissection for curative intent, and in whom the locations of pathologic metastatic lymph nodes and outcome evaluations were available. Of 1309 patients, 559 (42.7%) had no nodal metastases, 560 (42.8%) had at least 1 positive node but were supraclavicular node-negative, and 190 (14.5%) had supraclavicular node metastases. The 5-year survival was 73.7% for patients with N0, 40.4% for node-positive patients without supraclavicular node disease, and 24.1% for patients with supraclavicular node metastasis. In a multivariate analysis, male sex (Pnodes (PSupraclavicular node metastasis was not significant (P=.062). The survival benefit of dissection of metastases to the supraclavicular lymph nodes was indicated in patients with thoracic esophageal carcinoma. Supraclavicular nodes appear to be regional nodes similar to other regional nodes. Copyright © 2014 The American Association for Thoracic Surgery. Published by Elsevier Inc. All rights reserved.

  18. Hydrocephaly management in patients with tumors in the posterior fossa. Manejo de la hidrocefalia en pacientes con tumores de fosa posterior.

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    Omar López Arbolay.

    2005-11-01

    Full Text Available Introduction: Preoperative hydrocephalus is reported in about 80 % of posterior fossa tumor patients and in 15-40% of cases postoperative treatment for persistent or progressive hydrocephalus is required. There is no consensus on the way hydrocephalus should be managed before, during, and after PF surgery. Objective: To determine the presence of hidrocephalia in the tumors of the PF and the therapeutic focus in our means. Methods: We report a descriptive, retrospective study of 10 adult patients with posterior fossa mass lesions and obstructive hydrocephalus who were managed medically for compensate intracranial hypertension plus observation and were operated through posterior fossa craniectomy and tumor excision as unique method of surgical treatment. Results: In all 10 cases clinical improvement was obtained immediately after medical treatment. Circulation of cerebrospinal fluid (CSF was totally restored only by tumor excision in 9 patients. The other case had progression of hydrocephalus after surgery and a ventriculoperitoneal shunt was inserted. Radiological normal sized ventricles was obtained between one and two months of surgery Conclusions: Surgical elimination of CFS circulation obstacle helped by medical treatment for lower intracranial pressure should be considered as a safe option in adult patients, reserving endoscopic ventriculostomy and shunt insertion for cases with persistent or progressive hydrocephalus after treatment. Prospective multicenters randomized trials are needed to obtain stronger evidences. Fundamento: La hidrocefalia preoperatoria se reporta en el 80 % de los pacientes con tumores de fosa posterior y en 15-40 % de los casos se necesita tratamiento postoperatorio para hidrocefalia persistente o progresiva. No existe consenso en cuanto a la forma en que la hidrocefalia debe ser tratada antes, durante, o después de

  19. COMPARISON OF THE EFFECTS OF FENTANYL AND DEXMEDETOMIDINE IN SUPRACLAVICULAR BRACHIAL PLEXUS BLOCK ACHIEVED WITH ROPIVACAINE

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    Soma C.

    2015-07-01

    Full Text Available BACKGROUND & OBJECTIVES: Supraclavicular block of brachial plexus provides complete and reliable anaesthesia for upper limb surgeries. Ropivacaine, is an affective local anaesthetic in for brachial plexus anaesthesia. It is a potent blocker of Aδ and C fibres, rendering good sensory effect but le ss motor blockade. We evaluated the anaesthetic quality and length of analgesia with the addition of either fentanyl or dexmedetomidine to ropivacaine for Supraclavicular brachial plexus block. METHODS: In a prospective clinical trial, 90 patients were ran domly allocated to either receive 30 ml ropivacaine 0.5% (Group R, 30 ml ropivacaine 0.5% with fentanyl 50 mcg (Group RF or 30 ml ropivacaine 0.5% with dexmedetomedine 50 mcg (Group RD in Supraclavicular brachial plexus. The characteristics for anaesthe sia and analgesia were assessed for the three groups. OBSERVATIONS: Demographic profile was comparable in the groups. The onset of analgesia and time to complete analgesia was enhanced in Group RD and Group RF compared to Group R. Prolongation of sensory b lockade and motor blockade with extended duration of postoperative analgesia was observed in Group RD and Group RF compared to Group R. There were minimum haemodynamic disturbances and side - effects in any group except f or Grade 3 sedation score which was f requently noted in patients receiving dexmedetomidine as adjunct. RESULTS: Compared to the use of ropivacaine 0.5%, 30 ml alone for supraclavicular brachial plexus block, the addition of 50 mcg fentanyl or 50 mcg dexmedetomidine to ropivacaine enhanced onset of block and also increased duration of surgical anaesthesia with prolongation of post - operative analgesia. Furthermore blockade characteristics improved better with addition of dexmedetomodine than fentanyl without increasing incidence of unwanted s ide - effects.

  20. ULTRASOUND GUIDED SUPRACLAVICULAR BRACHIAL PLEXUS BLOCK WITH AND WITHOUT MAGNESIUM SULPHATE: A COMPARATIVE STUDY

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    Narmatha

    2016-05-01

    Full Text Available BACKGROUND Many drugs have been used as adjuvants to local anaesthetics to prolong the duration of analgesia after a peripheral nerve block. In this study, we evaluate the effects of adding MgSO4 to local anaesthetics in supraclavicular block to prolong the duration of analgesia. AIM AND OBJECTIVES To compare the effect of addition of MgSO4 to local anaesthetics in supraclavicular block and study the onset of sensory blockade, motor blockade, duration of motor blockade and duration of analgesia. MATERIALS AND METHOD This study was conducted in 60 patients of ASA Grade 1 and 2, undergoing upper limb orthopaedic procedures using ultrasoundguided supraclavicular block after getting Ethical Committee approval. They were divided into two groups of 30 each. Group 1 received 1.5% adrenalized lignocaine 13 mL + 0.5% bupivacaine 13 mL and 2 mL of 10% MgSO4. Group 2 received 1.5% adrenalized lignocaine 13 mL + 0.5% bupivacaine 13 mL and 2 mL of 0.9% normal saline. Following data were recorded for 24 hrs. after surgeryOnset and duration of sensory and motor blockade, analgesic duration using VAS pain score and side effects. RESULTS The duration of analgesia was significantly longer in MgSO4 group than in saline group. In MgSO4 group, duration was 834 minutes Vs 276 minutes in normal saline group. The p value was <0.0001, which was significant. But onset times of sensory and motor blockade were not significantly different between the two groups. Also there was no significant difference observed in the side effects between the groups. CONCLUSION The addition of 10% MgSO4 2 mL (200 mg as adjuvant to local anaesthetic for supraclavicular block prolongs the duration of analgesia.

  1. COMPARISON BETWEEN ULTRASOUND-GUIDED SUPRACLAVICULAR AND INFRACLAVICULAR APPROACHES FOR SUBCLAVIAN VENOUS CATHETERISATION IN ADULTS

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    Paul Ovungal

    2016-05-01

    Full Text Available BACKGROUND The Subclavian Vein (SV is one of the preferred route for central venous catheterisation. There is limited data comparing the efficacy of Ultrasound (US guided Supraclavicular (SC and Infraclavicular (IC approaches for SV cannulation in India. The purpose of this study was to compare the effectiveness of these procedures. METHODOLOGY We selected 130 patients aged ≥18 years (Mean age 59, men 57% and recruited them equally into a supraclavicular and infraclavicular groups on alternate basis. Catheterisation was done by a single experienced anaesthesiologist using standard protocols. Information on age, sex, time for locating the vein, puncture time, number of attempts, catheter insertion time and incidence of complications were collected using a structured proforma. Data were analysed comparing the two groups using SPSS. RESULTS The mean time for locating the vein was 24 seconds (s in the infraclavicular group which is significantly higher than that in the supraclavicular group, 17s (p<0.001. The puncture time was 54 s in the IC group and 40 s in the SC group (p=0.001. Catheterisation time was 132 s in the IC group and 120 s in the SC group (p=0.003. Number of multiple attempts was 22 in the IC group and 8 in the SC group (p=0.005. There were no complications and no guide wire misplacements in either group. CONCLUSION The supraclavicular approach for US-guided subclavian vein catheterisation in adults is clinically more advantageous in terms of shorter time for location, puncture time, catheterisation time, lower number of attempts & a potentially lower incidence of complications when compared to the infraclavicular approach.

  2. Metastases in supraclavicular lymph nodes in lung cancer: assessment with palpation, US, and CT.

    Science.gov (United States)

    van Overhagen, Hans; Brakel, Koen; Heijenbrok, Mark W; van Kasteren, Jan H L M; van de Moosdijk, Cees N F; Roldaan, Albert C; van Gils, Ad P; Hansen, Bettina E

    2004-07-01

    To compare ultrasonography (US), computed tomography (CT), and palpation for diagnosing supraclavicular lung cancer metastases and to assess the effect of proved metastases on TNM stage and diagnostic work-up. One hundred seventeen consecutive patients (91 men and 26 women; mean age, 64.0 years) underwent palpation, US, and CT of supraclavicular regions and chest and upper abdominal CT. Fine-needle aspiration cytologic (FNAC) analysis was performed in patients with nodes with a short-axis diameter of 5 mm or greater; cytologic diagnosis was used as the standard of reference. Sensitivities of palpation, US, and CT were compared with McNemar testing. Relationship between size and palpability of nodes with metastasis was evaluated with logistic regression. Supraclavicular metastases were diagnosed cytologically in 30 (26%) of 117 patients: eight (31%) of 26 patients with small cell lung cancer (SCLC) and 22 (24%) of 91 patients with non-small cell lung cancer (NSCLC). Sensitivities of US (1.00; 30 of 30 patients) and CT (0.83; 25 of 30 patients) for detection of metastases were significantly higher (P nodes with metastasis (mean diameter, 25.2 mm) were significantly larger than nonpalpable nodes with metastasis (mean diameter, 13.7 mm) (P =.002). To have a 50% chance of being palpable, nodes with metastasis had to have a diameter of at least 22.3 mm. TNM stage was changed in three of 91 patients with NSCLC, and further invasive diagnostic procedures were prevented in 11 of such patients because it was proved that nonpalpable nodes had metastases. Supraclavicular lung cancer metastases were cytologically proved in 26% of patients. Nodes with metastasis were only palpable when markedly enlarged. US tripled the sensitivity of palpation for detection of metastases. Results of US and US-guided FNAC analysis can change the work-up in patients with lung cancer. Copyright RSNA, 2004

  3. Limited Supraclavicular Radiation Field in Breast Cancer With ≥ 10 Positive Axillary Lymph Nodes.

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    Yu, Jeong Il; Park, Won; Choi, Doo Ho; Huh, Seung Jae; Nam, Seok Jin; Kim, Seok Won; Lee, Jeong Eon; Kil, Won Ho; Im, Young-Hyuck; Ahn, Jin Seok; Park, Yeon Hee; Cho, Eun Yun

    2016-06-01

    The present study was conducted to evaluate the patterns of recurrence and factors related to axillary or supraclavicular recurrence (ASR) and to suggest the probable indications of supraclavicular radiotherapy (SCRT) field modification for breast cancer patients with ≥ 10 axillary lymph node (LN) metastases who had received the current standard systemic management and limited-field SCRT. We performed a retrospective study of patients with breast cancer with ≥ 10 axillary LN metastases who had received standard surgery with postoperative RT, including limited SCRT (level III and supraclavicular area) and taxane-based adjuvant chemotherapy (except for neoadjuvant chemotherapy), from January 2000 to June 2012. ASR was defined as recurrence to levels I to III of the axillary or supraclavicular area. The present study included 301 patients with breast cancer with ≥ 10 axillary LN metastases. The median follow-up period was 59.1 months (range, 7.4-167.9 months). Overall, 32 cases (10.6%) of locoregional recurrence were observed, and 27 patients (9.0%) exhibited ASR. Additionally, 16 patients (5.3%) developed recurrence in levels I or II of the axillary area, which are not included in the SCRT field. ASR-free survival was significantly related to the LN ratio (LNR) in both univariate and multivariate analysis. ASR was the most prevalent locoregional recurrence pattern in patients with breast cancer with ≥ 10 axillary LN metastases, and LNR was a significant prognostic factor for the development of ASR. Modification of the SCRT field, including the full axilla, should be considered in patients with a greater LNR. Copyright © 2015 Elsevier Inc. All rights reserved.

  4. Long-term symptoms after radiotherapy of supraclavicular lymph nodes in breast cancer patients.

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    Lundstedt, Dan; Gustafsson, Magnus; Steineck, Gunnar; Alsadius, David; Sundberg, Agnetha; Wilderäng, Ulrica; Holmberg, Erik; Johansson, Karl-Axel; Karlsson, Per

    2012-05-01

    Irradiation of the supraclavicular lymph nodes has historically increased the risk of brachial plexopathy. We report long-term symptoms after modern radiotherapy (based on 3D dose planning) in breast cancer patients with or without irradiation of the supraclavicular lymph nodes. We collected information from 814 women consecutively treated with adjuvant radiotherapy for breast cancer. The women had breast surgery with axillary dissection (AD) or sentinel node biopsy (SNB). The breast area was treated to 50 Gy in 2.0 Gy fractions. Women with >three lymph node metastases had regional radiotherapy (RRT) to the supraclavicular lymph nodes. Three to eight years after radiotherapy, they received a questionnaire asking about paraesthesia, oedema, pain, and strength in the upper limb. Paraesthesia was reported by 38/192 (20%) after AD with RRT compared to 68/505 (13%) after AD without RRT (relative risk [RR] 1.47; 95% confidence interval [CI] 1.02-2.11) and by 9/112 (8%) after SNB without RRT (RR 2.46; 95% CI 1.24-4.90). Corresponding risks adjusted for oedema (RR 1.28; 95% CI 0.93-1.76) and (RR 1.75; 95% CI 0.90-3.39). In women ≤ 49years with AD and RRT, 27% reported paraesthesia. No significant pain or decreased strength was reported after RRT. Radiotherapy to the supraclavicular lymph nodes after axillary dissection increases the occurrence of paraesthesia, mainly among younger women. When adjusted for oedema the contribution from radiotherapy is no longer formally statistically significant indicating that there is also an indirect effect mediated by the oedema. Copyright © 2012 Elsevier Ireland Ltd. All rights reserved.

  5. Measurement of Thyroid Dose by TLD arising from Radiotherapy of Breast Cancer Patients from Supraclavicular Field

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    Farhood B.

    2016-06-01

    Full Text Available Background: Breast cancer is the most frequently diagnosed cancer and the leading global cause of cancer death among women worldwide. Radiotherapy plays a significant role in treatment of breast cancer and reduces locoregional recurrence and eventually improves survival. The treatment fields applied for breast cancer treatment include: tangential, axillary, supraclavicular and internal mammary fields. Objective: In the present study, due to the presence of sensitive organ such as thyroid inside the supraclavicular field, thyroid dose and its effective factors were investigated. Materials and Methods: Thyroid dose of 31 female patients of breast cancer with involved supraclavicular lymph nodes which had undergone radiotherapy were measured. For each patient, three TLD-100 chips were placed on their thyroid gland surface, and thyroid doses of patients were measured. The variables of the study include shield shape, the time of patient’s setup, the technologists’ experience and qualification. Finally, the results were analyzed by ANOVA test using SPSS 11.5 software. Results: The average age of the patients was 46±10 years. The average of thyroid dose of the patients was 140±45 mGy (ranged 288.2 and 80.8 in single fraction. There was a significant relationship between the thyroid dose and shield shape. There was also a significant relationship between the thyroid dose and the patient’s setup time. Conclusion: Beside organ at risk such as thyroid which is in the supraclavicular field, thyroid dose possibility should be reduced. For solving this problem, an appropriate shield shape, the appropriate time of the patient’s setup, etc. could be considered.

  6. Burned-out tumor of the testis presenting as supraclavicular lymphadenopathy

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    Kebapci, Mahmut; Aslan, Ozgur [Dept. of Radiology, Osmangazi University School of Medicine, Meselik, Eskisehir (Turkey); Can, Cavit [Department of Urology, Osmangazi University School of Medicine, Meselik, Eskisehir (Turkey); Isiksoy, Serap; Oner, Ulku [Department of Pathology, Osmangazi University School of Medicine, Meselik, Eskisehir (Turkey)

    2002-02-01

    Burned-out tumor of the testis is a rare clinical entity. It generally presents with metastases and is nonpalpable in testicular palpation. We present a case of testicular burned-out tumor having supraclavicular and retroperitoneal lymph node metastases. Imaging findings of such tumors have insufficiently been documented in radiology literature. Scrotal sonography is crucial in detecting the regressed tumors especially in patients with extragonadal metastasis of a testicular primary. (orig.)

  7. The supraclavicular fossa ultrasound view for central venous catheter placement and catheter change over guidewire.

    Science.gov (United States)

    Kim, Se-Chan; Klebach, Christian; Heinze, Ingo; Hoeft, Andreas; Baumgarten, Georg; Weber, Stefan

    2014-12-23

    The supraclavicular fossa ultrasound view can be useful for central venous catheter (CVC) placement. Venipuncture of the internal jugular veins (IJV) or subclavian veins is performed with a micro-convex ultrasound probe, using a neonatal abdominal preset with a probe frequency of 10 Mhz at a depth of 10-12 cm. Following insertion of the guidewire into the vein, the probe is shifted to the right supraclavicular fossa to obtain a view of the superior vena cava (SVC), right pulmonary artery and ascending aorta. Under real-time ultrasound view, the guidewire and its J-tip is visualized and pushed forward to the lower SVC. Insertion depth is read from guidewire marks using central venous catheter. CVC is then inserted following skin and venous dilation. The supraclavicular fossa view is most suitable for right IJV CVC insertion. If other insertion sites are chosen the right supraclavicular fossa should be within the sterile field. Scanning of the IJVs, brachiocephalic veins and SVC can reveal significant thrombosis before venipuncture. Misplaced CVCs can be corrected with a change over guidewire technique under real-time ultrasound guidance. In conjunction with a diagnostic lung ultrasound scan, this technique has a potential to replace chest radiograph for confirmation of CVC tip position and exclusion of pneumothorax. Moreover, this view is of advantage in patients with a non-p-wave cardiac rhythm were an intra-cardiac electrocardiography (ECG) is not feasible for CVC tip position confirmation. Limitations of the method are lack of availability of a micro-convex probe and the need for training.

  8. Faster onset time of supraclavicular brachial plexus block using local anesthetic diluted with dextrose

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    Hong Jin Lim

    Full Text Available Abstract Background and objectives: A high sodium concentration is known to antagonize local anesthetics when infiltrated around neural tissue. Thus, we hypothesized that the onset time for sensory and motor blockade, in supraclavicular brachial plexus block using ropivacaine diluted with dextrose would be shorter than with saline. Methods: Patients scheduled for upper limb surgery were randomized to receive ultrasound guided supraclavicular brachial plexus block with 0.5% ropivacaine. Evaluation of sensory and motor blockade was performed every 5 min for 60 min. Patients were followed-up on postoperative day 1, and between days 7 and 10 for the presence of any complications. Twenty-five patients in each group were analyzed. Results: Mean time for onset of analgesia for the dextrose group was 37.6 ± 12.9 min while the mean time for the saline group was 45.2 ± 13.9 min with a p-value of 0.05. The effect size was 0.567, which was moderate to large. No major complications were observed. Conclusion: We conclude that there was a decrease in onset time of analgesia when dextrose was used as a diluent instead of saline for ultrasound guided supraclavicular block.

  9. Predictive factors for supraclavicular lymph node recurrence in N1 breast cancer patients.

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    Kong, Moonkyoo; Hong, Seong Eon

    2013-01-01

    The purpose of this study was to identify predictive factors for supraclavicular lymph node recurrence (SCLR) in N1 breast cancer patients and define a high-risk subgroup who might benefit from supraclavicular nodal radiotherapy (RT). From January 1995 to December 2009, 113 breast cancer patients with 1 to 3 positive axillary lymph nodes were enrolled in this study. All patients underwent breast-conserving surgery (BCS) or modified radical mastectomy (MRM). RT was given to all patients who received BCS. Among the patients given MRM, those with breast tumors >5 cm in size received RT. Regional nodal irradiation was not applied. Systemic chemotherapy was given to 105 patients (92.9%). Patient data were retrospectively reviewed and analyzed to identify predictive factors for SCLR. The median follow-up duration was 6.5 years, with 5- and 10-year actuarial SCLR rates of 9.3% and 11.2%, respectively. Factors associated with SCLR on univariate analysis included histologic grade, number of dissected axillary lymph nodes, lymphovascular invasion, extracapsular extension (ECE), and adjuvant chemotherapy. On multivariate analysis, histologic grade and ECE remained significant. The patient group with grade 3 and ECE had a significantly higher rate of SCLR compared with the remainder (5-year SCLR rate; 71.4% vs. 4.0%, pSupraclavicular nodal RT is necessary in N1 breast cancer patients featuring histologic grade 3 and ECE.

  10. Dexamethasone added to mepivacaine prolongs the duration of analgesia after supraclavicular brachial plexus blockade.

    Science.gov (United States)

    Parrington, Simon J; O'Donnell, Dermot; Chan, Vincent W S; Brown-Shreves, Danielle; Subramanyam, Rajeev; Qu, Melody; Brull, Richard

    2010-01-01

    Corticosteroids have been used successfully to prolong the duration of local anesthetic action after peripheral nerve and epidural blockade. We hypothesized that the addition of dexamethasone to mepivacaine would prolong the duration of analgesia after ultrasound-guided supraclavicular brachial plexus block for patients undergoing upper-limb surgery. After Federal Health Department and institutional review board approval, 45 adult patients undergoing elective hand or forearm surgery under supraclavicular brachial plexus blockade were randomized to receive either 30 mL mepivacaine 1.5% plus dexamethasone 8 mg (4 mg/mL), or 30 mL mepivacaine 1.5% plus 2 mL normal saline. The primary outcome measure was duration of analgesia. Secondary outcomes included onset times of sensory and motor blockade, pain and satisfaction scores, analgesic consumption, and block-related complications. Patient characteristics were similar between groups. The median duration of analgesia was significantly prolonged in the Dexamethasone group (332 mins; interquartile range, 225-448 mins) compared with the Normal Saline group (228 mins; interquartile range, 207-263 mins; P = 0.008). The onset times of sensory and motor block were similar between the groups. Complications were minor and transient and did not differ between groups at 2 weeks postoperatively. The addition of dexamethasone to mepivacaine prolongs the duration of analgesia but does not reduce the onset of sensory and motor blockade after ultrasound-guided supraclavicular block compared with mepivacaine alone.

  11. Occult supraclavicular lymph node metastasis identified by FDG-PET in patients with carcinoma of the uterine cervix.

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    Tran, Binh N; Grigsby, Perry W; Dehdashti, Farrokh; Herzog, Thomas J; Siegel, Barry A

    2003-09-01

    The objective was to evaluate the frequency and prognostic significance of occult supraclavicular lymph node metastases identified by 2-[(18)F]fluoro-2-deoxy-D-glucose-positron emission tomography (FDG-PET) in patients with cervical carcinoma. Between March 1998 and January 2002, 186 patients with a new diagnosis of cervical cancer underwent whole-body FDG-PET before therapy. Fourteen patients had abnormal FDG uptake in left supraclavicular lymph nodes without palpable disease. All 14 patients underwent sonographically guided fine-needle aspiration of the left supraclavicular lymph nodes. One patient refused therapy, 6 were treated with palliative intent, and 7 received definitive irradiation and concurrent chemotherapy. Survival was calculated by the Kaplan-Meier method. The overall frequency of FDG-positive left supraclavicular lymph nodes was 8% (14/186). Metastasis was pathologically confirmed in all 14 patients. Therefore, the positive predictive value of abnormal FDG uptake in left supraclavicular lymph nodes was 100%. Nineteen percent of all patients (35/186) had abnormal FDG uptake in para-aortic lymph nodes. The frequency of positive FDG uptake in the left supraclavicular lymph nodes was 40% (14/35) in those with para-aortic lymph node uptake and 15% in those with stage IIIb disease. The median overall survival was 7.5 months. At last follow-up, 11 patients were dead and 3 were alive with disease. All patients developed metastatic disease, most commonly to bone and lung. The positive predictive value of abnormal FDG uptake in left supraclavicular lymph nodes was 100%. Prognosis for these patients was dismal despite aggressive therapy.

  12. Ultrasound guided fine-needle aspiration biopsy of metastases in nonpalpable supraclavicular lymph nodes in lung cancer patients.

    Science.gov (United States)

    Kendirlinan, Resat; Ozkan, Gülcihan; Bayram, Mehmet; Bakan, Nur Dilek; Tutar, Mehmet; Gür, Aygün; Camsari, Güngör

    2011-08-31

    To assess frequency and significance of enlarged nonpalpable supraclavicular lymph nodes with routine ultrasound (US) evaluation and US-guided fineneedle aspiration biopsy (FNAB) for the diagnosis and staging of patients with lung cancer. 106 consecutive patients with lung cancer and nonpalpable supraclavicular lymph nodes were evaluated with cervical US for the presence of pathological lymph nodes. FNAB was performed in patients with nodes with short-axis > 5 mm, rounded shape and missing echogenic hilum. 27 (25.5%) patients had enlarged supraclavicular lymph nodes on US. Fourteen patients (13.2%) had cytologically proven lymph node involvement. Supraclavicular lymph node metastasis was more frequent in patients with mediastinal invasion (p = 0.0001) and patients with enlarged lymph nodes on upper paratracheal stations on thorax CT (p = 0.0001). No relation was found between supraclavicular lymph node involvement and T stage (p = 0.27), distant metastasis (p = 0.50) or histological type (p = 0.80). Three patients were upstaged from IIIA to IIIB status. US-guided FNAB was the only diagnostic method in 2 patients. US-guided FNAB is a simple and safe procedure which can document N3 stage of disease in lung cancer patients. Thereby more invasive and expensive diagnostic procedures can be avoided in selected lung cancer patients.

  13. Ultrasound guided fine-needle aspiration biopsy of metastases in nonpalpable supraclavicular lymph nodes in lung cancer patients

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    Kendirlinan Resat

    2011-08-01

    Full Text Available Abstract Background and objectives To assess frequency and significance of enlarged nonpalpable supraclavicular lymph nodes with routine ultrasound (US evaluation and US-guided fineneedle aspiration biopsy (FNAB for the diagnosis and staging of patients with lung cancer. Materials and methods 106 consecutive patients with lung cancer and nonpalpable supraclavicular lymph nodes were evaluated with cervical US for the presence of pathological lymph nodes. FNAB was performed in patients with nodes with short-axis > 5 mm, rounded shape and missing echogenic hilum. Results 27 (25.5% patients had enlarged supraclavicular lymph nodes on US. Fourteen patients (13.2% had cytologically proven lymph node involvement. Supraclavicular lymph node metastasis was more frequent in patients with mediastinal invasion (p = 0.0001 and patients with enlarged lymph nodes on upper paratracheal stations on thorax CT (p = 0.0001. No relation was found between supraclavicular lymph node involvement and T stage (p = 0.27, distant metastasis (p = 0.50 or histological type (p = 0.80. Three patients were upstaged from IIIA to IIIB status. US-guided FNAB was the only diagnostic method in 2 patients. Conclusion US-guided FNAB is a simple and safe procedure which can document N3 stage of disease in lung cancer patients. Thereby more invasive and expensive diagnostic procedures can be avoided in selected lung cancer patients.

  14. Estudio hermenéutico de la izquierda colombiana como alternativa política de partido

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    Emma Doris López

    2013-07-01

    Full Text Available ResumenEl presente estudio hermenéutico parte de los argumentosplanteados en el seminario electivo de comportamientopolítico, en el Doctorado de Ciencias Políticas,orientado por el doctor José Enrique Molina.La interpretación política de la izquierda en Colombiaha incidido a través de la historia como una fuerzaque, a pesar de su fragmentación, hoy se está consolidandocomo una alternativa de partido que abarca el manejode los comportamientos electorales desde lo psicológicoy lo sociológico.Este artículo está fundamentado en Pérez (2006 y enlos planteamientos de Torcal y Mainwaring. Se trató deinterpretar la posición de la izquierda como política alternativapara el mejoramiento de los estados sociales enlos países de América Latina.Palabras clave: Hermenéutica, Política de izquierda,Comportamiento electoral. AbstractThis hermeneutic study of the arguments raised inthe seminar elective political behavior, the Ph.D. in PoliticalScience, guided by Dr. José Enrique Molina.The political interpretation of the left in Colombiahas affected through history as a power that, despite itsfragmentation, today is emerging as an alternative partythat covers the management of electoral behavior fromthe psychological and the sociological.This paper it is based on Pérez (2006 and approachesTorcal and Mainwaring. He tried to interpret the positionof the left as an alternative for improving social conditionsin Latin American politics.Keywords: Hermeneutics, Leftist politics, ElectoralbehaviorCómo

  15. Supraclavicular Lymph Node Metastasis from Various Malignancies: Assessment with 18F-Fluorodeoxyglucose Positron Emission Tomography/CT, Contrast-Enhanced CT and Ultrasound

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    Ryu, Eun Bi; Oh, Kyung Seung; Jeong, Kyung Soon [Dept. of Radiology, Kosin University Gospel Hospital, Kosin University College of Medicine, Busan (Korea, Republic of)

    2012-01-15

    The purpose of this study is to compare the usefulness of 18F-fluorodeoxyglucose positron emission tomography (18F-FDG PET)/CT, contrast-enhanced CT and ultrasound (US) for diagnosing metastatic supraclavicular lymph nodes. This study included 53 supraclavicular lymph nodes of 48 consecutive patients with various malignancies observed on 18F-FDG PET/CT, contrast-enhanced CT and US. Detection of supraclavicular lymph nodes was determined by 18F-FDG PET/CT where uptake was greater than that of surrounding tissue and contrast-enhanced CT with a node short-axis diameter of 5 mm or more. On US, we classified the supraclavicular lymph node as benign or malignant by sonographic criteria. The diagnostic values of these modalities were compared in the detection of metastatic supraclavicular lymph nodes. Metastatic supraclavicular lymph nodes were diagnosed cytologically in 44 (83%) of 53 lesions. In the detection of metastatic supraclavicular lymph nodes, the diagnostic accuracies of 18F-FDG PET/CT, contrast-enhanced CT, and US were 92%, 89%, and 91%, respectively. The specificity (67%) and negative predictive value (86%) of 18F-FDG PET/CT were higher than those of contrast-enhanced CT and US. 18F-FDG PET/CT is more useful for detecting and characterizing supraclavicular lymph nodes in patients with cancer, because of its high specificity and negative predictive value.

  16. Origen anómalo de la coronaria izquierda en la arteria pulmonar: resultados de la cirugía correctora

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    Andrés J. Schlichter; María I. Román; Christian Kreutzer; Ignacio Lugones

    2010-01-01

    IntroducciónEl origen anómalo de la arteria coronaria izquierda en la arteria pulmonar es una cardiopatía congénita rara que produce isquemia miocárdica con disfunción ventricular izquierda e insuficiencia mitral de grado variable. Las técnicas actuales han modificado la historia natural de esta enfermedad mediante el restablecimiento de un sistema de doble irrigación coronaria.ObjetivosEvaluar la experiencia institucional en la corrección quirúrgica del origen anómalo de la coronaria izquier...

  17. Isolated Supraclavicular Lymph Node Metastasis in Pancreatic Adenocarcinoma: A Report of Three Cases and Review of the Literature

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    Arundhati D Soman

    2010-11-01

    Full Text Available Context Supraclavicular lymph nodes represent a rare site of metastasis in pancreatic cancer. We report three cases of pancreatic adenocarcinoma with metastases to supraclavicular lymph nodes. Case report A 51-year-old male was diagnosed with locally advanced pancreatic adenocarcinoma on computed tomography (CT scan. He was recommended neoadjuvant chemotherapy followed by chemoradiation therapy. However, positron emission tomography (PET/CT scans and subsequent fine needle aspiration cytology showed supraclavicular lymph node metastasis. The patient received systemic chemotherapy for metastatic pancreatic adenocarcinoma. The second patient, a 66-year-old female with pancreatic adenocarcinoma, underwent pancreaticoduodenectomy and was found to have peripancreatic lymph node involvement. She received adjuvant chemotherapy and was followed-up with surveillance CT scans, which did not reveal any metastasis. However, the patient complained of neck swelling. PET/CT scan and biopsy revealed supraclavicular lymph node metastasis from a pancreatic adenocarcinoma primary. The third patient, a 79-year-old male with a past history of thyroid carcinoma who was treated with partial thyroidectomy, developed neck swelling 4 years after his surgery. Fine needle aspiration cytology was consistent with known papillary thyroid carcinoma. Staging evaluations revealed a pancreatic mass for which he underwent subtotal pancreatectomy and splenectomy. Histopathology revealed grade 3 pancreatic adenocarcinoma. Excisional biopsy of a supraclavicular lymph node showed metastatic pancreatic adenocarcinoma. PET/CT results were consistent with these findings. Conclusion In patients with pancreatic adenocarcinoma, supraclavicular lymph node metastasis represents an uncommon, but clinically significant finding that can lead to changes in treatment planning. PET imaging represents a valuable tool in the detection and follow up of these patients.

  18. Isolated supraclavicular lymph node metastasis in pancreatic adenocarcinoma: a report of three cases and review of the literature.

    Science.gov (United States)

    Soman, Arundhati D; Collins, Joseph M; DePetris, Giovanni; Decker, G Anton; Silva, Alvin; Moss, Adyr; Greer, Wendy; Ashman, Jonathan; Callister, Matthew; Borad, Mitesh J

    2010-11-09

    Supraclavicular lymph nodes represent a rare site of metastasis in pancreatic cancer. We report three cases of pancreatic adenocarcinoma with metastases to supraclavicular lymph nodes. A 51-year-old male was diagnosed with locally advanced pancreatic adenocarcinoma on computed tomography (CT) scan. He was recommended neoadjuvant chemotherapy followed by chemoradiation therapy. However, positron emission tomography (PET)/CT scans and subsequent fine needle aspiration cytology showed supraclavicular lymph node metastasis. The patient received systemic chemotherapy for metastatic pancreatic adenocarcinoma. The second patient, a 66-year-old female with pancreatic adenocarcinoma, underwent pancreaticoduodenectomy and was found to have peripancreatic lymph node involvement. She received adjuvant chemotherapy and was followed-up with surveillance CT scans, which did not reveal any metastasis. However, the patient complained of neck swelling. PET/CT scan and biopsy revealed supraclavicular lymph node metastasis from a pancreatic adenocarcinoma primary. The third patient, a 79-year-old male with a past history of thyroid carcinoma who was treated with partial thyroidectomy, developed neck swelling 4 years after his surgery. Fine needle aspiration cytology was consistent with known papillary thyroid carcinoma. Staging evaluations revealed a pancreatic mass for which he underwent subtotal pancreatectomy and splenectomy. Histopathology revealed grade 3 pancreatic adenocarcinoma. Excisional biopsy of a supraclavicular lymph node showed metastatic pancreatic adenocarcinoma. PET/CT results were consistent with these findings. In patients with pancreatic adenocarcinoma, supraclavicular lymph node metastasis represents an uncommon, but clinically significant finding that can lead to changes in treatment planning. PET imaging represents a valuable tool in the detection and follow up of these patients.

  19. The significance of a supraclavicular node metastasis in patients with breast cancer. A literature review

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    Debois, J.M. [Eeuwfeestkliniek, Antwerpen (Belgium). Dept. of Radiation Oncology

    1997-01-01

    Background: Data on the incidence, the risk factors, the possibilities of the different adjuvant therapies in the prevention and the prognosis of a supraclavicular metastatic node in a patient with breast cancer are rather scarce, when compared with the literature on axillary nodes. Material: Relevant literature. Results: In spite of the low attention in the literature, we could have an insight on its incidence, the impact of positive axillary nodes, the rather low efficiency of chemotherapy in preventing them and the more pronounced effect of locoregional radiotherapy. conclusion: The prognosis is rather dismal as supraclavicular nodes are mostly the prelude to new metastases. Supraclavicular nodes can well be treated but the treatment does not influence survival. (orig.) [Deutsch] Hintergrund: Die Inzidenz von supraklavikulaeren Lymphknotenmetastasen (SCN) haengt im wesentlichen ab von der Tumorgroesse, dem axillaeren Status, der adaequaten Ausraeumung der Axilla und von der adaequaten Durchfuehrung der Radiotherapie. Sie wird wahrscheinlich nicht von der adjuvanten Chemotherapie beeinflusst. Haeufig, d.h. in etwa 75%, sind zeitgleich weitere Fernmetastasen vorhanden. Eine spuraklavikulaere Lymphknotenmetastase ist - ebenso wie dies fuer axillaere Lymphknotenmetastasen bekannt ist - ein klarer Hinweis fuer eine hohe Wahrscheinlichkeit der Fernmetastasierung. Die Prognose von SCN ist schlecht, mit einigen Ausnahmen. Daher muss alles getan werden, um sie zu verhindern. Die Radiotherapie ist wahrscheinlich die beste Methode und sollte immer dann prophylaktisch im Bereich der Supraklavikularregion verabreicht werden, ebenso wie die Behandlung der Brustwand oder Brust, wenn die axillaeren Lymphknoten positiv sind. Die adjuvante Chemotherapie macht die adjuvante Radiotherapie nicht ueberfluessig. Schlussfolgerung: Es muss noch viel zur Erkennung von exakten Patientenparametern getan werden, die kritisch fuer die Entwicklung von SCN sind, um solche Patienten zur

  20. Izquierda y derecha en Venezuela:nuevas fuentes de diferenciación ideológica

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    José Guillermo García Chourio

    2003-01-01

    Full Text Available La tendencia en Venezuela durante las dos últimas elecciones presidenciales de una alineación del voto a partir de la propia ubicación que hace el elector en el continuo izquierda-derecha, ha venido cercando la volatilidad electoral que produce la erosión de las identidades partidistas dentro de los límites de dicho continuo. En pro de revelar si estas alineaciones están orientadas o no por los principios doctrinarios de tales nociones ideológicas, este trabajo identifica los valores que de manera coherente aparecen asociados a la posición de los venezolanos en el espectro izquierda-derecha. Mediante el análisis de regresión estadística sobre datos de la Encuesta Mundial de Valores para los años 1996 y 2000, se comprueba la hipótesis que a partir de la década de los noventa en adelante ha habido cambios en lo que entienden los venezolanos por tales dimensiones ideológicas, lo cual ha representado una redefinición de las mismas bajo nuevas fuentes de diferenciación vinculadas de manera directa con la vida cotidiana del individuo, rompiendo así con la tradicional coherencia ideológica que hasta entonces había presentado el ciudadano.

  1. La España democrática y la primera revista de izquierdas: 'La Calle' (1978-1982

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    Lic. Vanessa Sáiz Echezarreta

    1999-01-01

    Full Text Available En plena transición de la dictadura de Franco al régimen democrático en España, pudieron salir a la luz pública las revistas de ideología de izquierdas, revistas que llevaban casi cuatro décadas en el exilio o la clandestinidad. Una de las primeras en aparecer fue 'La Calle', subtitulada "La primera a la izquierda", en la que se tratan temas prohibidos como las nacionalidades, el terrorismo del País Vasco, etc. En ella colaboraron jóvenes como Alfaya, Raúl del Pozo, Vázquez Montalbán y otros periodistas que todavía hoy crean opinión pública en prensa, radio y televisión en España. Su desaparición coincidiendo con la llegada del Partido Socialista al poder, el año 1982, es un hito de difícil explicación y que intentan argumentar los autores del artículo.

  2. El contexto histórico del chavismo y los partidos políticos venezolanos de la izquierda

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    Rickard Lalander

    2008-01-01

    Full Text Available Muchos académicos han ignorado la importancia de conexiones históricas entre el movimiento político alrededor del Presidente venezolano Hugo Rafael Chávez Frías (Chavismo y los partidos políticos históricos de la izquierda. En este artículo se analizan las raíces, así como el desarrollo y la situación actual del Chavismo a través de consideraciones históricas sobre los partidos políticos izquierdistas del país. Se consideran aspectos de conflicto y cambio por dentro y fuera del Chavismo en el contexto de la democracia venezolana y los actores políticos de izquierda, tanto los que han estado asociados al movimiento de Chávez, como los de la presente y reciente oposición política. Asimismo, se consideran el carácter personalista del Chavismo y sus posibles implicaciones para el sistema partidista y los partidos políticos individuales.

  3. Postmastectomy radiation in supraclavicular and internal mammary regions of patients with breast cancer of stage II/III

    Institute of Scientific and Technical Information of China (English)

    MEI Xin; GUO Xiao-mao; ZHANG Zhen; CHEN Jia-yi

    2009-01-01

    @@ Adjuvant radiotherapy plays a vital role in the treatment of breast cancer, but irradiated area was not standardized. The ipsilateral chest wall and supraclavicular regions with or without internal mammary lymph nodes were reported in patients receiving postmastectomy radiotherapy.1,2 In our study, 133 consecutive patients with breast cancer of stage II/III who had received postmastectomy radiotherapy of supraclavicular and internal mammary regions at Cancer Hospital of Fudan University were analyzed for their survival and locoregional control as well as their relative prognostic predicator.

  4. The usefulness of combined axial and coronal computed tomography for the evaluation of metastatic supraclavicular lymph nodes.

    Science.gov (United States)

    Choi, Hyun Jin; Lee, Kyung Hee; Kim, Na Hee; Kim, Jun Ho; Hyun, In Young; Ryu, Jeong-Seon

    2015-01-01

    The purpose is to assess the value of adding coronal images for the identification of metastatic supraclavicular lymph nodes (LNs). Two radiologists reviewed axial images and combined axial and coronal images using thoracic computed tomography (CT) of 386 patients whose maximum standardized uptake value measured in a supraclavicular LN was ≥2.0 on a positron emission tomography. We compared sensitivity and agreement between readers before and after the addition of coronal images. For combined images, agreement was almost perfect (κ=0.982), and sensitivity was significantly higher (90.4%, Psupraclavicular metastasis. Copyright © 2015 Elsevier Inc. All rights reserved.

  5. Supraclavicular approach of central venous catheter insertion in critical patients in emergency settings: Re-visited

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    Gaurav Singh Tomar

    2013-01-01

    Full Text Available The supraclavicular approach was first put into clinical practice in 1965 by Yoffa and is an underused method for gaining central access. It offers several advantages over the conventional infraclavicular approach to the subclavian vein. At the insertion site, the subclavian vein is closer to the skin, and the right-sided approach offers a straighter path into the subclavian vein. Also, this site is often more accessible during CPR and surgical procedures. In patients who are obese, this anatomic area is less distorted and in patient with congestive heart failure and cervical spine instability repositioning is not required.

  6. Male Occult Breast Cancer First Manifesting as a Supraclavicular Lymph Node Metastasis: A Case Report

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    Maoyuan Zhao

    2017-06-01

    Full Text Available Male occult breast cancer has a lower incidence, later clinical stage at detection, poorer differentiation, worse prognosis, and metastasizes earlier than breast cancer in females due to its rarity and a lack of public awareness. We report a 64 year old male patient presenting with palpable masses in his left cervical region, in whom imaging was unremarkable, except for slightly enlarged axillary lymph nodes without increased metabolic activity and an area of high metabolic activity in the left supraclavicular fossa. The purpose of this case report is to present the imaging, pathological features, and our treatment for male OBC.

  7. Prostate adenocarcinoma presenting with supraclavicular node enlargement: report of a case.

    Science.gov (United States)

    Platania, Marco; Bajetta, Emilio; Guadalupi, Valentina; Buzzoni, Roberto; Colecchia, Maurizio

    2008-01-01

    This report describes a case of prostate adenocarcinoma presenting with supraclavicular adenopathy and deep venous thrombosis in the ipsilateral arm. Biopsy revealed the enlarged node to be an undifferentiated adenocarcinoma of unknown origin, while CT scan evidenced widespread adenopathies. Because of the increase in serum PSA, the immunohistochemical staining of the biopsy specimen was reviewed and strong positivity for PSA suggested a prostatic origin. We emphasize the importance of PSA immunohistochemistry and serum PSA level monitoring in men presenting with carcinoma of undetermined origin and generalized lymphadenopathies.

  8. Complete Sequence of a Novel IncR-F33:A–:B– Plasmid, pKP1034, Harboring fosA3, blaKPC-2, blaCTX-M-65, blaSHV-12, and rmtB from an Epidemic Klebsiella pneumoniae Sequence Type 11 Strain in China

    Science.gov (United States)

    Xiang, Dai-Rong; Li, Jun-Jie; Sheng, Zi-Ke; Yu, Hai-Ying; Deng, Mei; Bi, Sheng; Hu, Fei-Shu; Chen, Wei; Xue, Xiao-Wei; Zhou, Zhi-Bo; Doi, Yohei; Li, Lan-Juan

    2015-01-01

    A high fosfomycin resistance rate was observed in Klebsiella pneumoniae carbapenemase (KPC)-producing K. pneumoniae (KPC-KP) in our previous study, but little is known about its mechanisms. In this study, we explored the prevalence of plasmid-mediated fosfomycin resistance determinants among fosfomycin-resistant KPC-KP strains from a Chinese university hospital and determined the complete sequence of a novel fosA3-carrying plasmid isolated from an epidemic K. pneumoniae sequence type (ST) 11 strain. A total of 97 KPC-KP strains were studied, of which 57 (58.8%) were resistant to fosfomycin, including 44 (45.4%) harboring fosA3 and 1 harboring fosA. All fosA3-positive strains belonged to the dominant ST11-pulse type (PT) A clone according to multilocus sequence typing and pulsed-field gel electrophoresis, suggesting clonal dissemination. The fosA-positive isolate belonged to ST11-PTE. The fosA3-carrying plasmid pKP1034 is 136,848 bp in length and is not self-transmissible. It is a multireplicon plasmid belonging to IncR-F33:A−: B−. Besides fosA3, a variety of other resistance determinants, including blaKPC-2, rmtB, blaCTX-M-65, and blaSHV-12, are identified in pKP1034, which would allow for coselection of fosA3 by most β-lactams and/or aminoglycosides and facilitate its dissemination despite limited use of fosfomycin in China. Detailed comparisons with related plasmids revealed that pKP1034 is highly mosaic and might have evolved from alarming recombination of the blaKPC-2-carrying plasmid pKPC-LK30 from Taiwan and the epidemic fosA3-carrying plasmid pHN7A8 from mainland China. PMID:26666939

  9. A percutaneous needle biopsy technique for sampling the supraclavicular brown adipose tissue depot of humans.

    Science.gov (United States)

    Chondronikola, M; Annamalai, P; Chao, T; Porter, C; Saraf, M K; Cesani, F; Sidossis, L S

    2015-10-01

    Brown adipose tissue (BAT) has been proposed as a potential target tissue against obesity and its related metabolic complications. Although the molecular and functional characteristics of BAT have been intensively studied in rodents, only a few studies have used human BAT specimens due to the difficulty of sampling human BAT deposits. We established a novel positron emission tomography and computed tomography-guided Bergström needle biopsy technique to acquire human BAT specimens from the supraclavicular area in human subjects. Forty-three biopsies were performed on 23 participants. The procedure was tolerated well by the majority of participants. No major complications were noted. Numbness (9.6%) and hematoma (2.3%) were the two minor complications noted, which fully resolved. Thus, the proposed biopsy technique can be considered safe with only minimal risk of adverse events. Adoption of the proposed method is expected to increase the sampling of the supraclavicular BAT depot for research purposes so as to augment the scientific knowledge of the biology of human BAT.

  10. Impact of middle and lower jugular neck dissection on supraclavicular lymph node metastasis from endometrial carcinoma

    Science.gov (United States)

    2012-01-01

    Supraclavicular lymph node metastasis from endometrial carcinoma is considerably rarer than metastasis from uterine cervical cancer. To date, there have been no reported cases regarding systematic neck dissection as a salvage treatment. In this report, we describe the neck dissection procedure carried out on a 74-year-old woman with supraclavicular lymph node metastasis. Our objective was to histologically determine the origin of the metastasis while simultaneously providing appropriate treatment. The patient’s past medical history included two prior cases of cancer: rectal cancer 7 years earlier and endometrial adenocarcinoma 4 years earlier. We determined that middle and lower jugular neck dissection was appropriate in treating this case based on the results of our preoperative FDG-PET and tumor markers. This surgery provided histological evidence that metastasis occurred from endometrial carcinoma. Middle and lower jugular neck dissection was expected to improve the patient’s prognosis without impacting the patient’s active daily life. We have continued to monitor the patient closely over an extended period. PMID:22788987

  11. Fine needle aspiration cytology of supraclavicular lymph nodes: Our experience over a three-year period.

    Science.gov (United States)

    Mitra, Sumit; Ray, Suchandra; Mitra, Pradip K

    2011-07-01

    This study was taken up with the aim to investigate the pattern of supraclavicular lymphadenopathy among patients presenting to our tertiary care institution, evaluate the diagnostic efficacy of fine needle aspiration cytology (FNAC), and analyze the diagnostic pitfalls. A total of 215 patients were subjected to FNAC of supraclavicular lymph nodes over a three-year period (August 2006 to July 2009). Since in 18 patients as either the aspirate was inadequate or the opinion was equivocal, we analyzed the remaining 197 cases. Malignant pathology accounted for 79.7% (157/197) of the cases. These were mostly cases of metastatic squamous cell carcinoma (79/197, 40.1%), adenocarcinoma (47/197, 23.9%), small cell carcinoma (12/197, 6.1%) and lymphoma (10/197, 5%). There were 28 (14.2%) cases of tuberculosis. Out of these 197 patients, 92 patients were biopsied. The opinion based on FNAC was erroneous in 6 cases but corroborated with the final histopathology findings in the remaining 86 cases. FNAC is an excellent first line of investigation; and when used with a proper combination of experience and diligence, it can greatly reduce the number of errors.

  12. The impact of ultrasonography-guided fine needle aspiration of no palpable supraclavicular lymph nodes on diagnosis and staging in advanced lung cancer.

    Science.gov (United States)

    Ozkan, Gülcihan; Tutar, Mehmet; Bayram, Mehmet; Bakan, Dilek; Gür, Aygün; Camsari, Güngör

    2009-01-01

    Diagnosis and accurate staging of lung cancer is essential for selection of appropriate curative or palliative therapy and affects patient prognosis. Both invasive and non-invasive procedures are used for this purpose. We aimed to assess the frequency of no palpable supraclavicular lymph node metastases in lung cancer patients with enlarged mediastinal lymph nodes, and their impact on diagnosis and staging using ultrasound in this study. Lung cancer patients with no palpable supraclavicular lymph nodes and at least 2 enlarged mediastinal lymph nodes on computerized tomography underwent supraclavicular ultrasound examination. Ultrasound-guided fine needle aspiration (US-guided FNA) was performed when enlarged lymph nodes were present. Supraclavicular lymph node metastasis was confirmed cytologically via US-guided FNA in 16 (40%) of 40 patients. Upper paratracheal lymphadenomegaly was significantly higher in patients with supraclavicular metastases than in those without. No statistical significant differences were observed in the stage, cell types, and metastases of patients with or without supraclavicular metastases. In 3 patients US-guided FNA was used for diagnosis. More than one-third of lung cancer patients with enlarged mediastinal lymph nodes had supraclavicular lymph node metastases in present study. US-guided FNA is an easier, safer, and less invasive procedure than standard techniques used to diagnose lung cancer patients with enlarged mediastinal lymph nodes.

  13. Diagnóstico fractal de disfunción cardíaca severa. Dinámica fractal de la ramificación coronaria izquierda

    Directory of Open Access Journals (Sweden)

    Javier O. Rodríguez, MD

    2012-09-01

    Conclusiones: se generalizó una nueva metodología diagnóstica de aplicación clínica que detecta disfunciones cardiacas severas sub-diagnosticadas con las metodologías actuales, mediante la caracterización de la dinámica total de la ramificación coronaria izquierda.

  14. Factores de riesgo para disfunción sistólica ventricular izquierda en adultos de un programa de salud global

    Directory of Open Access Journals (Sweden)

    Yessica María Giraldo Castrillón

    2017-01-01

    Full Text Available Introducción: La falla cardiaca, es un síndrome clínico habitualmente progresivo que con frecuencia comienza como disfunción sistólica ventricular izquierda y culmina con manifestaciones clínicas diversas de fallo de bomba y bajo gasto cardiaco hasta la muerte. Objetivo: Caracterizar los factores de riesgo que están asociados al desarrollo de disfunción sistólica ventricular izquierda y falla cardiaca secundaria como parte del espectro del síndrome de falla cardiaca en la población de Barranquilla-Colombia. Materiales y Métodos: Se realizó un estudio descriptivo de corte transversal con fuente secundaria de un estudio de salud global en la ciudad de Barranquilla-Colombia, en el que se hizo análisis univariado y bivariado para describir factores de riesgo asociados a la disfunción sistólica ventricular izquierda. Resultados: Se obtuvieron las prevalencias de cuatro factores de riesgo asociados al desarrollo de disfunción sistólica ventricular izquierda: hipertensión arterial 29.7%, obesidad 26.5%, hiperglucemia 4.6%, hipercolesterolemia 8.2% en pacientes mayores de 40 años los cuales tienen mayor riesgo. Discusión: Este estudio buscó llamar la atención sobre la disfunción sistólica ventricular izquierda, como una condición de descripción relativamente reciente y de potencial impacto en la salud de las poblaciones y los recursos de los sistemas de salud. Conclusiones: La prevalencia de los factores de riesgo para este estado pre-clínico podría llegar a ser alta y estos pacientes ameritarían, según recomendación de cierta evidencia, tamización para disfunción sistólica ventricular izquierda, así como estudios adicionales son requeridos. Cómo citar este artículo: Giraldo YM, Muñoz F, Navarro E, Segura ÁM. Factores de riesgo para disfunción sistólica ventricular izquierda en adultos de un programa de salud global. Rev Cuid. 2017; 8(1: 1519-28. http://dx.doi.org/10.15649/cuidarte.v8i1.371

  15. Supraclavicular lymph nodes detected by 18F-FDG PET/CT in cancer patients: assessment with 18F-FDG PET/CT and sonography.

    Science.gov (United States)

    Lee, Jae-hoon; Kim, Jinna; Moon, Hee Jung; Cho, Arthur; Yun, Mijin; Lee, Jong Doo; Kang, Won Jun

    2012-01-01

    The purposes of this study were to assess the diagnostic accuracy of 18F-FDG PET (FDG PET) for the detection of metastatic supraclavicular lymph nodes (LNs) and to propose an optimal diagnostic strategy with additional sonography, contrast-enhanced CT (CECT), or both. One hundred supraclavicular LNs initially detected using FDG PET were examined using sonography. Regardless of the imaging findings, all 100 supraclavicular LNs underwent sonography-guided fine-needle aspiration biopsy. The maximum standardized uptake values (SUVsmax) of the supraclavicular LNs were measured, and a receiver operating characteristic (ROC) analysis was performed to determine the cutoff SUVmax. Then we evaluated the diagnostic performance of FDG PET and figured out the optimal combination of FDG PET and sonography or CECT to improve the diagnostic accuracy of the imaging studies and minimize procedures. In total, 86 of 100 PET-detected supraclavicular LNs were malignant. With application of the cutoff value obtained by ROC analysis (SUVmax=3.0), the diagnostic accuracy of FDG PET was 75.0% with a sensitivity of 74.4% and specificity of 78.6%. For supraclavicular LNs with an SUVmax of more than 3.0, FDG PET showed a positive predictive value of 95.5%; for supraclavicular LNs with an SUVmax of 3.0 or less, sonography excluded all false-negative FDG PET cases and showed a high negative predictive value of 100%. When sonography was selectively applied to cases with an SUVmax of 3.0 or less, the overall diagnostic accuracy increased to 92%. Our study revealed a high incidence rate of metastasis in PET-detected supraclavicular LNs in cancer patients. We believe that our proposed diagnostic workflow could decrease unnecessary diagnostic procedures in the evaluation of PET-positive supraclavicular LNs in cancer patients with reliability.

  16. Volumen de la aurícula izquierda indexada por superficie corporal en sujetos normales divididos por sexo y edad

    Directory of Open Access Journals (Sweden)

    Héctor A. Deschle

    2010-01-01

    Full Text Available RESUMENIntroducciónEl tamaño de la aurícula izquierda (AI se ha relacionado con la ocurrencia de eventoscardiovasculares en pacientes mayores sin cardiopatía previa.Los valores considerados normales en adultos se suelen tomar de publicaciones extranjerasque presentan valores disímiles y no incluyen la división por edades, por lo que no quedaclaro el impacto que el envejecimiento podría tener sobre el tamaño auricular izquierdo, locual los hace difícilmente aplicables a la población general.ObjetivosEvaluar las modificaciones en el volumen indexado de la aurícula izquierda en sujetos saludablesde nuestro medio divididos por sexo y edad.Material y métodosEntre 2007 y 2008 ingresaron 725 pacientes asintomáticos sin antecedentes de cardiopatía,diabetes, ni enfermedades de relevancia clínica. Sexo masculino: 325. Se dividieron en gruposetarios: a 65 años. El volumen de laaurícula izquierda (AI se calculó de acuerdo con la fórmula: 8/3 π [(A1(A2/(L] (A1 = áreaen 4 cámaras, A2 = área en 2 cámaras, L = longitud más pequeña entre ambas vistas. Lasuperficie corporal se calculó con la fórmula de Mosteller.ResultadosEl volumen indexado de la AI fue significativamente mayor en varones > 64 años (32,89 ±5,93 cm³/m² con respecto a los tres primeros grupos etarios (p < 0,01. No hubo diferenciassignificativas entre los grupos del sexo femenino.ConclusiónEl volumen de la AI es significativamente mayor en varones de más de 64 años.REV ARGENT CARDIOL 2010;78:39-42.

  17. Reducción de la aurícula izquierda y reemplazo de válvula mitral mediante técnica de autotransplante en paciente con aurícula izquierda gigante

    OpenAIRE

    Ríos, Josías; Morón, Julio

    2013-01-01

    El 19% de los pacientes con patología mitral reumática presenta aurícula izquierda gigante (diámetro mayor a 65mm), esta patología ha sido asociada con incremento del riesgo de stroke y de muerte súbita. La indicación de reducción auricular se establece cuando existe compresión de las extructuras vecinas, antecedentes de fenómenos tromboembólicos o en pacientes asintomáticos para restablecer el ritmo sinusal (Cirugía de Maze). Se presenta el caso de una mujer de 63 años con estenosis e insufi...

  18. Supra-Clavicular Brachial Plexus Block: Ultra-Sonography Guided Technique Offer Advantage Over Peripheral Nerve Stimulator Guided Technique

    Directory of Open Access Journals (Sweden)

    Krutika B Rupera

    2013-06-01

    Conclusion: Ultrasonography guided supraclavicular brachial plexus block is quick to perform, offers improved safety and accuracy in identifying the position of the nerves to be blocked and of the structures. [Natl J Med Res 2013; 3(3.000: 241-244

  19. Clonidine as an adjuvant to local anesthetic in supraclavicular brachial plexus block: a randomized, double blinded placebo controlled study

    Directory of Open Access Journals (Sweden)

    Preeti Rustagi

    2016-10-01

    Conclusions: Clonidine 2 and micro;g / kg added to 10 ml of 0.5 % Bupivacaine + 20 ml of 2% lignocaine with adrenaline (1:200000 is a good option for improving the quality and duration of supraclavicular brachial plexus block. [Int J Basic Clin Pharmacol 2016; 5(5.000: 1892-1897

  20. Non-Hodgkin's lymphoma of supraclavicular lymph nodes can mimic metastasis of breast cancer during chemotherapy on FDG PET/CT.

    Science.gov (United States)

    Hua, Fengchun; Feng, Xiaoyuan; Guan, Yihui; Zhao, Jun; Huang, Zhemin

    2009-09-01

    A 43-year-old woman who had a history of right mastectomy for breast cancer presented with fever and swelling in the right supraclavicular region during her second course of chemotherapy. An FDG PET/CT was performed to evaluate this patient, which revealed mildly increased FDG activity in the lymph node in the supraclavicular region. A metastatic lesion from the known breast cancer was considered. However, biopsy results demonstrated that the abnormal activity in the right supraclavicular region is due to T-cell lymphoma.

  1. Curative Chemoradiotherapy in Patients With Stage IVB Cervical Cancer Presenting With Paraortic and Left Supraclavicular Lymph Node Metastases

    Energy Technology Data Exchange (ETDEWEB)

    Kim, Ji-Yoon [Department of Radiation Oncology, Catholic University of Korea, College of Medicine, Seoul (Korea, Republic of); Kim, Joo-Young [Research Institute and Hospital, National Cancer Center, Goyang (Korea, Republic of); Kim, Jin Hee [Department of Radiation Oncology, Dongsan Medical Center, Keimyung University School of Medicine, Daegu (Korea, Republic of); Yoon, Mee Sun [Department of Radiation Oncology, Chonnam National University Hwasun Hospital, Chonnam National University Medical School, Jeollanam-do (Korea, Republic of); Kim, Juree [Department of Radiation Oncology, Cheil General Hospital and Women' s Healthcare Center, Kwandong University, College of Medicine, Seoul (Korea, Republic of); Kim, Young Seok, E-mail: ysk@amc.seoul.kr [Department of Radiation Oncology, Asan Medical Center, University of Ulsan, College of Medicine, Seoul (Korea, Republic of)

    2012-11-01

    Purpose: To evaluate the efficacy and toxicity of concurrent chemoradiotherapy (CCRT) with curative intent in patients with stage IVB cervical cancer initially presenting with paraortic and left supraclavicular lymph node metastases. Methods and Materials: The medical records of 25 patients with both paraortic and left supraclavicular lymph nodal metastases (group I) were reviewed and compared with those of 101 women with paraortic lymph node metastases alone (group II). Group I received a mean 59.4 Gy to the paraortic and left supraclavicular areas and 50.4 Gy to the pelvis, followed by 30 Gy of high-dose-rate brachytherapy in 6 fractions. Group II received the same dose to the paraortic area and pelvis followed by intracavitary brachytherapy. All patients received platinum-based chemotherapy simultaneously. Results: Of the 25 patients in group I, 16 (64%) experienced acute grade 3-4 hematologic toxicities, and 1 had a late grade 3 genitourinary toxicity. Complete responses, including the primary mass and pelvic, paraortic, and left supraclavicular lymph nodes, were observed in 13 patients (52%). At a median follow-up of 32 months for surviving patients, 3 experienced in-field failure, 6 showed distant failure, and 9 showed both. The 3-year overall and disease-free survival rates were 49% and 33%, respectively. In comparison, of the 101 patients in group II, 16 showed in-field failure, 14 experienced distant failure, and 11 showed both. The 3-year overall and disease-free survival rates were 69% and 57%, respectively. Conclusions: Curative CCRT is feasible in patients with stage IVB cervical cancer presenting with paraortic and left supraclavicular lymph nodal metastases, with acceptable late toxicity and high response rates, despite high rates of acute hematologic toxicity.

  2. Curative chemoradiotherapy in patients with stage IVB cervical cancer presenting with paraortic and left supraclavicular lymph node metastases.

    Science.gov (United States)

    Kim, Ji-Yoon; Kim, Joo-Young; Kim, Jin Hee; Yoon, Mee Sun; Kim, Juree; Kim, Young Seok

    2012-11-01

    To evaluate the efficacy and toxicity of concurrent chemoradiotherapy (CCRT) with curative intent in patients with stage IVB cervical cancer initially presenting with paraortic and left supraclavicular lymph node metastases. The medical records of 25 patients with both paraortic and left supraclavicular lymph nodal metastases (group I) were reviewed and compared with those of 101 women with paraortic lymph node metastases alone (group II). Group I received a mean 59.4 Gy to the paraortic and left supraclavicular areas and 50.4 Gy to the pelvis, followed by 30 Gy of high-dose-rate brachytherapy in 6 fractions. Group II received the same dose to the paraortic area and pelvis followed by intracavitary brachytherapy. All patients received platinum-based chemotherapy simultaneously. Of the 25 patients in group I, 16 (64%) experienced acute grade 3-4 hematologic toxicities, and 1 had a late grade 3 genitourinary toxicity. Complete responses, including the primary mass and pelvic, paraortic, and left supraclavicular lymph nodes, were observed in 13 patients (52%). At a median follow-up of 32 months for surviving patients, 3 experienced in-field failure, 6 showed distant failure, and 9 showed both. The 3-year overall and disease-free survival rates were 49% and 33%, respectively. In comparison, of the 101 patients in group II, 16 showed in-field failure, 14 experienced distant failure, and 11 showed both. The 3-year overall and disease-free survival rates were 69% and 57%, respectively. Curative CCRT is feasible in patients with stage IVB cervical cancer presenting with paraortic and left supraclavicular lymph nodal metastases, with acceptable late toxicity and high response rates, despite high rates of acute hematologic toxicity. Copyright © 2012 Elsevier Inc. All rights reserved.

  3. Dexmedetomidine prolongs the effect of bupivacaine in supraclavicular brachial plexus block

    Directory of Open Access Journals (Sweden)

    Sandhya Agarwal

    2014-01-01

    Full Text Available Background: We compared the effects of adding dexmedetomidine to a 30 ml solution of 0.325% bupivacaine in supraclavicular brachial plexus block. Onset and duration of sensory and motor block along with the duration of analgesia were the primary endpoints. Materials and Methods: Fifty patients posted for upper limb surgeries were enrolled for a prospective, randomized, double-blind, placebo-controlled trial. Patients were divided into two groups, the control group S and the study group SD. In group S (n = 25, 30 ml of 0.325% bupivacaine + 1 ml normal saline; and in group SD (n = 25, 30 ml of 0.325% bupivacaine + 1 ml (100 μg dexmedetomidine were given for supraclavicular brachial plexus block using the peripheral nerve stimulator. Onset and duration of sensory and motor blocks were assessed along with the duration of analgesia, sedation, and adverse effects, if any. Hemodynamic parameters, like heart rate (HR, systolic arterial blood pressure (SBP, and diastolic arterial blood pressure (DBP were also monitored. Results: Demographic data and surgical characteristics were comparable in both the groups. The onset times for sensory and motor blocks were significantly shorter in SD than S group (P < 0.001, while the duration of blocks was significantly longer (P < 0.001 in SD group. Except for the initial recordings (at 0, 5, 10, and 15 min, heart rate levels in group SD were significantly lower (P < 0.001. SBP and DBP levels in SD group at 15, 30, 45, 60, 90 and 120 min were significantly lower than in S group (P < 0.001. In fact, when the percentage changes in HR/SBP/DBP were compared from 0-5/0-10/0-15/0-30/0-45/0-60/0-90/0-120 min in SD with S group, they came out to be highly significant (P < 0.001 in group SD. The duration of analgesia (DOA was significantly longer in SD group than S group (P < 0.001. Except that, bradycardia was observed in one patient in the group SD, no other adverse effects were observed in either of the groups. Conclusion

  4. Dexmedetomidine as an adjuvant to levobupivacaine in supraclavicular brachial plexus block: A novel anesthetic approach

    Science.gov (United States)

    Singh, Arvinder Pal; Mahindra, Malika; Gupta, Ruchi; Bajwa, Sukhminder Jit Singh

    2016-01-01

    Aims and Objectives: Supplementation of dexmedetomidine produces a dose-dependent sedation, anxiolysis and analgesia without respiratory depression. This study was conducted to evaluate the possible effect of dexmedetomidine as an adjuvant to levobupivacaine for supraclavicular brachial plexus block in upper limb surgery. Settings and Design: Tertiary care institute, Department of Anaesthesiology and Intensive Care, a placebo-controlled study. Materials and Methods: After obtaining Ethical Committee approval, a randomized, double-blind, placebo-controlled study was conducted on sixty American Society of Anesthesiologists physical status I and II patients in the age group of 18–60 years, divided randomly into two groups, Group I received 30 ml of 0.5% levobupivacaine with 1 ml of isotonic sodium chloride solution and Group II received 30 ml of 0.5% levobupivacaine and 1 ml (100 mcg) of dexmedetomidine for supraclavicular brachial plexus block. The onset and duration of sensory and motor blockade, duration of analgesia (DOA) and any adverse effects were noted. At the end of the study, data were compiled and analyzed using appropriate statistical tests. The value of P < 0.05 was considered significant. Results: Demographic profile was comparable in both the groups. The time to onset of sensory and motor block was 10.54 ± 2.333 min and 12.21 ± 2.529 min in Group I while it was 3.24 ± 0.951 min and 2.83 ± 1.197 min in Group II, respectively. The duration of sensory and motor block was 7.79 ± 2.007 h and 9.18 ± 1.701 h in Group I, and it was 16.31 ± 2.606 h and 17.52 ± 2.098 h in Group II, respectively. The DOA was 678.68 ± 20.492 min in Group I and 1273.79 ± 83.139 min in Group II. On statistical comparison, these values were highly significant (P < 0.001). Side effects such as nausea, vomiting, hypoxemia, pruritis, or urinary retention were not observed in either of the groups. Conclusion: Dexmedetomidine shortens the onset time for sensory and motor block

  5. Discordant lymphoma consisting of mediastinal large B-cell lymphoma and nodular sclerosis Hodgkin lymphoma in the right supraclavicular lymph nodes: a case report

    National Research Council Canada - National Science Library

    Zhang, Chun; Yi, Yuanxue; Chen, Chunyan; Wang, Jianrong; Liu, Zhu

    2015-01-01

    .... Here, we report a case of discordant lymphoma in a 34-year-old female patient that involved mediastinal large B-cell lymphoma and nodular sclerosis Hodgkin lymphoma in the right supraclavicular lymph nodes...

  6. Supraclavicular and/or celiac lymph node metastases from thoracic esophageal squamous cell carcinoma did not compromise survival following neoadjuvant chemoradiotherapy and surgery

    Science.gov (United States)

    Ahn, Yong Chan; Shim, Young Mog; Zo, Jae Ill; Sun, Jong-Mu; Ahn, Myung-Ju; Park, Keunchil

    2017-01-01

    This study is to evaluate the prognostic significance of supraclavicular and/or celiac lymph node (LN) metastases in locally advanced thoracic esophageal squamous cell carcinoma (ESCC) patients treated with neoadjuvant chemoradiotherapy (NACRT) and surgery. Among the total 199 patients, 75 (37.7%) had supraclavicular and/or celiac LN metastasis. Surgery was performed following NACRT in 168 patients (84.4%). After the median 18.7 (1.0-147.2) months’ follow-up, 2-year rates of progression-free survival (PFS) and overall survival (OS) in all patients were 48.1% and 65.7%, respectively. In multivariate analyses, negative surgical margin (p supraclavicular and/or celiac LNs was significant factor neither for PFS (p = 0.311) nor OS (p = 0.515). Supraclavicular and/or celiac LN metastasis did not compromise the clinical outcomes following NACRT and surgery. PMID:27682879

  7. Contribution of ultrasound-guided fine-needle aspiration cell blocks of metastatic supraclavicular lymph nodes to the diagnosis of lung cancer

    Directory of Open Access Journals (Sweden)

    Hai-Ying Tian

    2015-01-01

    Conclusion: Cell-block samples from US-guided FNA is a promising, relatively noninvasive technique to provide additional information in lung cancer diagnosis. Analysis of cell blocks allows for genetic analysis of the patients with supraclavicular lymph nodes metastasis.

  8. Placental, hepatic, and supraclavicular lymph node metastasis in pancreatic adenocarcinoma during pregnancy: A case report.

    Science.gov (United States)

    Şahin Aker, Seda; Katlan, Doruk Cevdi; Yüce, Tuncay; Söylemez, Feride

    2016-09-01

    The occurrence of coexisting cancer in pregnant women is not a common phenomenon. It complicates approximately 1 in 1000 to 1500 pregnancies. We present a multiparous woman aged 27 years in her 28(th) week of pregnancy who was admitted to our clinic with right upper quadrant pain and was finally revealed to have multiple metastatic pancreatic adenocarcinoma. To the best of our knowledge, this is the first documented case of pancreatic adenocarcinoma to metastasize both to the placenta and multiple maternal sites (liver, supraclavicular, para-aortic lymph nodes) in a pregnant patient. Unpredictable metastases to the placenta may be encountered and may even lead to definitive diagnosis, as in our case. Therefore, the placenta in any patient with known malignancy should be sent for pathologic evaluation.

  9. Pedicled Supraclavicular Artery Island Flap Versus Free Radial Forearm Flap for Tongue Reconstruction Following Hemiglossectomy.

    Science.gov (United States)

    Zhang, Senlin; Chen, Wei; Cao, Gang; Dong, Zhen

    2015-09-01

    This study investigated the tongue function and donor-site morbidity of patients with malignant tumors who had undergone immediate flap reconstruction surgery. Twenty-seven patients who had undergone immediate reconstruction after hemiglossectomy were observed. Twelve patients were reconstructed using the pedicled supraclavicular artery island flap (PSAIF) and 15 patients using the free radial forearm flap (FRFF). Flap survival, speech and swallowing function, and donor-site morbidity at the 6-month follow-up were evaluated. All the flaps were successfully transferred. No obvious complications were found in either the transferred flaps or donor regions. Age, sex, defect extent, speech and swallowing function were comparable between the 2 groups. Donor-site complications were less frequent with PSAIF reconstruction than FRFF reconstruction. The PSAIF is reliable and well suited for hemiglossectomy defect. It has few significant complications, and allows preservation of oral function.

  10. Combined versus sequential injection of mepivacaine and ropivacaine for supraclavicular nerve blocks.

    Science.gov (United States)

    Roberman, Dmitry; Arora, Harendra; Sessler, Daniel I; Ritchey, Michael; You, Jing; Kumar, Priya

    2011-01-01

    An ideal local anesthetic with rapid onset and prolonged duration has yet to be developed. Clinicians use mixtures of local anesthetics in an attempt to combine their advantages. We tested the hypothesis that sequential supraclavicular injection of 1.5% mepivacaine followed 90 secs later by 0.5% ropivacaine speeds onset of sensory block and prolongs duration of analgesia compared with simultaneous injection of the same 2 local anesthetics. We enrolled 103 patients undergoing surgery suitable for supraclavicular anesthesia. The primary outcome was time to 4-nerve sensory block onset in each of the 4 major nerve distributions: median, ulnar, radial, and musculocutaneous. Secondary outcomes included time to onset of first sensory block, time to complete motor block, duration of analgesia, pain scores at rest and with movement, and total opioid consumption. Outcomes were compared using the Kaplan-Meier analysis with the log-rank test or the analysis of variance, as appropriate. Times to 4-nerve sensory block onset were not different between sequential and combined anesthetic administration. The time to complete motor block onset was faster in the combined group as compared with the sequential. There were not significant differences between the 2 randomized groups in other secondary outcomes, such as the time to onset of first sensory block, the duration of analgesia, the pain scores at rest or with movement, or the total opioid consumption. Sequential injection of 1.5% mepivacaine followed 90 secs later by 0.5% ropivacaine provides no advantage compared with simultaneous injection of the same doses. Copyright © 2011 by American Society of Regional Anesthesia and Pain Medicine

  11. Insuficiencia cardiaca aguda en el anciano: características clínicas y mortalidad según la fracción de eyección ventricular izquierda

    Directory of Open Access Journals (Sweden)

    Jonathan Franco

    2017-05-01

    Conclusiones: La mortalidad al año de los pacientes ancianos con insuficiencia cardiaca es alta, así mismo tienen una mayor proporción de la fracción de eyección ventricular izquierda preservada, que a la vez asocia un mayor número de comorbilidades y una tendencia a mayor supervivencia al año con respecto a la fracción de eyección ventricular izquierda no preservada.

  12. Contralateral breast doses in radiotherapy: effect of wedges introduction versus supraclavicular field; Dosis a la mama contralateral en radioterapia: effecto de la introduccion de las cunas frente a la del campo supraclavicular

    Energy Technology Data Exchange (ETDEWEB)

    Carrera, Francisco; Velazquez, Santiago; Bayo, Eloisa [Hospital Juan Ramon Jimenez, Huelva (Spain); Ojeda, Carmen; Ruiz-Cruzes, Rafael; Diez de los Rios, Antonio [Universidad de Malaga (Spain). Grupo de Investigacion en Proteccion Radiologica (PRUMA)

    2001-07-01

    It is interesting the influence of physical wedges on medial tangential field, and subsequent extrafocal electronic contamination on the contralateral breast dose (CBD). This study compares effects produced by wedges versus internal scattering produced by supraclavicular field. An anthropomorphic phantom with wax breast was used. Average dose to every quadrant was evaluated; this was realized using data from treatment planning system (TPP) and, on the other hand, using lectures from TLD; versus distance to medial axis and lower edge from the medial tangential field. TPP does not have on account scattered radiation out of patient's contour. In conclusion, comparing supraclavicular field versus wedges influence, the importance of the last one on CBD is lower. It is casted doubt on the sacrifice of a distribution of a homogeneous dose to the treated breast in interest of the saving of CBD, although it is interesting the use of virtual wedges or external protection, having on account the influence of external scattering. (author)

  13. Límites en la vida media del neutrón en un modelo con simetría izquierda-derecha

    Directory of Open Access Journals (Sweden)

    A. Gutiérrez-Rodríguez

    2006-01-01

    Full Text Available Se calculan límites en la vida media del neutrón a través de n→p→e→ev y en el contexto de un modelo con simetría izquierda-derecha. Se aplica este modelo para incorporar las corrientes derechas, por lo que se propone una amplitud cuya parte leptónica contiene el parámetro definido como el parámetro λ de asimetría izquierda-derecha, el cual mide la violación de paridad. Se encuentra que los límites son dependientes del parámetro de asimetría λ. En nuestros cálculos se toman en cuenta correcciones de masa, es decir, mp≠ mny el retroceso del protón. PACS: 13.30.Ce, 23.40.-S, 14.60.St.

  14. El giro a la izquierda en América Latina y el nacimiento del "nuevo bolivarismo": las tradiciones de Komintern y la actualidad

    Directory of Open Access Journals (Sweden)

    Lazar Jeifets

    2009-12-01

    Full Text Available La idea de una "Revolución Bolivariana", proclamada por el Presidente de Venezuela Hugo Chávez. puede parecer novedosa y propia del giro actual a la izquierda de varios países sudamericanos. Sin embargo, dicha idea ya era conocida e impulsada en la primera mitad del siglo XX, cuando diferentes movimiemos políticos revolucionarios buscaban el apoyo de Moscú para lograr la toma del poder en los países andinos. Este artículo examina la influencia de la Tercera Internacional sobre los planes de los grupos revolucionarios en los llamados países bolivarianos durante la década de los años veinte y treinta del siglo pasado y señala semejanzas y diferencias entre dicha relación y la que sostiene actualmente el chavismo con algunos movimientos de izquierda venezolanos.

  15. Supraclavicular lymphadenopathy as the initial presentation of metastatic prostate cancer: A case report and review of literature

    Science.gov (United States)

    Chan, Garson; Domes, Trustin

    2013-01-01

    Prostate cancer usually metastasizes to the regional lymph nodes, and distal metastases to supraclavicular lymph nodes are rarely reported, especially as an initial presentation. Limited case reports describe cervical lymphadenopathy as the initial presentation of metastatic prostate cancer, and often with widely disseminated disease. Patients with this initial presentation rarely undergo digital rectal examination or serum prostate-specific antigen (PSA) level measurement as part of their initial investigations. A high index of suspicion is necessary to make the diagnosis of prostate cancer in this clinical setting. We present a rare case of prostate carcinoma presenting with supraclavicular lymph node enlargement at the initial diagnosis. A review of the relevant literature is provided. PMID:23826058

  16. Reporte del primer caso de implante exitoso de asistencia ventricular izquierda HeartMate II como terapia de destino en Suramérica

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    Antonio Figueredo

    2016-11-01

    Full Text Available Se describe el caso de una paciente de sexo femenino de 55 años de edad, con insuficiencia cardiaca congestiva descompensada secundaria a cardiopatía dilatada idiopática y con contraindicación para trasplante cardiaco, en quien se implanta de manera exitosa el primer dispositivo de asistencia ventricular izquierda HeartMate II en Suramérica.

  17. Effect of dexamethasone in low volume supraclavicular brachial plexus block: A double-blinded randomized clinical study

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    Arun Kumar Alarasan

    2016-01-01

    Full Text Available Background and Aims: With the use of ultrasound, a minimal effective volume of 20 ml has been described for supraclavicular brachial plexus block. However achieving a long duration of analgesia with this minimal volume remains a challenge. We aimed to determine the effect of dexamethasone on onset and duration of analgesia in low volume supraclavicular brachial plexus block. Material and Methods: Sixty patients were randomly divided into two groups of 30 each. Group C received saline (2 ml + 20 ml of 0.5% bupivacaine and Group D received dexamethasone (8 mg + 20 ml of 0.5% bupivacaine in supraclavicular brachial plexus block. Hemodynamic variables and visual analog scale (VAS score were noted at regular intervals until 450 min. The onset and duration of sensory and motor block were measured. The incidence of "Halo" around brachial plexus was observed. Student′s t-test and Chi-square test were used for statistical analysis. Results: The onset of sensory and motor block was significantly earlier in dexamethasone group (10.36 ± 1.99 and 12 ± 1.64 minutes compared to control group (12.9 ± 2.23 and 18.03 ± 2.41 minutes. The duration of sensory and motor block was significantly prolonged in dexamethasone group (366 ± 28.11 and 337.33 ± 28.75 minutes compared to control group (242.66 ± 26.38 and 213 ± 26.80 minutes. The VAS score was significantly lower in dexamethasone group after 210 min. "Halo" was present around the brachial plexus in all patients in both the groups. Conclusion: Dexamethasone addition significantly increases the duration of analgesia in patients receiving low volume supraclavicular brachial plexus block. No significant side-effects were seen in patients receiving dexamethasone as an adjunct.

  18. Combined photon-electron beams in the treatment of the supraclavicular lymph nodes in breast cancer: A novel technique that achieves adequate coverage while reducing lung dose.

    Science.gov (United States)

    Salem, Ahmed; Mohamad, Issa; Dayyat, Abdulmajeed; Kanaa'n, Haitham; Sarhan, Nasim; Roujob, Ibrahim; Salem, Abdel-Fattah; Afifi, Shatha; Jaradat, Imad; Mubiden, Rasmi; Almousa, Abdelateif

    2015-01-01

    Radiation pneumonitis is a well-documented side effect of radiation therapy for breast cancer. The purpose of this study was to compare combined photon-electron, photon-only, and electron-only plans in the radiation treatment of the supraclavicular lymph nodes. In total, 13 patients requiring chest wall and supraclavicular nodal irradiation were planned retrospectively using combined photon-electron, photon-only, and electron-only supraclavicular beams. A dose of 50Gy over 25 fractions was prescribed. Chest wall irradiation parameters were fixed for all plans. The goal of this planning effort was to cover 95% of the supraclavicular clinical target volume (CTV) with 95% of the prescribed dose and to minimize the volume receiving ≥ 105% of the dose. Comparative end points were supraclavicular CTV coverage (volume covered by the 95% isodose line), hotspot volume, maximum radiation dose, contralateral breast dose, mean total lung dose, total lung volume percentage receiving at least 20 Gy (V(20 Gy)), heart volume percentage receiving at least 25 Gy (V(25 Gy)). Electron and photon energies ranged from 8 to 18 MeV and 4 to 6 MV, respectively. The ratio of photon-to-electron fractions in combined beams ranged from 5:20 to 15:10. Supraclavicular nodal coverage was highest in photon-only (mean = 96.2 ± 3.5%) followed closely by combined photon-electron (mean = 94.2 ± 2.5%) and lowest in electron-only plans (mean = 81.7 ± 14.8%, p supraclavicular nodal irradiation and results in adequate target coverage, acceptable dosimetric hotspot volume, and slightly reduced lung dose. Copyright © 2015 American Association of Medical Dosimetrists. Published by Elsevier Inc. All rights reserved.

  19. The Media Politics of Latin America’s Leftist Governments La política de medios de los gobiernos de izquierda en América Latina

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    Philip Kitzberger

    2012-01-01

    Full Text Available Does Latin America’s left turn matter in media politics? Has ideology any impact on governments’ practices and policies regarding media and journalistic institutions? This essay focuses on the existence of a specific kind of media activism on the part of leftist governments in Latin America. It does so by assessing discourses on the media, direct-communication practices, and media regulation policies. While showing that the current binary distinctions stressing the existence of two lefts – “populist” and “nonpopulist” – obscure important commonalities and continuities, the author demonstrates that institutional and structural constraints account for the differences among the various leftist governments in Latin America. In sum, the paper challenges the prevailing neglect of ideology as a relevant factor in explaining developments in government–media relationships in the region.¿Ha sido relevante el giro a la izquierda en América Latina para la política de medios? ¿Tuvo impacto la ideología en las prácticas y políticas gubernamentales relativas a los medios y las instituciones políticas? Por medio de una evaluación de los discursos sobre los medios, de las prácticas de comunicación directa y de las políticas de regulación del sector mediático por parte de los recientes gobiernos de izquierda en América Latina, el presente ensayo focaliza en la existencia de un activismo mediático de los gobiernos de izquierda en la región. En tanto muestra cómo las distinciones binarias corrientes que afirman la existencia de dos izquierdas – populista y no-populista – oscurece importantes rasgos comunes y continuidades, el autor plantea que las restricciones institucionales y estructurales dan cuenta de las diferencias entre los varios gobiernos de izquierda en América Latina. En suma, el artículo desafía la prevaleciente subestimación del factor ideológico en las explicaciones de las relaciones entre medios y

  20. La figura del gorila en el imaginario político de la izquierda brasileña

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    Rodrigo Patto Sá Motta

    2014-09-01

    Full Text Available El texto analiza los orígenes y usos de la figura caricaturezca del gorila en el contexto de la crisis política que llevó al golpe de Estado de 1964 en Brasil, marcada por la radicalización y la movilización intensa de las fuerzas en disputa en el escenario público. El contexto fue propicio para el enriquecimiento del discurso político tanto verbal como visual e la imagen del gorila fue construida en medio de las batallas discursivas del período. El propósito del artículo es mostrar el papel desempeñado por esa figura en el imaginario construido por las izquierdas en acción en los inicios de los años sesenta, que seria movilizada para atacar a los enemigos de derecha, principalmente los militares, dando origen a una representación caricaturezca que continuaría en uso durante la dictadura militar.

  1. Eficacia de materiales de resina autograbadores como selladores de fosas y fisuras : un año de seguimiento en niños no portadores de aparatos fijos de ortodoncia

    OpenAIRE

    Pagán Cánovas, Eva

    2015-01-01

    La caries dental es la enfermedad crónica más frecuente en la infancia. Su aparición viene determinada por múltiples factores, debiendo evaluar el riesgo de caries de cada paciente individualmente. Los selladores de fosas y fisuras se utilizan como método de prevención, ya que las superficies oclusales son uno de los principales lugares de instauración de las lesiones de caries. El propósito de esta tesis es analizar y proponer técnicas y materiales que mejoren el uso de los selladores de ...

  2. Treatment outcome in breast cancer patients with ipsilateral supraclavicular lymph node metastasis at time of diagnosis: a review of the literature.

    Science.gov (United States)

    Grotenhuis, B A; Klem, T M A L; Vrijland, W W

    2013-03-01

    In the revised 6th edition of the AJCC-TNM staging system for breast cancer, metastasis in ipsilateral supraclavicular lymph node(s) is considered as a locoregional disease and classified as N3c rather than M1 distant disease. The aim of this review was to search the recent literature in order to investigate whether the reported treatment outcome of patients with ipsilateral supraclavicular metastases in breast cancer patients justifies this revision. A review of the recent English-language literature (January 2001-June 2012) concerning breast cancer with supraclavicular involvement was performed. A total number of six studies were included in the current review. All reported comparable data with regard to treatment outcome after multimodality treatment, despite considerable heterogeneity in study populations. Patients with ipsilateral supraclavicular lymph node involvement showed outcomes more similar to locally advanced breast cancer patients rather than patients with distant tumor spread. It seems that the 2002 revision of the AJCC-TNM staging system for breast cancer has appropriately reclassified patients with supraclavicular disease to a new category (N3c). Copyright © 2012 Elsevier Ltd. All rights reserved.

  3. A clinical study to assess the pathological involvement of occult supraclavicular lymphnode metastasis in case of locally advanced operable breast carcinoma.

    Science.gov (United States)

    Virani, S J; Patni, S; Shah, R

    2015-01-01

    The prognosis of ipsilateral supraclavicular lymph node (SCLN) recurrence after early breast cancer appears to be worse than for other locoregional recurrences, but better than for distant metastases. Prophylactic radiotherapy (RT) to supraclavicular region decreases risk of ipsilateral SCLN recurrence. Currently, all patients with locally advanced breast cancer are considered high-risk for SCLN metastasis and treated with prophylactic RT. This study is carried out to identify risk factors associated with occult SCLN metastases in locally advanced breast cancer. Total 48 female patients of all ages presenting with locally advanced carcinoma of breast who were operable by protocol criteria were included in the study. All the patients underwent modified radical mastectomy with supraclavicular lymphnode dissection. The resected specimen was processed for the histopathological analysis. Occult SCLN metastases are found in 25% (12/48) of the patients in this study. Eleven factors were identified and analyzed to know whether or not they are associated with SCLN metastasis. Of those only pathological N stage (7% for supraclavicular lymphnode metastasis. Other factors such as age, menopausal status, T stage, pathologic grade, lymphovascular invasion, extracapsular extension, hormone receptor, and Her2 neu receptor status are not associated with risk for SCLN metastasis. Our study has shown that only high axillary disease burden in terms of more than 10 node positivity or more than 75% positive node out of total dissected nodes is associated with occult supraclavicular lymphnode metastasis breast cancer.

  4. Novel use of a supraclavicular transverse cervical artery customised perforator flap: a paediatric emergency.

    LENUS (Irish Health Repository)

    Dolan, R T

    2013-08-01

    Perforation of the piriform fossa is a rare, potentially life-threatening paediatric emergency. Prompt diagnosis and early operative intervention is key to patient survival, yet restoring aerodigestive continuity can pose a significant reconstructive challenge. A seven-month old baby girl presented to an emergency department acutely unwell with a twenty-four-hour history of haemoptysis, cough and worsening respiratory distress. A contrast swallow demonstrated extension of contrast into the retropharyngeal region necessitating immediate surgical intervention. A 3.0 cm×1.0 cm perforation within the left posterolateral piriform fossa was identified. The defect was repaired with a supraclavicular transverse cervical artery customised perforator flap. This was inset into the piriform fossa luminal defect as a life-saving procedure. Following a stormy post-operative course, the child was discharged home on day 28 of admission and admitted electively 6 weeks later for division of flap pedicle. This case highlights the novel use of this fasciocutaneous island flap to reconstruct an extensive, potentially fatal, piriform fossa defect in an acute paediatric setting. This simple flap design offers timely mobilisation, reliable blood supply, adequate tenuity and surface area, to reconstruct this extensive defect as a life-saving intervention in a profoundly septic child.

  5. [Optimized definition and delineation of supraclavicular lymph nodes target in postmastectomy radiotherapy for breast cancer patients].

    Science.gov (United States)

    Huang, Shujing; Huang, Xiaobo; Wang, Xicheng; Zhang, Yujing; Sun, Jiayuan; He, Liru; Wen, Ge; He, Zhichun

    2014-07-01

    To explore the optimized methods to define and delineate supraclavicular lymph nodal target in postmastectomy radiotherapy for breast cancer patients. From September 2012 to August 2013, a total of 10 breast cancer patients at Sun Yan-sen University Cancer were selected for mastectomy plus postoperative radiotherapy. The clinical target volume (CTV) of every patient was delineated on CT-slices after computed tomography (CT) simulation by 6 radiation oncologists. Then the coverage discrepancy in anatomic lymphatic drainage subregions was analyzed among both CTVs by different oncologists and CTVs for patients with different clinical characters. The average volume of SCLN-CTVs was 110 ± 28 cm(3). All SCLN, neck-IV and axilla III regions were covered in CTV, none of axillaIregion. The covergy rates of nonsurgery-axillaII, Rotter-LN, intraclavicular-LN, neck-Vb, scalenus gap, neck-III and surgery-axilla IIregions was 75%, 85%, 73%, 88%, 68%, 10%, 17% , respectively. SCLN, neck-IV and axilla III regions should be covered according to consensus. However, the opinions of nonsurgery-axillaII, Rotter-LN, intraclavicular-LN, neck-Vb, scalenus gap, neck-III and surgery-axilla IIremain divisive.

  6. Clinical Outcomes of Resectable Esophageal Cancer with Supraclavicular Lymph Node Metastases Treated with Curative Intent.

    Science.gov (United States)

    Honma, Yoshitaka; Hokamura, Nobukazu; Nagashima, Kengo; Sudo, Kazuki; Shoji, Hirokazu; Iwasa, Satoru; Takashima, Atsuo; Kato, Ken; Hamaguchi, Tetsuya; Boku, Narikazu; Umezawa, Rei; Ito, Yoshinori; Itami, Jun; Koyanagi, Kazuo; Igaki, Hiroyasu; Tachimori, Yuji

    2017-07-01

    In the seventh edition of the Union for International Cancer Control (UICC) TNM classification, supraclavicular lymph node (SCLN) in regard to thoracic esophageal cancer (EC) is regarded as a distant organ, therefore, if resectable, SCLN metastasis is considered a candidate for systemic chemotherapy. The purpose of this study was to clarify the survival outcome in patients with resectable thoracic EC with SCLN metastases (M1LYM) treated with curative intent. Clinical outcomes in patients with resectable thoracic EC with SCLN metastases (M1LYM) treated by esophagectomy or definitive chemoradiotherapy (dCRT) were retrospectively analyzed. A total of 102 patients were divided in three groups: Surgery with perioperative therapy, n=45; surgery alone, n=19; and dCRT, n=38. Overall, median progression-free survival and median survival time were 9.3 and 26.7 months, respectively. The median survival time was 27.5 months in the group treated with surgery with perioperative treatment, 50.6 months in those treated with surgery alone, and 22 months in the dCRT group. No significant survival difference was seen among the three groups. Over 30% of patients with resectable M1LYM treated with curative intent achieved long-term survival. Copyright© 2017, International Institute of Anticancer Research (Dr. George J. Delinasios), All rights reserved.

  7. Treatment Outcome of Breast Cancer with Pathologically Proven Synchronous Ipsilateral Supraclavicular Lymph Node Metastases.

    Science.gov (United States)

    Jung, Jinhong; Kim, Su Ssan; Ahn, Seung Do; Lee, Sang-Wook; Ahn, Sei-Hyun; Son, Byung Ho; Lee, Jong Won; Choi, Eun Kyung

    2015-06-01

    The aim of this study was to investigate the prognosis, patterns of failure, and prognostic factors for breast cancer patients with pathologically proven synchronous ipsilateral supraclavicular lymph node (ISCLN) metastases. We reviewed the records of breast cancer patients with pathologically proven ISCLN metastases. Local aggressive treatment was defined as treatment including surgery, axillary lymph node dissection (ALND), ISCLN excision, radiotherapy (RT), and chemotherapy. A total of 111 patients were included. The 5-year overall survival (OS) and disease-free survival (DFS) rates were 64.2% and 56.2%, respectively. On univariate analysis, RT, ALND, trastuzumab treatment, hormone receptor (HR) status, and local aggressive treatment were identified as significant factors for OS. The 5-year OS for 73 patients who received local aggressive treatment was superior to that of 38 patients who received nonaggressive treatment (70.9% vs. 49.3%, p=0.036). Multivariate analysis showed that RT, HR status, and trastuzumab were significant variables for the 5-year OS and DFS. Multimodality treatment with surgery, taxane-based chemotherapy, hormone therapy, and RT is strongly recommended for breast cancer patients with synchronous ISCLN metastases.

  8. Significance of supraclavicular lymph node involvement on determination of clinical staging for thoracic esophageal carcinoma

    Energy Technology Data Exchange (ETDEWEB)

    Wu, Hong Gyun; Park, Charn II; Ha, Sung Whan; Kim, Il Han [College of Medicine, Seoul National Univ., Seoul (Korea, Republic of)

    1999-06-01

    Involvement of supraclavicular lymph nodes (SCL) is considered distant metastasis for thoracic esophageal carcinoma in AJCC staging system revised in 1997. We investigated significance of SCL involvement compared to other regional lymph node involvement. Two- hundred eighty-nine patients with unresectable esophageal carcinoma were treated with radiation therapy from June of 1979 through December 1992. of these patients, 25 were identified having SCL involvement. Survival rate and relapse patterns were compared with that of mediastinal and perigastric lymph node positive patients to evaluate prognostic significance of SCL involvement. Median survival for patients with SCL involvement was 7 months and 2- and 5-year overall survival rates were 12.0% and 4.0% respectably. Corresponding features for regional node positive patients were 9 month, 17.0% and 3.8%. There was no significant difference between two groups. There was also no difference in patterns of recurrence. Results of this analysis showed that SCL involvement should be staged as nodal disease in contrast to present classification of metastatic disease.

  9. Radiation to supraclavicular and internal mammary lymph nodes in breast cancer increases the risk of stroke.

    Science.gov (United States)

    Nilsson, G; Holmberg, L; Garmo, H; Terent, A; Blomqvist, C

    2009-03-10

    The aim of this study was to assess whether adjuvant treatment of breast cancer (BC) affects the risk of stroke, and to explore radiation targets and fraction doses regarding risk and location of stroke. In a Swedish BC cohort diagnosed during 1970-2003, we carried out a nested case-control study of stroke after BC, with relevant details extracted from medical records. The odds ratio (OR) for radiotherapy (RT) vs that of no RT did not differ between cases and controls (OR=0.85; confidence interval, CI=0.6-1.3). Radiotherapy to internal mammary chain (IMC) and supraclavicular (SCL) lymph nodes vs that of no RT was associated with a higher, although not statistically significant, risk of stroke (OR=1.3; CI=0.8-2.2). In a pooled analysis, RT to IMC and SCL vs the pooled group of no RT and RT to breast/chest wall/axilla (but not IMC and SCL), showed a significant increase of stroke (OR=1.8; CI=1.1-2.8). There were no associations between cancer laterality, targets of RT, and location of stroke. The radiation targets, IMC and SCL, showed a statistically significant trend for an increased risk of stroke with daily fraction dose. Our finding of a target-specific increased risk of stroke and a dose-response relationship for daily fraction dose, indicate that there may be a causal link between RT to the IMC and SCL and risk of stroke.

  10. Ultrasound-Guided Tissue Core Biopsies in Supraclavicular Lymph Nodes in Patients with Suspected Thoracic Malignancies.

    Science.gov (United States)

    Stigt, Jos A; Boers, James E; Boomsma, Martijn F

    2015-01-01

    Supraclavicular (SC) lymph node metastases are important in the analysis of thoracic malignancies for staging as well as for diagnosing purposes. Ultrasound (US) guidance visualises lesions very precisely, enabling tissue biopsies in real-time mode. To report on the diagnostic qualities of SC tissue core biopsies (TCB). A retrospective database analysis was performed in TCB performed under US guidance in SC nodes in patients suspected of having a thoracic malignancy. Clinical characteristics and results of diagnostic evaluations were analysed. Between October 2008 and October 2014, 67 sessions for TCB in 65 patients were performed. The diagnostic accuracy of TCB for all diagnoses is 90%, with a sensitivity of 89%. For malignant diagnoses, the sensitivity of US-guided TCB is 93%. In 20 patients, molecular analysis for EGFR and KRAS was performed, with a diagnostic success rate of 95%. One patient suffered a moderate haemorrhage after TCB. TCB of SC nodes in the analysis of suspected thoracic malignancy is safe and has a high diagnostic accuracy in determining tumour subtype as well as molecular analysis. © 2015 S. Karger AG, Basel.

  11. THE EFFECT OF CLONIDINE ON LIDOCAINE INDUCED SUPRACLAVICULAR BRACHIAL PLEXUS BLOCK

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    Shrinivas

    2014-08-01

    Full Text Available BACKGROUND: Brachial plexus nerve blocks (BPB are the most common nerve blocks used for upper limb surgeries. Techniques using only Local Anaesthetics (LA have limited duration of post-operative analgesia. Clonidine has been used to prolong the duration of LA s for neuraxial blocks. Hence the effect of clonidine on Lidocaine induced BPB was studied. METHODS: 60 patients of American Society of Anesthesiologists (ASA class I and II were randomly divided into 2 groups. Group L given 30 ml of Lidocaine with adrenaline 1.5% with 0.6 ml of normal saline and the Group C given 30 ml of same LA with 0.6 ml of 90mcg of Clonidine. All the patients’ supraclavicular BPB was given using Winnies’ peri-vascular approach. The primary outcome was onset, duration of sensory and motor blockade. The secondary outcomes were motor block duration, opioid supplementation, and BPB complication. RESULTS: There was no statistically significant difference in the onset of sensory and motor block, motor blockade quality and overall quality of block. Duration of sensory and motor blockade was prolonged in groups with Clonidine. No adverse events / hemodynamic instability noted in either group. Sedation scores were higher in Clonidine group. No patients required any intervention. CONCLUSIONS: 90µg Clonidine added to Lidocaine 1.5% with adrenaline produces prolongation of both the duration of sensory and motor blockade with minimal adverse effects.

  12. Prevalencia de hipertrofia ventricular izquierda en pacientes diabéticos Prevalence of left ventricular hypertrophy in diabetic patients

    Directory of Open Access Journals (Sweden)

    Diego Valarezo-Sevilla

    2013-03-01

    Full Text Available Con el objetivo de establecer la prevalencia de hipertrofia ventricular izquierda (HVI en pacientes con diabetes mellitus tipo 2 (DM, se realizó un estudio transversal en estos pacientes, estableciendo sus características antropométricas, presión arterial y control metabólico. Para evaluar la presencia de HVI se empleó ecocardiografía transtorácica. El estudio incluyó 91 pacientes, en los cuales la prevalencia de HVI fue de 63,7%, siendo más frecuente en mujeres que en varones (p=0,001. Adicionalmente, se encontró un 46,2% de pacientes con disfunción diastólica del ventrículo izquierdo. Se concluye que existe una importante prevalencia de HVI en pacientes diabéticos sin antecedentes de causas definidas de hipertrofia. No se encontró relación con sexo, control metabólico, IMC y tiempo de diagnósticoIn order to establish the prevalence of left ventricular hypertrophy (LVH in patients with type 2 diabetes mellitus, (DM a cross-sectional study was conducted in these patients studying their anthropometric characteristics, blood pressure and metabolic control. To evaluate the presence of LVH, a trans-thoracic echocardiogram was used. The study included 91 patients, finding a 63.7% prevalence of HVI, with women being more affected than men (p=0.001. Additionally, 46.2% of patients were found to have diastolic dysfunction of the left ventricle. We conclude that there is an important prevalence of LVH in diabetic patients without defined causes of hypertrophy. There was no association with sex, metabolic control, BMI and time of diagnosis

  13. [A case of breast cancer with postoperative metastasis to the supraclavicular lymph nodes-recurrence-free survival achieved by surgical excision following chemotherapy].

    Science.gov (United States)

    Tezuka, Kenji; Dan, Nobuhiro; Tendo, Masashige; Hori, Takeshi; Nishino, Hiroji

    2011-08-01

    The patient, a 58-year-old woman, underwent a partial excision of the right breast and an axillary lymph node dissection in October 2004. The histopathological findings were: solid tubular carcinoma with metastasis to 17 axillary lymph nodes; triple negative-type breast cancer. As adjuvant therapy, FEC60 was administered 6 times, followed by radiotherapy applied to the residual breast and the right supraclavicular fossa. In Novermber 2007, she noted a tumorous growth above the right clavicle. The pathological diagnosis via fine needle biopsy was adenocarcinoma. An oral antineoplastic agent was given for about 6 months, but did not alter the lymph nodes. No distant recurrence was noted during this time. In August 2008, the right supraclavicular lymph nodes were dissected. The patient has been under observation without treatment, but no signs of recurrence have been noted. It was thought that excision of the recurrent supra-clavicular lymph nodes should be considered after careful examination in some individual cases.

  14. [A case of advanced ascending colon cancer, curatively resected after complete response in left supraclavicular and paraaortic lymph nodes and liver metastases to FOLFOX4 therapy].

    Science.gov (United States)

    Furumoto, Katsuyoshi; Kojima, Hidenobu; Takaya, Haruo; Okuno, Masayuki; Fuji, Hiroaki; Mizuno, Rei; Mori, Tomohiko; Ito, Daisuke; Kogire, Masafumi

    2010-02-01

    We report a resected case of ascending colon cancer with left supraclavicular and paraaortic lymph nodes and liver metastases which completely responded in terms of metastases but not the primary tumor to FOLFOX4 therapy. A 62-year-old woman with epigastric discomfort was initially diagnosed as malignant lymphoma by FDG-PET with abnormal accumulation at left supraclavicular and paraaortic lesions. Pathological examination of the supraclavicular lymph nodes showed undifferentiated adenocarcinoma, and ascending colon cancer was detected by colonoscopy which was a mixture of various types of differentiation. FOLFOX4 therapy was effective for metastatic lesions but colon tumor did not regress and was accompanied by abdominal pain. Macroscopically, a curative right hemicolectomy was performed, and microscopic examination revealed that the tumor had become a mass of undifferentiated cancer cells. Thus, the present case demonstrates the dedifferentiation of colon cancer during chemotherapy.

  15. Persistencia de la vena cava superior izquierda: Diagnóstico e importancia prenatal Persistency of the left superior caval vein: Diagnosis and its prenatal importance

    Directory of Open Access Journals (Sweden)

    Juan F Jaramillo

    2010-04-01

    Full Text Available Durante un ultrasonido obstétrico de rutina se deben realizar ciertos planos del corazón en los cuales no es complejo identificar un grupo de anomalías como la persistencia de la vena cava superior izquierda. Cuando se identifica una vena cava superior izquierda aislada, sin otras anomalías del corazón fetal, no existe ninguna repercusión perinatal. Su importancia radica en que un grupo considerable de estos casos se acompaña de cardiopatías congénitas y anomalías anatómicas y cromosómicas. En este artículo se describen nueve casos de vena cava superior izquierda persistente, al igual que las anomalías del corazón asociadas, como también las alteraciones extracardiacas encontradas.Certain heart fetal planes must be realized during a routine obstetric ultrasound in order to identify a group of anomalies such as the persistency of the left superior caval vein. When an isolated left superior venal vein is identified without any other anomaly of the fetal heart, it does not have any perinatal repercussion. Its importance lies in the fact that a considerable number of these cases are associated with a high incidence of congenital heart diseases and anatomic and chromosomal abnormalities. This article reports nine cases of persistency of the left superior caval vein as well as the associated heart abnormalities and the extra-cardiac alterations found.

  16. La intolerancia a la glucosa aumenta el índice de masa ventricular izquierda y la distensibilidad arterial en un grupo de hipertensos leves de sexo masculino

    Directory of Open Access Journals (Sweden)

    Claudio R. Majul

    2005-01-01

    Full Text Available Con la finalidad de evaluar si en un grupo de hipertensos de nivel I con intolerancia a la glucosa y obesidad abdominal, por lo cual reúnen criterios para diagnóstico de síndrome metabólico (SM, existe un índice de masa ventricular izquierda mayor y una alteración mayor de la distensibilidad arterial respecto de un grupo de hipertensos de nivel I con obesidad abdominal, no intolerantes a la glucosa y sin SM, en el presente trabajo se incluyeron 56 varones, de 51 ± 6 años, con hipertensión de nivel I, que se dividieron en dos grupos. Grupo A 28 con SM: glucemia en ayunas >1,10 g/L y 1,40 g/L y menor de 2,00 g/L, perímetro abdominal > 102 cm y PA = 130 y/u / 85 mm Hg. Grupo B 28 sin SM: el perímetro abdominal y la presión arterial eran similares al grupo A, pero con glucemias en ayunas < 1,10 g/L y poscarga < 1,40 g/L. Se midió el índice de masa ventricular izquierda (IMVI por ecocardiografia bidimensional y distensibilidad arterial: velocidad de onda de pulso, onda refleja central (ORC por Sphygmocor: Grupo A Grupo B p < 0,05 IMVI g/m2 140 ± 30 101 ± 28 0,002 ORC mm Hg 28 (R 15/48 21 (R 11/38 0,003 Conclusión La presencia de intolerancia a la glucosa en pacientes con hipertensión de nivel I se asocia con mayor masa ventricular izquierda y rigidez arterial que en los casos con el mismo nivel de hipertensión sin intolerancia a la glucosa.

  17. [Clinical value of ultrasound in the diagnosis of supraclavicular lymph node 
metastasis of primary lung cancer].

    Science.gov (United States)

    Liu, Zhao; Cheng, Wen; Li, Pengfei; Sun, Yixin; Wang, Qiucheng

    2014-09-20

    Primary lung cancer has been common malignant tumors. Accurate preoperative N staging can avoid unnecessary surgical operations, and patients with N3 has non-surgical treatment of indications. The aim of this study is to investigate the clinical value of ultrasound in the diagnosis of supraclavicular lymph node metastasis and staging of primary lung cancer. We retrospectively analyzed 131 patients who were pathologically diagnosed with lung cancer from October 2012 to November 2013. All patients received ultrasound and contrast-enhanced computed tomograohy (CT) examination of the supraclavicular area, and those who were with positive results underwent ultrasound-guided biopsy. The accuracy of the two methods was compared according to their consistency with the pathological results. The pathological diagnosis was used as the diagnosis standard of lymph node metastasis. There were 50 cases of patients who were confirmed supraclavicular lymph node metastasis pathologically in a total of 131 cases of patients with lung cancer. Fifty-four cases were tested positive by ultrasound, and 50 cases were pathologically proven to be with lymph node metastasis. For comparison, the ratio was 36 out of 41 for contrast-enhanced CT. The sensitivity, specificity, You den's index, the positive predictive value and the negative predictive value of ultrasound (100%, 95.06%, 95.06%, 92.59%, 100%) was significantly higher than that of contrast-enhanced CT (72%, 93.83%, 65.83%, 87.80%, 84.44%). The differences of accuracy of the two methods in TNM staging of lung cancer had statistically significance (Psupraclavicular lymph node metastasis in lung cancer, and at the same time can determine the TNM staging of primary lung cancer more accurately.

  18. The surgical anatomy of the supraclavicular lymph node flap: A basis for the free vascularized lymph node transfer.

    Science.gov (United States)

    Steinbacher, Johannes; Tinhofer, Ines E; Meng, Stefan; Reissig, Lukas F; Placheta, Eva; Roka-Palkovits, Julia; Rath, Thomas; Cheng, Ming-Huei; Weninger, Wolfgang J; Tzou, Chieh Han

    2017-01-01

    Vascularized lymph node transfer is an effective surgical method in reducing lymphedema. This study provides the first detailed description of the surgical anatomy of the supraclavicular lymph node flap in regard to pedicle length, pedicle diameter, and the number of lymph nodes and their exact location inside the flap. Bilateral supraclavicular dissections of nine fresh cadavers (five female) were performed. Before the dissection, the exact number of lymph nodes was determined sonographically by an experienced radiologist, and their distance from the jugular notch was measured. After anatomic dissection, the vascular pedicle's diameter and length were measured. The mean number of lymph nodes was 1.5 ± 1.85 on the right side and 3 ± 2.26 on the left. Their mean distance from the jugular notch was 8.29 ± 2.15 cm on the right and 6.10 ± 1.21 cm on the left. The pedicle's length was 4.72 ± 1.03 cm on the right and 4.86 ± 0.99 cm on the left, and its diameter 2.03 ± 0.83 on the right and 1.80 ± 0.77 on the left. The pedicle length and diameter of the supraclavicular lymph node flap are suitable for a microvascular tissue transfer. J. Surg. Oncol. 2017;115:60-62. © 2016 Wiley Periodicals, Inc. © 2016 Wiley Periodicals, Inc.

  19. Breast cancer regional radiation fields for supraclavicular and axillary lymph node treatment: is a posterior axillary boost field technique optimal?

    Science.gov (United States)

    Wang, Xiaochun; Yu, Tse Kuan; Salehpour, Mohammad; Zhang, Sean X; Sun, Tzouh Liang; Buchholz, Thomas A

    2009-05-01

    To assess whether using an anterior oblique supraclavicular (SCV) field with a posterior axillary boost (PAB) field is an optimal technique for targeting axillary (AX) lymph nodes compared with two computed tomography (CT)-based techniques: (1) an SCV field with an anterior boost field and (2) intensity-modulated radiotherapy (IMRT). Ten patients with CT simulation data treated with postmastectomy radiation that included an SCV field were selected for the study. Supraclavicular nodes and AX Level I-III nodes within the SCV field were contoured and defined as the treatment target. Plans using the three techniques were generated and evaluated for each patient. The anterior axillary boost field and IMRT resulted in superior dose coverage compared with PAB. Namely, treatment volumes that received 105%, 80%, and 30% of prescribed dose for IMRT plans were significantly less than those for the anterior axillary boost plans, which were significantly less than PAB. For PAB and anterior axillary boost plans, there was a linear correlation between treatment volume receiving 105% of prescribed dose and maximum target depth. Furthermore, the IMRT technique resulted in better lung sparing and dose conformity to the target than anterior axillary boost, which again was significantly better than PAB. The maximum cord dose for IMRT was small, but higher than for the other two techniques. More monitor units were required to deliver the IMRT plan than the PAB plan, which was more than the anterior axillary boost plan. The PAB technique is not optimal for treatment of AX lymph nodes in an SCV field. We conclude that CT treatment planning with dose optimization around delineated target volumes should become standard for radiation treatments of supraclavicular and AX lymph nodes.

  20. Identification of risk factors and characteristics of supraclavicular lymph node metastasis in patients with small cell lung cancer.

    Science.gov (United States)

    Feng, Zhen-Xing; Zhao, Lu-Jun; Guan, Yong; Sun, Yao; Meng, Mao-Bin; Ji, Kai; Wang, Ping

    2013-03-01

    Thoracic radiotherapy provides a survival benefit in patients with limited-stage disease of small cell lung cancer (LS-SCLC), but inclusion and exclusion of prophylactic irradiation of the supraclavicular area are still controversial. This study analyses the risk factors and characteristics of lymph node metastases in the supraclavicular area of LS-SCLC patients, which could help in developing a better radiotherapy for the patients. A total of 239 patients with LS-SCLC were included in this retrospective analysis. Clinical characteristics and mediastinal lymph node metastasis were analyzed for association with SCM, and the SCM pattern was further analyzed based on the treatment planning CT scans. The SCM incidence was 34.7 % (83 of 239). The multivariate analysis showed that only the mediastinal level 2 (OR = 16.101, P = 0.000) and level 3 (OR = 5.597, P = 0.000) lymph node metastases were significantly associated with SCM. As the most frequently involved region, supraclavicular level I lymph node metastases were identified in 61 of 83 patients (73.5 %), followed by level III, level IV, level V, and level II lymph node metastases, accounting a total of 95.2 % for level I and/or III lymph node metastases, whereas the incidence of skip metastasis was only 4.8 %. SCLC patients with mediastinal level 2 and level 3 lymph node metastasis were at high risk of SCM. If prophylactic irradiation therapy is considered, the nodal clinical target volume of irradiation should include bilateral lower para-recurrent laryngeal neural region (level I) and the para-internal jugular venous region (level III).

  1. El Partido Socialista de las Izquierdas: organización, proyecto político y participación electoral, 1933-1940

    OpenAIRE

    JAVIER MAC GREGOR CAMPUZANO

    2009-01-01

    El artículo analiza a un actor poco conocido de la escena política mexicana de mediados de la década de 1930, el Partido Socialista de las Izquierdas, el cual, asociado directamente con la figura de Adalberto Tejeda, impulsó la candidatura del político veracruzano a la presidencia de la República en 1934. Se estudia su propuesta política, su forma organizativa, así como algunas de las principales ramificaciones que tenía en el país. A través de su órgano informativo, nos acercamos a los momen...

  2. De "El Auténtico" a "La Voz": el pensamiento de la izquierda peronista antes y después de la dictadura (1975-1984

    Directory of Open Access Journals (Sweden)

    Joaquín Baeza Belda

    2010-01-01

    Full Text Available En 1975, en el contexto del conflictivo y cada vez más represivo gobierno de Isabel Perón, la organización armada Montoneros, de la izquierda peronista, decide lanzar un partido político propio, el Partido Peronista Auténtico, con la intención de desarrollar una labor fuera de la clandestinidad. El partido editó además el periódico El Auténtico, en el que se expresaban las ideas de este importante segmento de la izquierda peronista. Tras el golpe de 1976 y varios años de dura represión, durante los primeros pasos de la apertura política se creó el diario La Voz, en torno al que se reagrupó gran parte de la izquierda peronista superviviente que se desarrollaba a partir de la línea interna Intransigencia y Movilización. Si bien no es posible encontrar una sucesión directa entre ambas publicaciones, las continuidades son evidentes y su comparación permite estudiar los cambios producidos en el ideario y en la cultura política del peronismo y sus sectores de izquierda durante la transición a la democracia.______________ABSTRACT:In 1975, in the context of the troubled and ever more repressive government of Isabel Peron, the Montoneros, a guerrilla force from the peronist left, decided to create their own political party: Partido Peronista Auténtico. Their aim was to develop their activities outside clandestinity.  Besides, they started to publish El Autentico, a newspaper through which they expressed the ideas of this important segment of the peronist left. After the 1976 coup d’état, and several years of harsh repression, the first steps to political liberalization were taken. It was in those years that the newspaper La Voz was created as a meeting point for most of the surviving peronist left, which formed part of the Intransigencia y Movilización movement, an internal line within the party.  Although there is no direct succesion between both publications, there is a clear continuity between them. This is why their

  3. ¿Por qué la Gente Vota a la Izquierda? Clivajes, Ideología y Voto Retrospectivo en Bolivia y Uruguay en Perspectiva Comparada

    OpenAIRE

    Tomáš Došek

    2014-01-01

    El objetivo de este artículo es explicar las razones del voto de los ciudadanos hacia Evo Morales y José Mujica en las elecciones presidenciales de 2009 y evaluar en qué medida los determinantes del voto permiten distinguir las supuestas "dos izquierdas" en América Latina. Utilizando datos de encuestas de opinión pública para los dos casos representativos este trabajo muestra cómo las razones son diferentes, ya que en Uruguay pesa relativamente más la ideología y los elementos programáticos y...

  4. "La izquierda política y sindical ha perdido su capacidad de reacción frente a la voracidad del capitalismo"

    Directory of Open Access Journals (Sweden)

    Daniel Lacalle

    2011-06-01

    Full Text Available Entrevista del Consejo de Redacción de Encrucijadas a Daniel Lacalle, responsable de la sección de Economía y Sociedad en la Fundación de Investigaciones Marxistas (FIM y con una dilatada carrera investigadora. En ella responde a cuestiones sobre la mutación de la "clase obrera" y su conceptualización, así como otros aspectos relacionados con la precariedad en el trabajo, la izquierda política y el sindicalismo.

  5. Del dogmatismo católico al dogmatismo de izquierda. El Ambiente Político en la Universidad Nacional en los 60s y 70s

    OpenAIRE

    William Maurico Beltrán

    2009-01-01

    L a Universidad Nacional estuvo inmersa durante las décadas del 60 y 70 en un ambiente altamente politizado en el que nacieron y fructificaron diversos movimientos de izquierda. La mayoría de estos movimientos heredaron del catolicismo el dogmatismo y la intolerancia, lo que influyó para que se convirtieran en sectas cerradas y totalitarias semejantes en muchas de sus características a los movimientos religiosos voraces. El presente ensayo pretende explotar las posibilidades explicativas que ...

  6. Variation in 'supraclavicular' lymph node depth is partly determined by treatment position

    Energy Technology Data Exchange (ETDEWEB)

    Klages, H.T.; Szafinski, F.; Makosi, H.B. [Klinikum Duisburg, Wedau Kliniken (Germany). Strahlenklinik, Radioonkologie, Nuklearmedizin

    2000-07-01

    Background: The so-called 'supraclavicular' region bears the confluence of deep jugular, upper mediastinal and axiallary lymph node groups and therefore it is often part of the target volume in common malignancies like lung cancer, breast cancer and head and neck cancer. For treating this area, several authors recommend an anterior portal with the dose prescribed to a tissue depth of 3 cm, which does not fit our institution's experience. Patients and methods: In 119 consecutive patients a computed tomography for planning purposes was performed. We used the subclavian blood vessels between clavicula and first rib as an estimate of the confluence of the mentioned lymph node regions and determined their tissue depth (which does not describe the deepest part of the lymph vessels). Results: Mean and median of the tissue depth were 5 cm in a range from 2 to 9 cm. Only in less than 20% of the measurements we found the vessels located 3 cm or less under the surface which would correspond to a depth of the lymph node target volume 4 to 5 cm. Increasing body mass resulted in deeper location of the vessels. The position of the patient's arms influenced the tissue depth even more. Arms risen above the head resulted in 55% of the measurements in tissue depths of 6 cm or deeper compared to 6% in patients treated with arms beside the body. Conclusion: Standardized treatment prescriptions do not cope adequately with individual anatomy. Treatment position especially of the arms influences location of the 'supraclavicular' lymph node region in thoracic treatment. Target volume delineation by computed tomography seems the most accurate solution, although it is the most expensive one. Patient immobilization is crucial for accuracy of treatment delivery. (orig.) [German] Hintergrund: In der so genannten 'Supraklavikularregion' findet sich der Zusammenfluss der tief zervikalen, oberen mediastinalen und zentral axillaeren Lymphwege; daher gehoert

  7. A Case of Pulmonary Cryptococcosis in an Immunocompetent Male Patient Diagnosed by a Percutaneous Supraclavicular Lymph Node Biopsy.

    Science.gov (United States)

    Sung, Ji Hee; Kim, Do Hoon; Oh, Mi-Jung; Lee, Kyoung Ju; Bae, Young A; Kwon, Kye Won; Lee, Seung Min; Kang, Ho Joon; Choi, Jinyoung

    2015-07-01

    Cryptococcal pneumonia usually occurs in immunocompromised patients with malignancy, acquired immune deficiency syndrome, organ transplantations, immunosuppressive chemotherapies, catheter insertion, or dialysis. It can be diagnosed by gaining tissues in lung parenchyma or detecting antigen in blood or bronchoalveolar lavage fluid. Here we report an immunocompetent 32-year-old male patient with diabetes mellitus diagnosed with cryptococcal pneumonia after a ultrasound-guided percutaneous supraclavicular lymph node core needle biopsy. We treated him with fluconazole at 400 mg/day for 9 months according to the guideline. This is the first case that cryptococcal pneumonia was diagnosed from a percutaneous lymph node biopsy in South Korea.

  8. Preliminary PET/CT Study of 18F-FDG Uptake in Cervical and Supraclavicular Brown Adipose Tissue

    Institute of Scientific and Technical Information of China (English)

    Na Fang; Wei Ding; Yanli Wang; Xinjian Cui; Lei Zeng; Lili Ma; Xiumei Zhao; Wei Zhao; Qing Wang; Shan Gao

    2008-01-01

    OBJECTIVE The clinical use of PET/CT in oncology has led to the realization that 18F-FDG uptake in brown adipose tissue (BAT)can be a common cause of potentially misleading false-positive PET scans.The goal of this study was to study 18F-FDG uptake in cervical and supraclavicular regions and its characteristics with PET/CT.METHODS All the PET/CT scans obtained at our institution from July 2007 to January 2008 were retrospectively reviewed for increased 18F-FDG uptake in BAT.The cases in which increased 18F-FDG in cervical and supraclavicular regions was not localized to a soft-tissue mass or lymph node or muscle on the CT images,were included in this study.The following features were recorded:body weight,body mass index (BMI) and maximal standardized uptake value (SUVmax).In these selected patients,the BAT uptake in other area of the body was also recorded.RESULTS PET/CT scans were obtained in 457 patients (259 males and 198 females).In all of the scans,cervical and supraclavicular BAT uptake was observed in 12 patients (2 males and 10 females) and was typically bilateral,symmetric and intense.The range of the SUVmax was 3.6~12.82 (mean 6.9 ± 2.6).BAT uptake was more common in females than in males,showing a significant difference (P = 0.004).Although 18F-FDG uptake in BAT occurred more often in underweight patients with low BMI,there was no difference in the body weight (P = 0.607) or BMI (P =0.491) of these patients with hypermetabolic BAT compared with controls.CONCLUSION Hypermetabolic BAT uptake can be localized in cervical and supraclavicular regions with it occurring more commonly in females compared to males.Knowledge of this potential pitfall with PET/CT is important in improving diagnostic interpretation and accurate staging.

  9. Victimización y heroísmo. Disputas de las memorias emblemáticas de la izquierda chilena en dos fechas conmemorativas: aniversario del golpe de Estado y día del joven combatiente

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    Tamara vidaurrazaga aránguiz

    2015-01-01

    Full Text Available En el presente trabajo proponemos reflexionar en torno a dos memorias emblemáticas y dicotómicas que tienen lugar dentro de la izquierda chilena a la hora de recordar a quienes resistieron a la dictadura de Pinochet, reelaboraciones que hemos denominado memoria de la victimización y memoria del heroísmo, y que ejemplificaremos en dos fechas icónicas para la izquierda chilena: la conmemoración del Golpe de Estado cada 11 de septiembre, y el Día del Joven Combatiente rememorado cada 29 de marzo. Lo que nos interesa es reflexionar en torno a la marmolización que implican estas dos reconstrucciones, y la dificultad para imaginar un futuro para el proyecto político heredado por la izquierda chilena al sumirnos en esta dicotomía estanca.

  10. A simplified CT-based definition of the supraclavicular and infraclavicular nodal volumes in breast cancer.

    Science.gov (United States)

    Atean, I; Pointreau, Y; Ouldamer, L; Monghal, C; Bougnoux, A; Bera, G; Barillot, I

    2013-02-01

    The available contouring guidelines for the supraclavicular and infraclavicular lymph nodes appeared to be inadequate for their delineation on non-enhanced computed tomography (CT) scans. For this purpose, we developed delineation guidelines for the clinical target volumes (CTV) of these lymph nodes on non-enhanced CT-slices performed in the treatment position of breast cancer. A fresh female cadaver study as well as delineation and an anatomical descriptions review were performed to propose a simplified definition of the supra- and infraclavicular lymph nodes using readily identifiable anatomical structures. This definition was developed jointly by breast radiologists, breast surgeons, and radiation oncologists. To validate these guidelines, the primary investigator and seven radiation oncologists (observers) independently delineated 10 different nodal CTVs. The primary investigator contours were considered to be the gold standard contours. Contour accuracy and concordance were evaluated. Written guidelines for the delineation of supra- and infraclavicular lymph nodes CTVs were developed. Consistent contours with minimal variability existed between the delineated volumes; the mean kappa index was 0.83. The mean common contoured and additional contoured volumes were 84.6% and 18.5%, respectively. The mean overlap volume ratio was 0.71. Simplified CT-based atlas for delineation of the supra- and infraclavicular lymph nodes for locoregional irradiation of the breast on non-enhanced CT-scan, have been developed in this study. This atlas provides a consistent set of guidelines for delineating these volumes. Copyright © 2012 Société française de radiothérapie oncologique (SFRO). Published by Elsevier SAS. All rights reserved.

  11. La orejuela izquierda como fuente de accidentes cerebrovasculares: cerrar (y cómo), o no cerrar (y por qué) Left atrial appendage as a source of stroke: to close (and how), or not to close (and why)

    OpenAIRE

    R. Hernández-Estefanía; Levy, B; G. Rábago

    2012-01-01

    La orejuela izquierda se considera la principal fuente de émbolos en los accidentes cerebrovasculares que se producen en pacientes con fibrilación auricular. El tratamiento con anticoagulantes orales reduce significativamente el riesgo de accidentes embólicos cerebrales en relación con la aspirina, pero se asocia a riesgo de complicaciones hemorrágicas, por lo que no siempre son utilizados. Se ha descrito que el cierre de la orejuela izquierda reduce la tasa de accidentes tromboembólicos y en...

  12. ¿Fascistas o revolucionarios? Política de izquierda y de derecha entre los campesinos pobres ¿Fascistas o revolucionarios? Política de izquierda y de derecha entre los campesinos pobres

    Directory of Open Access Journals (Sweden)

    Leslie Anderson

    2001-01-01

    Full Text Available La expansión de la democracia en América Latina y su extensión en el tiempo ha puesto de manifiesto una tendencia sorprendente y preocupante. Muchos de los nuevos electores latinoamericanos han dado su apoyo a candidatos de derecha y no democráticos que una vez en el poder han atentado de diversas maneras contra la democracia. Dentro del electorado se constata que ese apoyo a las fuerzas antidemocráticas es mayor en la población rural. A la luz de la bibliografía de los años 70 y 80 sobre las revoluciones campesinas de Rusia, China, Cuba o Nicaragua, este derechismo campesino es un rompecabezas: ¿los campesinos son fascistas o revolucionarios? Para descifrar este enigma, el trabajo en primer lugar analiza cuatro casos de apoyo rural al fascismo o al autoritarismo populista en la primera mitad del siglo XX (Francia, Italia, Alemania y Argentina. Compara los factores explicativos que emergen de esa comparación con los resultados obtenidos de la investigación sobre el izquierdismo campesino en China, Rusia, Cuba y Nicaragua. La conclusión del trabajo es que hay dos conjuntos de factores que explican el apoyo de los campesinos a la izquierda o a la derecha. El primer tipo de factores, de transfondo, incluye el contexto económico y las relaciones sociales de propiedad y tenencia de la tierra. El segundo tipo de factores, de primer plano,incluye el tipo de liderazgo, el estilo organizativo y la habilidad política, así como el tipo de retórica que se usa para atraer el voto campesino. La población rural no es por naturaleza ni de derecha ni de izquierda, sino que su apoyo puede llevarse a cualquiera de los dos lados dependiendo del trasfondo económico-social y de la escena política. En América Latina hay que estudiar en detalle los estilos de liderazgo y las retóricas de los candidatos. Estas variables de primera instancia nos van a permitir dictaminar si el apoyo electoral dará lugar a panoramas fascistas o autoritarios como los

  13. EFFECT OF BUPRENORPHINE ON POST OPERATIVE ANALGESI A IN SUPRACLAVICULAR BRACHIAL PLEXUS BLOCK USING PERIPHE RAL NERVE LOCATOR

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    Ritesh

    2013-01-01

    Full Text Available ABSTRACT : Supraclavicular brachial plexus block is known for its simplicity, effectiveness, safety, reliability and being economical for day ca re and emergency surgery, circumventing problems of full stomach. In our randomized prospective, double blind study, t otal 60 adult ASA class I and II patients undergoing upper limb surgeri es were given supraclavicular brachial plexus block with peripheral nerve locator and studied for effect of addition of buprenorphine on post operative analgesia. 30 Patients received 0.2 5% bupivacaine 40 ml in group Bupivacaine (B and added buprenorphine 3 μgm/kg in th e other group Bupivacaine + Buprenorphine (BB. All the patients were monitored fo r onset of effect, post op analgesia, time of first analgesic drug and number of analgesic dru g require in first 24 hrs. Onset and duration of motor and sensory block were same in both groups. Post operative analgesia was significantly better in BB. Consequently, number of doses of analgesic required in first 24 hours was less in buprenorphine group (BB.

  14. Acta Medica Indonesiana - The Indonesian Journal of Internal Medicine 333 Supraclavicular Lymphnodes: Unusual Manifestation of Metastase Adenocarcinoma Colon

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    Harijono Achmad

    2015-12-01

    Full Text Available We report a patient with supraclavicular lymph node metastasis from an undetectable adenocarcinoma of the transverse colon, who presented with cough and was diagnosed with typhoid fever, bronchitis as well as liver metastasis. There were an abdominal fullness, weight loss, constipation, pencil-like stool with mucous and blood, low-grade fever, bone ache, and tea-color urine. The first colonoscopy revealed lymphocytic ileitis and microscopic findings also showed lymphocytic ileitis. Abdominal USG and CT revealed liver metastasis of unknown origin. Based on the clinical sign and symptoms, we suspected that colorectal carcinoma was the primary site. Then, the second colonoscopy was performed and it revealed a small polyp, which was followed with a biopsy and the result supported a well-differentiated colon adenocarcinoma. Similar result was also revealed by the histopathological evaluation. This is an unusual case of liver and supraclavicular lymph node metastasis arising from a small polyp adenocacinoma of the transverse colon. Key words: liver metastase, colorectal carcinoma, lymph node.

  15. A study of the use of the supraclavicular artery flap for resurfacing of head, neck, and upper torso defects

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    Telang Parag

    2009-01-01

    Full Text Available The head and neck region is an aesthetically demanding area to resurface because of its high visibility. Tissue defects in this area often require distant flaps or free flaps to achieve an aesthetically acceptable result. The use of the Supraclavicular artery flap represents an extremely versatile and useful option for the resurfacing of head, neck and upper torso defects. Furthermore, islanding the flap gives it a wide arc of rotation and the color and texture match is superior to that of free flaps harvested from distant sites. In our study, we used the flap (both unexpanded and expanded predominantly for resurfacing neck defects resulting from the release of post-burn contractures. However, its applicability in other indications would also be similar. Except one, all our flaps survived almost completely and the post-operative morbidity was very low. We conclude that the supraclavicular artery flap not only provides a reasonably good color and texture match but also maintains the multi-directional activity in the neck region.

  16. ¿Por qué la Gente Vota a la Izquierda? Clivajes, Ideología y Voto Retrospectivo en Bolivia y Uruguay en Perspectiva Comparada

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    Tomáš Došek

    2014-09-01

    Full Text Available El objetivo de este artículo es explicar las razones del voto de los ciudadanos hacia Evo Morales y José Mujica en las elecciones presidenciales de 2009 y evaluar en qué medida los determinantes del voto permiten distinguir las supuestas "dos izquierdas" en América Latina. Utilizando datos de encuestas de opinión pública para los dos casos representativos este trabajo muestra cómo las razones son diferentes, ya que en Uruguay pesa relativamente más la ideología y los elementos programáticos y en Bolivia más el voto retrospectivo, cruzado cada uno por distintos clivajes estructurales. Discutiendo los resultados con la literatura secundaria sobre los demás casos sudamericanos, se argumenta que la clásica clasificación en dos izquierdas no se sostiene a partir del análisis de los determinantes del voto. Metodológicamente, se recurre al análisis de regresión logística binomial y a la comparación de una serie de modelos estadísticos.

  17. Matriz ideológico-política cristiana e izquierda social: la crítica a la modernidad en la revista Alternativa Latinoamericana (1985-1990

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    Guilhermo Barón

    2015-12-01

    Full Text Available Resumen En la Argentina el importante rol que el cristianismo liberacionista ha jugado en la conformación y planteamiento y conceptualización de una izquierda movimentaria no tradicionalmente política ha sido frecuentemente pasado por alto. En este artículo argumentamos sobre la presencia de una matriz político-ideológica cristiana, esto es, una tradición particular de objetivación de lo social y lo político, operando en el origen mismo de esta izquierda social. Analizamos posteriormente algunas de las características comunes a muchos de los nuevos movimientos sociales latinoamericanos y establecemos un paralelo con las formas de categorizar lo social típicas de los movimientos cristianos. Finalmente realizamos un relevamiento de esas categorías en una editorial de la revista Alternativa Latinoamericana, empleada aquí en tanto documento del discurso cristiano-ecuménico en la Argentina de los ’80.

  18. MORPHOMETRIC PARAMETERS OF THE GLENOID FOSSA WITH THE LABRUM ATTACHED. Parámetros morfométricos de la fosa glenoidea con el labrum incluido

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    Abduelmenem Alashkham

    2016-07-01

    Full Text Available Background: The height and width of the glenoid fossa is important in total shoulder replacement. Previous studies, using different methods, have reported differences in glenoid fossa height and width. The current study aims to provide the morphometric parameters of the glenoid fossa with the labrum attached. Material and Methods: One hundred and forty shoulders from 30 males and 40 females were dissected and measurements taken. Exposure of the glenoid fossa with the labrum attached was undertaken, followed by direct measurement of glenoid height, width and level of maximum width using digital calipers. Data were double-entered into the Statistical Package for Social Sciences (SPSS, version 21. Kruskal-Wallis and One Way Analysis of Variance on Ranks tests were used. Statistical significance was defined as p<0.05. Results: The overall mean height, width and the level of maximum width for both genders were 38.94 mm, 30.50 mm and 17.14 mm respectively. However, the mean height, width and level of maximum width were significantly greater in males than females (P<0.001 for each. Conclusion: The mean height, width and the level of maximum width with the glenoid labrum attached were significantly greater in males than females. It suggests that the increase in height and width is due to the glenoid labrum is proportionate to the height and width of the glenoid fossa thus accounting for the difference between males and females remaining significant with or without the glenoid labrum.  Introducción: La altura y la anchura de la cavidad glenoidea es importante en el reemplazo total de hombro. Estudios previos, utilizando diferentes métodos, han presentado diferencias respecto a la altura y a la anchura de la cavidad glenoidea. El presente estudio tiene como objetivo proporcionar los parámetros morfométricos de la fosa glenoidea con el labrum incluido. Materiales y métodos: Se disecaron y tomaron medidas de ciento cuarenta hombros pertenecientes a

  19. Fluid biopsy for circulating tumor cells in an occult ovarian cancer patient exhibiting bilateral supraclavicular lymph node metastases: A case report.

    Science.gov (United States)

    He, Shizhi; Li, Pingdong; Chen, Xiaohong; Yu, Zhenkun

    2013-08-01

    Metastases to the supraclavicular region usually originate from the head and neck or from infraclavicular tumors. Ovarian primaries of supraclavicular metastases are extremely rare. The present study reports the case of a 60-year-old patient with a bilateral supraclavicular mass that was diagnosed as a poorly-differentiated squamous cell carcinoma of unknown primary, following a fine-needle aspiration biopsy (FNAB) and comprehensive clinical investigation. The analysis of a peripheral blood sample using the CellSearch system revealed the presence of circulating tumor cells (CTCs) that were positive for epithelial cell adhesion molecule (EpCAM) and cytokeratin (CK) expression. Since EpCAM is usually expressed in adenocarcinoma, an excisional biopsy of the right supraclavicular lymph node was performed. The patient was diagnosed with occult ovarian low-grade serous carcinoma by immunohistochemistry. To the best of our knowledge, this is the first report to demonstrate that CTCs may be detected in the peripheral blood of a patient with cancer of unknown primary (CUP) by using the CellSearch system. A literature review was performed to analyze the diagnostic procedures of CUP metastatic to the cervical lymph nodes and the clinical features of CTCs.

  20. Dosimetric prospective study comparing 2D and 3D planning for irradiation of supraclavicular and infraclavicular regions in breast cancer patients

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    Mohsen Barsoum

    2015-03-01

    Conclusions: From the present study we concluded that the coverage of the supraclavicular and infraclavicular PTV is significantly worse with the 2D technique using a single oblique field at a fixed depth of 3 cm for all patients despite their different builts.

  1. SUPRACLAVICULAR LYMPH-NODE METASTASES IN CARCINOMA OF THE ESOPHAGUS AND GASTROESOPHAGEAL JUNCTION - ASSESSMENT WITH CT, US, AND US-GUIDED FINE-NEEDLE ASPIRATION BIOPSY

    NARCIS (Netherlands)

    VANOVERHAGEN, H; LAMERIS, JS; BERGER, MY; VANDERVOORDE, F; TILANUS, HW; KLOOSWIJK, AIJ; ZONDERLAND, HM; VANPEL, R

    The preoperative assessment of supraclavicular lymph node metastases was prospectively studied in 100 patients with carcinoma of the esophagus and gastroesophageal junction. Findings at computed tomography (CT), ultrasound (US), and palpation were compared, and US-guided fine-needle aspiration

  2. SUPRACLAVICULAR LYMPH-NODE METASTASES IN CARCINOMA OF THE ESOPHAGUS AND GASTROESOPHAGEAL JUNCTION - ASSESSMENT WITH CT, US, AND US-GUIDED FINE-NEEDLE ASPIRATION BIOPSY

    NARCIS (Netherlands)

    VANOVERHAGEN, H; LAMERIS, JS; BERGER, MY; VANDERVOORDE, F; TILANUS, HW; KLOOSWIJK, AIJ; ZONDERLAND, HM; VANPEL, R

    1991-01-01

    The preoperative assessment of supraclavicular lymph node metastases was prospectively studied in 100 patients with carcinoma of the esophagus and gastroesophageal junction. Findings at computed tomography (CT), ultrasound (US), and palpation were compared, and US-guided fine-needle aspiration biops

  3. [First experience of supraclavicular flap application for the closure of defects localized in the lower third of the face and neck].

    Science.gov (United States)

    Galich, S P; Reznikov, A V; Dabizha, A Iu; Gindich, O A; Ogorodnik, Ia P; Al'tman, I V; Valikhnovskiĭ, R L

    2011-04-01

    First experience of the supraclavicular flap transposition for closure of superficial, but extended, defects of the soft tissues in the lower third of face and neck region in 6 patients is presented. In all the patients good functional and cosmetic result was achieved.

  4. SUPRACLAVICULAR LYMPH-NODE METASTASES IN CARCINOMA OF THE ESOPHAGUS AND GASTROESOPHAGEAL JUNCTION - ASSESSMENT WITH CT, US, AND US-GUIDED FINE-NEEDLE ASPIRATION BIOPSY

    NARCIS (Netherlands)

    VANOVERHAGEN, H; LAMERIS, JS; BERGER, MY; VANDERVOORDE, F; TILANUS, HW; KLOOSWIJK, AIJ; ZONDERLAND, HM; VANPEL, R

    1991-01-01

    The preoperative assessment of supraclavicular lymph node metastases was prospectively studied in 100 patients with carcinoma of the esophagus and gastroesophageal junction. Findings at computed tomography (CT), ultrasound (US), and palpation were compared, and US-guided fine-needle aspiration biops

  5. Lymph node content of supraclavicular and thoracodorsal-based axillary flaps for vascularized lymph node transfer.

    Science.gov (United States)

    Gerety, Patrick A; Pannucci, Christopher J; Basta, Marten N; Wang, Amber R; Zhang, Paul; Mies, Carolyn; Kanchwala, Suhail K

    2016-01-01

    Microvascular transfer of lymph node flaps has recently gained popularity as a treatment for secondary lymphedema often occurring after axillary, groin, or pelvic lymph node dissections. This study aimed to delineate the lymph node contents and pedicle characteristics of the supraclavicular (SC) and thoracodorsal (TD)-based axillary flaps as well as to compare lymph node quantification of surgeon vs pathologist. SC and TD flaps were dissected from fresh female cadavers. The surgeon assessed pedicle characteristics, lymph node content, and anatomy. A pathologist assessed all flaps for gross and microscopic lymph node contents. The κ statistic was used to compare surgeon and pathologist. Ten SC flaps and 10 TD flaps were harvested and quantified. In comparing the SC and TD flaps, there were no statistical differences between artery diameter (3.1 vs 3.2 mm; P = .75) and vein diameter (2.8 vs 3.5 mm; P = .24). The TD flap did have a significantly longer pedicle than the SC flap (4.2 vs 3.2 cm; P = .03). The TD flap was found to be significantly heavier than the SC flap (17.0 ± 4.8 vs 12.9 ± 3.3 g; P = .04). Gross lymph node quantity was similar in the SC and TD flaps (2.5 ± 1.7 vs 1.8 ± 1.2; P = .33). There was good agreement between the surgeon and pathologist in detecting gross lymph nodes in the flaps (SC κ = 0.87, TD κ = 0.61). The SC and TD flaps have similar lymph node quantity, but the SC flap has higher lymphatic density. A surgeon's estimation of lymph node quantity is reliable and has been verified in this study by comparison to a pathologist's examination. Copyright © 2016 Society for Vascular Surgery. Published by Elsevier Inc. All rights reserved.

  6. IncA/C Plasmid Carrying bla(NDM-1), bla(CMY-16), and fosA3 in a Salmonella enterica Serovar Corvallis Strain Isolated from a Migratory Wild Bird in Germany.

    Science.gov (United States)

    Villa, L; Guerra, B; Schmoger, S; Fischer, J; Helmuth, R; Zong, Z; García-Fernández, A; Carattoli, A

    2015-10-01

    A Salmonella enterica serovar Corvallis strain was isolated from a wild bird in Germany. This strain carried the IncA/C2 pRH-1238 plasmid. Complete sequencing of the plasmid was performed, identifying the blaNDM-1, blaCMY-16, fosA3, sul1, sul2, strA, strB, aac(6')-Ib, aadA5, aphA6, tetA(A), mphA, floR, dfrA7, and merA genes, which confer clinically relevant resistance to most of the antimicrobial classes, including β-lactams with carbapenems, fosfomycin, aminoglycosides, co-trimoxazole, tetracyclines, and macrolides. The strain likely originated from the Asiatic region and was transferred to Germany through the Milvus migrans migratory route. Copyright © 2015, American Society for Microbiology. All Rights Reserved.

  7. Complete Sequence of a F33:A-:B- Conjugative Plasmid Carrying the oqxAB, fosA3 and blaCTX-M-55 Elements from a Foodborne Escherichia coli Strain

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    Marcus Ho-yin Wong

    2016-10-01

    Full Text Available This study reports the complete sequence of pE80, a conjugative IncFII plasmid recovered from an E. coli strain isolated from chicken meat. This plasmid harbors multiple resistance determinants including oqxAB, fosA3, blaCTX-M-55 and blaTEM-1, and is a close variant of the recently reported p42-2 element, which was recovered from E. coli of veterinary source. Recovery of pE80 constitutes evidence that evolution or genetic re-arrangement of IncFII type plasmids residing in animal-borne organisms is an active event, which involves acquisition and integration of foreign resistance elements into the plasmid backbone. Dissemination of these plasmids may further compromise the effectiveness of current antimicrobial strategies.

  8. Endocarditis verrucosa ventricular izquierda

    OpenAIRE

    Arias, Daniel Osvaldo; Tortora, M.; Cruz, A.; Klima, L.; Rodríguez, R.; Massone, Adriana R.; Stanchi, Néstor Oscar

    2002-01-01

    La endocarditis bacteriana es una entidad poco frecuente en caninos o subdiagnosticada. Un canino Rottweiler hembra de 3 años de edad fue derivado con signos compatibles de Insuficiencia Cardíaca Congestiva. El animal presentaba intolerancia al ejercicio, disnea y tos. La evolución del cuadro fue de 5 días con antecedentes de tos paroxística principalmente nocturna. La auscultación reveló un soplo de 6/6 en ambos precordios, ruidos hipofonéticos y ritmo irregular. A la palpación el choque car...

  9. Dosimetric prospective study comparing 2D and 3D planning for irradiation of supraclavicular and infraclavicular regions in breast cancer patients.

    Science.gov (United States)

    Barsoum, Mohsen; Mostafa, Magda; El Hossieny, Hisham; Nasr, Azza; Mahmoud, Mohamed; Fouda, Sally

    2015-03-01

    The purpose of this study is to compare 2D plan and 3D plan regarding coverage of the target (supraclavicular and infraclavicular regions) and dose reaching the risk organs (using mean DVH). Depending on the results of this study, modifications can be made to the 2D conventional planning of supraclavicular and infraclavicular regions in order to achieve better coverage of the target tissues. This is a dosimetric study carried out at the radiation oncology department in NCI-Cairo University in the period from January 2012 to October 2012, on 15 patients with breast cancer who are eligible for supraclavicular and infraclavicular irradiation. For All patients, a 2D and a 3D plan were done. We found that the coverage of the supraclavicular and infraclavicular regions and the chest wall or breast together with levels I and II axilla (PTV) were significantly better with the 3D technique with less over dose than the 2D technique. That difference was highly significant and was most evident in MRM cases. Also we found that organs at risk received a dose in the 3D technique that was more than that received in the 2D technique, again that difference was highly significant and was also most evident in MRM cases but all doses were still within tolerance. From the present study we concluded that the coverage of the supraclavicular and infraclavicular PTV is significantly worse with the 2D technique using a single oblique field at a fixed depth of 3 cm for all patients despite their different builts. Copyright © 2014. Production and hosting by Elsevier B.V.

  10. Seguimiento a largo plazo de pacientes con disfunción ventricular izquierda intervenidos de sustitución valvular aórtica. Experiencia en nuestra institución

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    Gemma Candela-Navarro

    2016-07-01

    Conclusiones: La sustitución valvular aórtica es una opción segura, eficaz y duradera en pacientes con disfunción ventricular izquierda. Se asocia a una mejoría en la clase funcional y fracción de eyección, con una perspectiva de futuro excelente.

  11. Seguridad y eficacia a corto plazo del cierre de orejuela izquierda con dispositivo WATCHMAN® en fibrilación auricular no valvular en pacientes con alto riesgo de sangrado

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    Andrés Fernández

    2017-07-01

    Conclusiones: El cierre percutáneo de la orejuela izquierda con dispositivo WATCHMAN® es un procedimiento seguro y eficaz en pacientes de alto riesgo con fibrilación auricular no valvular y contraindicación o dificultades para la anticoagulación oral.

  12. DEXMEDETOMIDINE AND CLONIDINE AS ADJUVANTS TO LEVOBUPIVACAINE IN SUPRACLAVICULAR BRACHIAL PLEXUS BLOCK: A COMPARATIVE RANDOMISED PROSPECTIVE CONTROLLED STUDY

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    Karthik

    2015-03-01

    Full Text Available BACKGROUND: There are always efforts to find better and safer local anaesthetics along with adjuvants for supraclavicular brachial plexus block. Levobupivacaine, has strongly emerged as a safer alternative for regional anesthesia than its racemic sibling, bupivacaine. Alpha 2 agonists are combined with local anaesthetics to improve the quality of regional anesthesia. AIMS AND OBJECTIVES: This study was conducted to evaluate and compare the onset, duration of sensory and motor blockade along with the duration of analges ia between dexmedetomidine and clonidine when administered along with 0.5% levobupivacaine in supraclavicular brachial plexus block for upper limb orthopaedic surgeries. MATERIALS AND METHODS: A prospective randomized study was carried out in the departmen t of Anaesthesia at Rajarajeswari Medical College and Hospital which included 50 adult patients between the ages of 20 and 50 years (of ASA I/II grade who underwent upper limb orthopaedic surgeries. The patients were randomly allocated into two groups; le vobupivacaine + dexmedetomidine (LD and levobupivacaine + clonidine (LC, comprising of 25 patients each. Group LD was administered 30 ml of 0.5% levobupivacaine and 1μg/kg of dexmedetomidine, while group LC received admixture of 30 ml of 0.5% levobupivac aine and 1 μg/kg of Clonidine. Onset, duration of sensory and motor blockade and duration of analgesia were observed. STATISTICAL ANALYSIS: Statistical analysis was done using student t test, chi - square test and Fisher Exact test. The Statistical Software namely SAS 9.2, SPSS 15.0, Stata 10.1, MedCalc 9.0.1, Sysatat 12.0 and R environment ver.2.11.1 were also used for the analysis of the data and Microsoft word and Excel have been used to generate graphs, tables etc. The value of P <0.05 was considered significant and P < 0.001 as highly significant. RESULTS: The onset of sensory and motor blockade was faster in Group LD when compared to Group LC. The duration of sensory

  13. Angioplastia del tronco de la arteria coronaria izquierda no protegido en pacientes con alto riesgo quirúrgico

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    Victor Mauro

    2008-01-01

    Full Text Available IntroducciónEl tratamiento de elección de la enfermedad del tronco de la coronaria izquierda (TCI es la cirugía de revascularización miocárdica (CRM. Un número creciente de pacientes presenta comorbilidades y/o inestabilidad clínica que condicionan un alto riesgo quirúrgico.ObjetivosEvaluar los resultados de la angioplastia (ATC del TCI no protegido en pacientes con alto riesgo para CRM (EUROSCORE = 6.Material y métodosDe 59 pacientes con ATC de TCI no protegido se excluyeron 8 con infarto agudo de miocardio (IAM en shock cardiogénico y 12 sin características de alto riesgo; de los restantes pacientes de alto riesgo fueron objeto de este estudio los 32 tratados con stents convencionales.Se comparó la mortalidad hospitalaria predicha por EUROSCORE logístico con la observada, así como la incidencia de complicaciones mayores y su evolución alejada.ResultadosLa mediana de edad fue de 76,5 años, el 41% tenía 80 años o más, el 22% eran mujeres, el 28% diabéticos, el 56% tenía disfunción ventricular moderada a grave, el 31% insuficiencia renal crónica, el 50% vasculopatía periférica, el 53% angina refractaria, el 22% IAM reciente, el 28% procedimientos de emergencia y la mediana de EUROSCORE fue de 10,5 puntos.El 41% de los pacientes presentaban compromiso del TCI distal. El éxito angiográfico fue del 94%. Se utilizaron inhibidores IIb/IIIa en el 47%, cutting balloon en el 28%, Rotablator® en el 3% y balón de contrapulsación en el 31%. En todos se implantó un stent y en el 50% se trataron otras obstrucciones.La mortalidad hospitalaria fue del 3,1% (intervalo de confianza del 95% 0,2%-14,5%, p = 0,003, en tanto que la predicha era del 23,8%. Ningún paciente presentó déficit neurológico, IAM transmural ni requirió diálisis. Un paciente debió ser sometido a CRM electiva por fracaso del procedimiento.La mediana de seguimiento fue de 15,5 meses, período en el que se registraron 6 muertes (2 cardiovasculares y 4

  14. The Right in “New Left” Latin America La derecha en tiempos de la nueva izquierda en América Latina

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    James David Bowen

    2011-01-01

    Full Text Available Over the past decade, there has been a surge of “new Left” governments in Latin America, yet polling data shows no comparable shift to the left among the general Latin American population. If electorates have not followed their political leaders to the left, then it is likely that new right-wing political actors will emerge to compensate for the leftward shift in Latin American politics. I propose a research agenda for studying right-wing politics in light of the current wave of left-leaning governments in the region. I argue that we should focus on four main areas of right-wing politics: the political agenda of right-wing groups; their political organization; their power capability; and the institutional environment in which they operate. This agenda requires that we move beyond the traditional focus on right-wing political parties and focus on right-wing organizations at all levels of formal politics, as well as groups that operate outside the formal political arena.Durante la última década han surgido en América Latina varios gobiernos de la llamada “nueva izquierda.” Sin embargo, las encuestas no muestran un movimiento correspondiente hacia la izquierda en la opinión pública. Si los electorados latinoamericanos no siguen a algunos de sus líderes hacia la izquierda es muy probable que pronto veamos la (reemergencia de actores políticos de corte derechista. Este ensayo propone un marco teórico y una agenda para el análisis de estos actores de derecha. Aquí se argumenta que deberíamos enfocarnos en cuatro temas principales: las agendas políticas de los grupos de derecha, sus formas de organización política, sus capacidades de aglutinar y usar varias fuentes de poder político, económico y social, y el ambiente institucional que servirá de contexto para su enfrentamiento con otros actores políticos. Esta agenda implica un cambio en los enfoques tradicionales sobre el estudio de la derecha que han puesto fuerte

  15. Anatomical variations of the clavicle and main vascular structures in two pediatric patients: subclavicular vein cannulation with supraclavicular approach

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    Oksuz H

    2009-05-01

    Full Text Available Central venous catheterization is a routine application in the management of patients in critical condition. However, the placement of central venous catheters is not without risk. The standard technique for central venous cannulation includes the use of anatomical landmarks. However, an ultrasound-guided method is recommended for catheterization in high-risk patients. In this report, we present two pediatric cases which had anatomical variations of the clavicles and main vascular structures due to cerebral palsy and were treated with mechanical ventilation because of pneumonia. The subclavian vein cannulation was performed using a supraclavicular approach under ultrasound guidance in both cases. We conclude that central venous catheterization of critical patients who have anatomical variations must be performed under ultrasound guidance as it provides greater safety and a higher success rate.

  16. Tratamiento de la compresión del tronco de la arteria coronaria izquierda en pacientes con hipertensión pulmonar

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    María L. Talavera

    2011-10-01

    Full Text Available La angina de pecho es un síntoma frecuente en pacientes con hipertensión pulmonar (HP de cualquier etiología. Aunque su fisiopatología no está aclarada, las causas propuestas son: la isquemia subendocárdica por aumento del estrés parietal del ventrículo derecho, la dilatación de la arteria pulmonar por incrementos transitorios de la presión pulmonar y la compresión extrínseca del tronco de la arteria coronaria izquierda (TCI por la arteria pulmonar (AP dilatada. Se presentan tres casos que muestran la relación entre la angina de pecho y la compresión del TCI en pacientes con HP asociada a cardiopatías congénitas, tratados mediante implante de stent coronario.

  17. Izquierdas, género e industria textil argentina. Los partidos comunista y socialista ante las demandas de las trabajadoras, 1936-1946

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    Verónica Norando

    2017-07-01

    Full Text Available En este artículo se aborda la incorporación de las demandas de género en los conflictos de las trabajadoras textiles en Argentina y cómo actuaron dos vertientes de la izquierda local: el Partido Socialista y el Partido Comunista. Se analizan tres estudios de caso: dos huelgas textiles y la demanda por la reforma de la ley del Seguro de Maternidad. El objetivo es estudiar la relación de estos partidos con las demandas de las trabajadoras desde una perspectiva que aúna las relaciones de género con las de clase, con base en fuentes de origen obrero y estatal. Una conclusión fundamental que se desprende de este trabajo es que los partidos socialista y comunista han intervenido activamente para transformar estas demandas en realizaciones concretas.

  18. Del dogmatismo católico al dogmatismo de izquierda. El Ambiente Político en la Universidad Nacional en los 60s y 70s

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    William Maurico Beltrán

    2009-11-01

    Full Text Available L a Universidad Nacional estuvo inmersa durante las décadas del 60 y 70 en un ambiente altamente politizado en el que nacieron y fructificaron diversos movimientos de izquierda. La mayoría de estos movimientos heredaron del catolicismo el dogmatismo y la intolerancia, lo que influyó para que se convirtieran en sectas cerradas y totalitarias semejantes en muchas de sus características a los movimientos religiosos voraces. El presente ensayo pretende explotar las posibilidades explicativas que pueda proporcionar la analogía entre sectarismo político y sectarismo religioso, en ese sentido se pretende describir el ambiente político que se respiraba en la Universidad Nacional durante estas décadas acudiendo a algunas categorías proporcionadas tanto por la sociología política como por la sociología de la religión.

  19. Effect of clonidine as adjuvant in bupivacaine-induced supraclavicular brachial plexus block: A randomized controlled trial

    Directory of Open Access Journals (Sweden)

    Chakraborty Susmita

    2010-01-01

    Full Text Available Objective: Clonidine has been used as adjuvant to local anesthetics in order to extend the duration of analgesia in various regional and central neuraxial blocks. It is previously reported that clonidine added to bupivacaine increases analgesia duration in brachial plexus block. We evaluated the effect of this combination in supraclavicular brachial plexus block for upper limb orthopedic procedures. Materials and Methods: A randomized double-blind placebo controlled trial was done with 70 patients of American Society of Anesthesiologists Grade I or II status undergoing upper limb orthopedic procedures. Group A (n = 35 patients received 25 ml of 0.5% bupivacaine and 0.2 ml (30 mcg clonidine, whereas group B (n = 35 received 25 ml of 0.5% bupivacaine and 0.2 ml normal saline through a supraclavicular approach for brachial plexus block. Vital parameters were recorded 10 min prior to block placement and every 3 min thereafter till the end of the procedure. Onset and duration of both sensory and motor blocks and sedation score were recorded. All patients were observed in postanesthesia care unit and received tramadol injection as soon as they complained of pain as rescue analgesic. Duration of analgesia was taken as the time from placement of block till injection of rescue analgesic. Results: Analgesia duration was 415.4 ± 38.18 min (mean ± standard deviation in Group A (clonidine compared to 194.2 ± 28.74 min in Group B (control. No clinically significant difference was observed in heart rate, blood pressure, and oxygen saturation. Sedation score was higher in the clonidine group. Conclusion: Addition of a small dose of clonidine to 0.5% bupivacaine significantly prolonged the duration of analgesia without producing any clinically important adverse reactions other than sedation.

  20. Supraclavicular node disease is not an independent prognostic factor for survival of esophageal cancer patients treated with definitive chemoradiation.

    Science.gov (United States)

    Jeene, Paul M; Versteijne, Eva; van Berge Henegouwen, Mark I; Bergmann, Jacques J G H M; Geijsen, Elisabeth D; van Laarhoven, Hanneke W M; Hulshof, Maarten C C M

    2017-01-01

    The prognostic value of supraclavicular lymph node (SCN) metastases in esophageal cancer is not well established. We analyzed the prognostic value of SCN disease in patients after definitive chemoradiation (dCRT) for esophageal cancer. We retrospectively analyzed 207 patients treated between 2003 and 2013 to identify the prognostic value of metastasis in the SCN on treatment failure and survival. All patients were treated with external beam radiotherapy (50.4 Gy in 28 fractions) combined with weekly concurrent paclitaxel 50 mg/m(2) and carboplatin AUC2. Median follow-up for patients alive was 43.3 months. The median overall survival (OS) for all patients was 17.5 months. OS at one, three and five years was 67%, 36% and 21%, respectively. For patients with metastasis in a SCN, OS was 23.6 months compared to 17.1 months for patients without metastasis in the SCN (p = .51). In multivariate analyses, higher cT status, cN status and adenocarcinoma were found to be prognostically unfavorable, but a positive SCN was not (p = .67). Median OS and median disease-free survival for tumors with SCN involvement and N0/1 disease was 49.0 months and 51.6 months, respectively, compared to 14.2 months and 8.2 months, respectively, in patients with N2/3 disease. In esophageal cancer treated with dCRT, the number of affected lymph nodes is an important independent prognostic factor, whereas involvement of a SCN is not. Supraclavicular lymph nodes should be considered as regional lymph nodes and treated with curative intent if the total number of involved lymph nodes is limited.

  1. Effect of dexamethasone added to lidocaine in supraclavicular brachial plexus block: A prospective, randomised, double-blind study

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    Prashant A Biradar

    2013-01-01

    Full Text Available Background: Different additives have been used to prolong brachial plexus block. We performed a prospective, randomised, double-blind study to evaluate the effect of dexamethasone added to lidocaine on the onset and duration of supraclavicular brachial plexus block as this is the most common type of brachial block performed in our institute. Methods: Sixty American Society of Anaesthesiologist′s physical status I and II patients undergoing elective hand, forearm and elbow surgery under brachial plexus block were randomly allocated to receive either 1.5% lidocaine (7 mg/kg with adrenaline (1:200,000 and 2 ml of normal saline (group C, n=30 or 1.5% lidocaine (7 mg/kg with adrenaline (1:200,000 and 2 ml of dexamethasone (8 mg (group D, n=30. The block was performed using a nerve stimulator. Onset and duration of sensory and motor blockade were assessed. The sensory and motor blockade of radial, median, ulnar and musculocutaneous nerves were evaluated and recorded at 5, 10, 20, 120 min, and at every 30 min thereafter. Results: Two patients were excluded from the study because of block failure. The onset of sensory and motor blockade (13.4±2.8 vs. 16.0±2.3 min and 16.0±2.7 vs. 18.7±2.8 min, respectively were significantly more rapid in the dexamethasone group than in the control group ( P=0.001. The duration of sensory and motor blockade (326±58.6 vs. 159±20.1 and 290.6±52.7 vs. 135.5±20.3 min, respectively were significantly longer in the dexamethasone group than in the control group ( P=0.001. Conclusion: Addition of dexamethasone to 1.5% lidocaine with adrenaline in supraclavicular brachial plexus block speeds the onset and prolongs the duration of sensory and motor blockade.

  2. Intelectuales de izquierda y nacionalsocialismo: alcances y límites de una recepción crítica (1933 - 1943.

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    Dennis Arias Mora

    2011-08-01

    Full Text Available El artículo aborda un estudio comparado de la recepción y el debate de ideas de la intelectualidad de izquierda costarricense, respecto al nacionalsocialismo. Esto se hace partir de la revisión de la revista  Repertorio Americano, del editor Joaquín García Monge, durante los años 1933-1943; del periódico  Trabajo, del Partido Comunista, durante el mismo período; y de seis libros del autor Vicente Sáenz, publicados entre 1938-1944. El propósito del texto es captar las diferentes apropiaciones que hizo una intelectualidad de izquierda que en su interior era heterogénea respecto a su trayectoria e idearios, pero que tuvo en general una posición crítica respecto al fenómeno nazi y que participó de distintas maneras en el movimiento antifascista de los años treinta y cuarenta. Se develan las diversas articulaciones hechas de la cuestión nacionalsocialista a sus respectivos idearios y a sus agendas políticas  particulares. Al mismo tiempo, no se pierde de vista el peso de la cultura política y del imaginario liberal de la nación, en las formas de pensar el nacionalsocialismo, de hacerle  críticas parciales, y de crear respuestas políticas frente a su impacto en la sociedad costarricense.

  3. “Si me asesinan, vengadme”. El gaitanismo en el imaginario de la nueva izquierda colombiana: el caso del moec 7 de enero

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    José Abelardo Díaz Jaramillo

    2010-10-01

    Full Text Available Normal 0 21 false false false ES-CO X-NONE X-NONE MicrosoftInternetExplorer4 /* Style Definitions */ table.MsoNormalTable {mso-style-name:"Tabla normal"; mso-tstyle-rowband-size:0; mso-tstyle-colband-size:0; mso-style-noshow:yes; mso-style-priority:99; mso-style-qformat:yes; mso-style-parent:""; mso-padding-alt:0cm 5.4pt 0cm 5.4pt; mso-para-margin-top:0cm; mso-para-margin-right:0cm; mso-para-margin-bottom:10.0pt; mso-para-margin-left:0cm; line-height:115%; mso-pagination:widow-orphan; font-size:11.0pt; font-family:"Calibri","sans-serif"; mso-ascii-font-family:Calibri; mso-ascii-theme-font:minor-latin; mso-fareast-font-family:"Times New Roman"; mso-fareast-theme-font:minor-fareast; mso-hansi-font-family:Calibri; mso-hansi-theme-font:minor-latin; mso-bidi-font-family:"Times New Roman"; mso-bidi-theme-font:minor-bidi;} En los años sesenta distintos movimientos de la izquierda colombiana se encargaron de rememorar el asesinato de Jorge Eliécer Gaitán y de retomar el legado del gaitanismo con el fin de generar un impacto político. Este artículo analiza la presencia del gaitanismo en la nueva izquierda colombiana de esos años, tomando como ejemplo al Movimiento Obrero Estudiantil Campesino(moec 7 de enero. Con base en los planteamientos de Tzvetan Todorov acerca de la memoria literal y la memoria ejemplar, el artículo expone la manera en que el moec 7 de enero asumió el gaitanismo, es decir, como un acontecimiento recuperado y leído de manera ejemplar por el movimiento.

  4. The Relationship Between Brown Adipose Tissue Content in Supraclavicular Fat Depots and Insulin Sensitivity in Patients with Type 2 Diabetes Mellitus and Prediabetes

    Science.gov (United States)

    Ustyuzhanin, Dmitry; Philippov, Yury; Mayorov, Alexander; Shestakova, Marina; Shariya, Merab; Ternovoy, Sergey; Dedov, Ivan

    2017-01-01

    Abstract Background: The evaluation of brown adipose tissue (BAT) and its role in metabolism and obesity remains an important topic in the recent literature. This study evaluated the influence of the BAT triglyceride content measured by proton magnetic resonance (MR) spectroscopy in patients with type 2 diabetes mellitus (DM2) and prediabetes on insulin sensitivity. Methods: A total of 25 patients with DM2 and prediabetes (45.9 ± 10.1 years old, body mass index [BMI] of 31.6 ± 5.4 kg/m2) underwent anthropometric measurements (BMI), insulin sensitivity analysis (M value during euglycemic hyperinsulinemic clamp and homeostasis model assessment of insulin resistance), proton MR spectroscopy, and blood tests (total cholesterol, low-density lipoproteins, high-density lipoproteins, and triglycerides). The relationship between the triglyceride content in the supraclavicular fat depot and insulin sensitivity, anthropometric measurements, and blood test results was assessed. Results: The triglyceride content in the supraclavicular fat depot varied between 79.2% and 97.1% (mean: 92.6% ± 4.2%). The triglyceride content in the subcutaneous white adipose tissue of the neck was significantly higher (85.3%–99.3%; mean: 95.5% ± 2.9%; P = 0.0007). The triglyceride content in the supraclavicular fat depot exhibited a significantly moderate correlation with the BMI (r = 0.64; P = 0.0009). A significant weak negative correlation between the supraclavicular fat content and M value was revealed (r = −0.44; P = 0.002). Patients with high insulin resistance (IR) had a higher triglyceride content in the supraclavicular fat depot than patients with normal and lower IR (94.3% ± 2.0% vs. 90.4% ± 5.2%; P = 0.02). Conclusions: Reducing the BAT content in the supraclavicular fat depot can influence the development of IR in patients with DM2 and prediabetes. PMID:28118051

  5. The Relationship Between Brown Adipose Tissue Content in Supraclavicular Fat Depots and Insulin Sensitivity in Patients with Type 2 Diabetes Mellitus and Prediabetes.

    Science.gov (United States)

    Koksharova, Ekaterina; Ustyuzhanin, Dmitry; Philippov, Yury; Mayorov, Alexander; Shestakova, Marina; Shariya, Merab; Ternovoy, Sergey; Dedov, Ivan

    2017-02-01

    The evaluation of brown adipose tissue (BAT) and its role in metabolism and obesity remains an important topic in the recent literature. This study evaluated the influence of the BAT triglyceride content measured by proton magnetic resonance (MR) spectroscopy in patients with type 2 diabetes mellitus (DM2) and prediabetes on insulin sensitivity. A total of 25 patients with DM2 and prediabetes (45.9 ± 10.1 years old, body mass index [BMI] of 31.6 ± 5.4 kg/m(2)) underwent anthropometric measurements (BMI), insulin sensitivity analysis (M value during euglycemic hyperinsulinemic clamp and homeostasis model assessment of insulin resistance), proton MR spectroscopy, and blood tests (total cholesterol, low-density lipoproteins, high-density lipoproteins, and triglycerides). The relationship between the triglyceride content in the supraclavicular fat depot and insulin sensitivity, anthropometric measurements, and blood test results was assessed. The triglyceride content in the supraclavicular fat depot varied between 79.2% and 97.1% (mean: 92.6% ± 4.2%). The triglyceride content in the subcutaneous white adipose tissue of the neck was significantly higher (85.3%-99.3%; mean: 95.5% ± 2.9%; P = 0.0007). The triglyceride content in the supraclavicular fat depot exhibited a significantly moderate correlation with the BMI (r = 0.64; P = 0.0009). A significant weak negative correlation between the supraclavicular fat content and M value was revealed (r = -0.44; P = 0.002). Patients with high insulin resistance (IR) had a higher triglyceride content in the supraclavicular fat depot than patients with normal and lower IR (94.3% ± 2.0% vs. 90.4% ± 5.2%; P = 0.02). Reducing the BAT content in the supraclavicular fat depot can influence the development of IR in patients with DM2 and prediabetes.

  6. Tortícolis recurrente como forma de presentación de un tumor de la fosa posterior del cerebro Recurrent torticollis as a form of presenting a tumor in the posterior fossa brain

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    Isael Olazábal Armas

    2012-09-01

    Full Text Available La tortícolis se presenta como una manifestación focal del sistema nervioso central, y es una afección poco frecuente, aunque puede ser el síntoma inicial en patologías de la fosa posterior del cerebro. Se presenta el caso de un paciente masculino de cuatro años de edad, con antecedentes de dolor, lateralización y torsión del cuello con nueve meses de evolución, cuyos síntomas se mantuvieron progresando. Gradualmente se asocian cefalea, náuseas e inestabilidad a la marcha. Al realizar el examen físico se encontraron elementos clínicos de una tortícolis y un síndrome cerebeloso de hemicuerpo derecho. Se realizó una resonancia magnética nuclear de cráneo, la cual evidenció una lesión sólida que ocupaba todo el piso del IV ventrículo, y se extendía hasta el segundo segmento medular cervical. Se efectuó abordaje quirúrgico de la fosa posterior del cerebro y exeresis de la lesión. El diagnóstico histológico fue el de un ependimoma. Aunque la tortícolis la mayoría de las ocasiones es una condición benigna, cuando se presenta secundariamente en los niños, uno de los diagnósticos diferenciales que deben tenerse en cuenta, son los tumores de la fosa posterior del cerebro, como ocurrió en este caso.Torticollis is presented as a focal demonstration of the central nervous system, and it is a rare condition, but it may be the initial symptom in diseases of the posterior fossa brain. We report the case of a male patient aged four, with a history of pain, lateralization and twisted neck with nine months of evolution, whose symptoms were progressing. Gradually, headache, nausea and gait instability are associated. When performing the physical examination, we found clinical elements of a stiff neck and a right hemisphere cerebellar syndrome. We performed a cranial MRI, which showed a solid lesion occupying the entire floor of the fourth ventricle, and it extended to the second cervical spinal segment. Surgical approach was

  7. COMPARATIVE CLINICAL EVALUATION OF 0.5% ROPIVACAINE AND 0.5% BUPIVACAINE FOR BRACHIAL PLEXUS BLOCK VIA SUPRACLAVICULAR APPROACH FOR UPPER LIMB SURGERIES.

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    Surendra

    2013-11-01

    Full Text Available ABSTRACT: Ropivacaine, a local anesthetic agent with similar pharmacological profile to that of bupivacaine has lower potential for toxic effect. The aim of our study is to compare the anesthetic characteristics of ropivacaine and bupivacaine when used for supraclavicular brachial plexus blockade in upper limb surgeries. Fifty patients was grouped equally and one group R received 0.5% ropivacaine (100mg 20ml and another group B received 0.5% bupivacaine (100mg 20ml. onset & durat ion of sensory and motor blockade, duration of analgesia and associated complications & side effects were recorded. It was found that there were no significant differences in duration of sensory & motor blockade, in complications or any other side effects in both the groups. But ropivacaine provided rapid onset of action and better quality of surgical anesthesia than bupivacaine when used in supraclavicular brachial plexus blockade.

  8. Adenopatía supraclavicular como forma de presentación de un carcinoma de cérvix asociado al complejo esclerosis tuberosa con linfangioleiomiomatosis

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    Pablo López Mato

    2013-09-01

    Full Text Available La linfangioleiomiomatosis es una proliferación del tejido muscular broncovascular que recientemente se ha definido como una expresión incompleta de la entidad “complejo esclerosis tuberosa”, una facomatosis a la que se asocian diversas neoplasias. Presentamos un caso de carcinoma de cérvix con metástasis supraclaviculares y cervicales, asociado a linfangioleiomiomatosis en el contexto de un “complejo esclerosis tuberosa”.

  9. Adenopatía supraclavicular como forma de presentación de un carcinoma de cérvix asociado al complejo esclerosis tuberosa con linfangioleiomiomatosis

    OpenAIRE

    Pablo López Mato; Alfonso Varela Fariña; Elena Seco Hernández; Antonio J. Chamorro Fernández

    2013-01-01

    La linfangioleiomiomatosis es una proliferación del tejido muscular broncovascular que recientemente se ha definido como una expresión incompleta de la entidad “complejo esclerosis tuberosa”, una facomatosis a la que se asocian diversas neoplasias. Presentamos un caso de carcinoma de cérvix con metástasis supraclaviculares y cervicales, asociado a linfangioleiomiomatosis en el contexto de un “complejo esclerosis tuberosa”.

  10. Assessment of Dose Delivery to Supraclavicular and Axillary Lymph Nodes in Adjuvant Breast Cancer Radiotherapy, with or without Posterior Axillary Boost in Relation to BMI

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    Mahdi Aghili

    2016-03-01

    Full Text Available Background: The axillary and supraclavicular nodal volume treatment results in improvement of local control and survival after breast conserving surgery (BCS or modified radical mastectomy (MRM. Studies on the depth of these nodes have questioned the consistent use of standard fields for all patients. This study was done to assess the dose delivery to these lymph nodes with conventional treatment techniques according to body mass index (BMI.Methods: Twenty six patients with breast cancer undergoing breast surgery were included and computed tomography (CT simulation was done. Their axillary and supraclavicular nodal volumes were contoured for planning target volume (PTV. Supraclavicular and posterior axillary fields were generated for each patient with digital reconstruction radiography (DRR technique. Then the dose distribution of the two conventional methods - anterior-posterior field (AP, and anterior field with posterior boost (AP+PA boost - for total dose of 5000 cGy, was examined with radiotherapy dose plan program. An AP planned field suitable for PTV, was designed and compared to AP+PA boost. The diameter of axilla was measured at the center of AP field in CT scan. Data were analyzed in relationship to BMI.Results: PTV coverage and excessively irradiating normal tissues (hot points, proved to have significant differences in each method (p < 0.001 to 0.01. Axillary and supraclavicular LNs were in 1.6 to 10 and 0.5 to 6.3 cm depth, respectively. Depth of the prescribed dose, which was gained from planned field, had a significant statistical association with BMI (p < 0.05.Conclusions: Current standard fields are not appropriate for all patients, because of poor coverage of PTV. To sum up, 3D CT planning is strongly recommended for patients with high BMI.

  11. The diagnostic value of fine needle aspiration cytology (FNAC) in the assessment of palpable supraclavicular lymph nodes: a study of 218 cases.

    Science.gov (United States)

    Gupta, R K; Naran, S; Lallu, S; Fauck, R

    2003-08-01

    The aim of this study was to evaluate the diagnostic value of fine needle aspiration cytology (FNAC) in the assessment of palpable supraclavicular lymph nodes. The material was analysed in 218 cases with enlarged supraclavicular lymph nodes in which FNAC was performed by the conventional method. In all cases cytological examination was performed on-site after staining the smears by the Papanicolaou method. In addition, air-dried smears, fixed smears, filter preparations from needle washings and cell blocks were studied. The FNAC diagnosis was supported by examining cell blocks which added the reliability of histological architecture; further support was obtained by tissue biopsy and/or comparison with the primary tumour in some of the cases. Eleven cases were diagnosed as inflammatory lesions and 41 cases were unsatisfactory because of scanty/acellular samples (despite two to three repeat samplings). However, in five of these, malignant tumours were later found on biopsy, which was done for persistent enlargement of the supraclavicular lymph node(s). Fifty-three cases were diagnosed as negative for malignancy (normal cellular elements, n=15; reactive elements, n=38) and 12 cases were suspicious of malignancy. In 11 cases a diagnosis of lymphoma was made on histology and in 90 cases metastatic tumours were diagnosed. The overall sensitivity was 92.7%, specificity 98.5%, positive predictive value 97.3% and the negative predictive value was 94.8%. Based on our study we feel that FNAC of palpable supraclavicular lymph nodes as a first line of investigation is a cost-effective procedure and is not only useful in the diagnosis of various lesions but can also help in deciding on appropriate management. Furthermore, the histological architecture from cell blocks can be correlated with cytology, and such material can be used for appropriate histochemical and immunomarker studies, which can be useful in enhancing the diagnosis.

  12. Adenopatía supraclavicular como forma de presentación de un carcinoma de cérvix asociado al complejo esclerosis tuberosa con linfangioleiomiomatosis

    OpenAIRE

    Pablo López Mato; Alfonso Varela Fariña; Elena Seco Hernández; Antonio J. Chamorro Fernández

    2013-01-01

    La linfangioleiomiomatosis es una proliferación del tejido muscular broncovascular que recientemente se ha definido como una expresión incompleta de la entidad “complejo esclerosis tuberosa”, una facomatosis a la que se asocian diversas neoplasias. Presentamos un caso de carcinoma de cérvix con metástasis supraclaviculares y cervicales, asociado a linfangioleiomiomatosis en el contexto de un “complejo esclerosis tuberosa”.

  13. Comparison of ultrasound-guided supraclavicular, infraclavicular and below-C6 interscalene brachial plexus block for upper limb surgery: a randomised, observer-blinded study.

    Science.gov (United States)

    Bharti, N; Bhardawaj, N; Wig, J

    2015-07-01

    This prospective, randomised, observer-blinded study was conducted to compare the ease of performance and surgical effectiveness of interscalene block below the C6 nerve root with supraclavicular and infraclavicular techniques of brachial plexus block for upper arm and forearm surgery. Sixty adult patients of American Society of Anesthesiologists grade 1 to 3, undergoing upper limb surgery, were randomly allocated into three groups. Group SC received supraclavicular blockade, group IC received infraclavicular blockade and Group IS received interscalene blockade. All blocks were guided by ultrasound with nerve stimulator confirmation. The anaesthetic mixture consisted of 0.5 ml/kg of equal volumes of 0.75% ropivacaine and 2% lignocaine-adrenaline. The imaging and block performance time, onset time, success rate, duration of block, and duration of postoperative analgesia were recorded by a blinded observer. The onset time was significantly longer in the interscalene group as compared with supraclavicular and infraclavicular approaches. The imaging time and block performance time were comparable between groups. No significant differences were observed between the three groups in terms of block-related pain scores, success rates, duration of block or of postoperative analgesia. Two patients in the interscalene group developed clinically detectable phrenic nerve palsy. Our findings indicate that, although interscalene block below the C6 nerve root can provide surgical anaesthesia for forearm and hand surgery, it appears to have a longer onset time than supra- and infraclavicular approaches and an unacceptable incidence of phrenic nerve palsy.

  14. Cartografía de las publicaciones periódicas judías de izquierda en Argentina, 1900-1953

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    Alejandro Dujovne

    2009-04-01

    Full Text Available ResumenLa fuerte inversión política y cultural en la palabra impresa que tuvo lugar dentro del mundo culturaljudío argentino a lo largo del siglo XX se mostró especialmente intensa y rica en el arco ideológico dela izquierda. Así, sobre la base de un prolongado trabajo de registro y sistematización de las publicacionesperiódicas judías impresas en Buenos Aires a lo largo del siglo XX, el artículo se concentra en el análisis delconjunto de publicaciones de izquierda editadas entre 1900 y 1953. En este sentido, se propone un mapeode la diversidad de emprendimientos y a partir de él un primer esbozo de periodización a partir del cualresulte posible aproximarnos a los rasgos generales de la emergencia y las transformaciones socio-históricasde un espacio específico de publicaciones judías de izquierda. De este modo, el texto expone los contornosde un universo denso de producción, circulación y consumo de bienes simbólicos estructurado sobre doslenguas y conformado por un diverso conjunto de agentes culturales y políticos situados en el país y en elexterior. La objetivación de este espacio mediante una aproximación cartográfica como la que aquí sepropone abre un terreno de problemas e hipótesis de investigación aún no explorado.AbstractThe strong political and cultural investment in the printed word that took place within the ArgentineJewish cultural world throughout the twentieth century was particularly intense and rich in the arc of theideological left. Thus, based on a lengthy work of record and systematization of Jewish periodicals printedin Buenos Aires along the twentieth century, the article focuses on the analysis of the left-wing periodicalspublished between 1900 and 1953. In this regard, it proposes a mapping of the diversity of enterprises, andfrom it a first outline of periodization from which it is possible to reach the general features of the emergencyand the socio-historical transformations of a specific

  15. Teoría crítica, izquierda y políticas públicas de comunicación: el caso de América Latina y los gobiernos progresistas

    OpenAIRE

    2015-01-01

    Este trabajo analiza la evolución de las políticas de comunicación en la agenda pública latinoamericana. Se focaliza en el estudio de países cuyos gobiernos se han proclamado a sí mismos como de izquierda o progresistas, en un intento por encontrar tendencias comunes en los procesos de implementación de sus políticas públicas.

  16. Sobre viejas y nuevas izquierdas. Los jóvenes comunistas uruguayos y el movimiento estudiantil de 1968 On the Old and New Left. Young Uruguayan Communists and the 1968 Student Movement

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    Vania Markarian

    2011-12-01

    Full Text Available Este trabajo se centra en la participación de los jóvenes comunistas uruguayos en el movimiento estudiantil de 1968 como parte de una generación de latinoamericanos que combinó una visión heroica de la militancia con la adopción de nuevas pautas culturales provenientes de Europa y Estados Unidos. Se analizan tanto las discusiones generadas en el seno de la izquierda sobre las "vías de la revolución" como el efecto de esas ideas y prácticas de circulación global en la conformación de identidades políticas a nivel local. La articulación entre militancia de izquierda, violencia política y cultura juvenil busca repensar algunas categorías usadas al estudiar los años sesenta en América Latina, especialmente las de "nueva izquierda" e "izquierda revolucionaria".This article focuses on the participation of young Uruguayan communists in the 1968 student movement as part of the generation of Latin Americans who combined a heroic view of militancy with the adoption of new cultural guidelines for Europe and the United States. It analyzes both the discussion that arose in the left on the "pathways of the revolution" and the effect of these global ideas and practices in shaping local political identities. The link between leftist militancy, political violence and youth culture attempts to rethink some of the categories used in studying the 1960s in Latin America, particularly those of the "new left" and "revolutionary left."

  17. Estudio comparativo in vitro de diferentes métodos de profilaxis y acondicionamiento del esmalte en la capacidad de adhesión de un sellador de fosas y fisuras

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    María Natalia Mandri

    Full Text Available Resumen El objetivo de este estudio comparativo in vitro fue evaluar y comparar el efecto de diferentes métodos de profilaxis y acondicionamiento del esmalte, en la capacidad de adhesión de un sellador de fosas y fisuras fotopolimerizable. La porción coronaria de 50 premolares extraídos se seccionaron en dos mitades (vestibular y lingual y se incluyeron en bloques de acrílico. Las muestras se dividieron en cinco grupos de acuerdo con los métodos de profilaxis: sin profilaxis, piedra pómez, gluconato de clorhexidina, pasta fluorada y limpiador por bicarbonato (air prophy; y técnicas de acondicionamiento del esmalte: grabado ácido con ácido fosfórico al 37% y adhesivo de autograbado. La fuerza de adhesión del sellador se midió en una máquina Instron® mediante una prueba de tracción. Los resultados no demostraron diferencias significativas en la resistencia a la tracción de acuerdo a las técnicas de acondicionamiento del esmalte utilizadas. En relación con los métodos de profilaxis estudiados, se observó que existieron diferencias significativas en los grupos tratados con pasta fluorada y limpiador por bicarbonato

  18. ¿Después del radicalismo la sensatez? El giro a la izquierda y la política económica en América Latina

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    Jorge Lazo Cividanes

    2008-01-01

    Full Text Available Este trabajo analiza el impacto que ha tenido el surgimiento de gobiernos de izquierda en América Latina en las políticas económicas que se aplican en la región. El artículo presenta y discute datos sociales y económicos de Argentina, Brasil, Chile y Venezuela, países donde la izquierda controla el gobierno, y dos casos contrastantes, Colombia y México, cuyos gobiernos están en manos de partidos de centro-derecha. Tomando como referencia aspectos centrales de las reformas estructurales de la década de los 90, nuestro análisis sugiere que los nuevos gobiernos de izquierda no han transformado la política económica de manera substancial, lo cual se contradice con la fuerte retórica antineoliberal que ha caracterizado a muchos de sus líderes durante las campañas electorales. En este sentido, el artículo finaliza con algunas hipótesis que podrían explicar tal comportamiento.

  19. Combined photon-electron beams in the treatment of the supraclavicular lymph nodes in breast cancer: A novel technique that achieves adequate coverage while reducing lung dose

    Energy Technology Data Exchange (ETDEWEB)

    Salem, Ahmed, E-mail: ahmed.salem@doctors.org.uk [Department of Radiation Oncology, King Hussein Cancer Center, Amman (Jordan); Mohamad, Issa; Dayyat, Abdulmajeed [Department of Radiation Oncology, King Hussein Cancer Center, Amman (Jordan); Kanaa’n, Haitham [Section of Medical Physics, Department of Radiation Oncology, King Hussein Cancer Center, Amman (Jordan); Sarhan, Nasim [Department of Radiation Oncology, King Hussein Cancer Center, Amman (Jordan); Roujob, Ibrahim [Section of Medical Physics, Department of Radiation Oncology, King Hussein Cancer Center, Amman (Jordan); Salem, Abdel-Fattah [Department of Obstetrics and Gynecology, Hashemite University, Zarqa (Jordan); Afifi, Shatha [Section of Medical Physics, Department of Radiation Oncology, King Hussein Cancer Center, Amman (Jordan); Jaradat, Imad; Mubiden, Rasmi; Almousa, Abdelateif [Department of Radiation Oncology, King Hussein Cancer Center, Amman (Jordan)

    2015-10-01

    Radiation pneumonitis is a well-documented side effect of radiation therapy for breast cancer. The purpose of this study was to compare combined photon-electron, photon-only, and electron-only plans in the radiation treatment of the supraclavicular lymph nodes. In total, 13 patients requiring chest wall and supraclavicular nodal irradiation were planned retrospectively using combined photon-electron, photon-only, and electron-only supraclavicular beams. A dose of 50 Gy over 25 fractions was prescribed. Chest wall irradiation parameters were fixed for all plans. The goal of this planning effort was to cover 95% of the supraclavicular clinical target volume (CTV) with 95% of the prescribed dose and to minimize the volume receiving ≥ 105% of the dose. Comparative end points were supraclavicular CTV coverage (volume covered by the 95% isodose line), hotspot volume, maximum radiation dose, contralateral breast dose, mean total lung dose, total lung volume percentage receiving at least 20 Gy (V{sub 20} {sub Gy}), heart volume percentage receiving at least 25 Gy (V{sub 25} {sub Gy}). Electron and photon energies ranged from 8 to 18 MeV and 4 to 6 MV, respectively. The ratio of photon-to-electron fractions in combined beams ranged from 5:20 to 15:10. Supraclavicular nodal coverage was highest in photon-only (mean = 96.2 ± 3.5%) followed closely by combined photon-electron (mean = 94.2 ± 2.5%) and lowest in electron-only plans (mean = 81.7 ± 14.8%, p < 0.001). The volume of tissue receiving ≥ 105% of the prescription dose was higher in the electron-only (mean = 69.7 ± 56.1 cm{sup 3}) as opposed to combined photon-electron (mean = 50.8 ± 40.9 cm{sup 3}) and photon-only beams (mean = 32.2 ± 28.1 cm{sup 3}, p = 0.114). Heart V{sub 25} {sub Gy} was not statistically different among the plans (p = 0.999). Total lung V{sub 20} {sub Gy} was lowest in electron-only (mean = 10.9 ± 2.3%) followed by combined photon-electron (mean = 13.8 ± 2.3%) and highest in photon

  20. An optimized posterior axillary boost technique in radiation therapy to supraclavicular and axillary lymph nodes: A comparative study

    Energy Technology Data Exchange (ETDEWEB)

    Hernandez, Victor, E-mail: vhernandezmasgrau@gmail.com [Department of Medical Physics, Hospital Sant Joan de Reus, IISPV, Tarragona (Spain); Arenas, Meritxell [Department of Radiation therapy, Hospital Sant Joan de Reus, IISPV, Tarragona (Spain); Müller, Katrin [Department of Medical Physics, Hospital Sant Joan de Reus, IISPV, Tarragona (Spain); Gomez, David; Bonet, Marta [Department of Radiation therapy, Hospital Sant Joan de Reus, IISPV, Tarragona (Spain)

    2013-01-01

    To assess the advantages of an optimized posterior axillary (AX) boost technique for the irradiation of supraclavicular (SC) and AX lymph nodes. Five techniques for the treatment of SC and levels I, II, and III AX lymph nodes were evaluated for 10 patients selected at random: a direct anterior field (AP); an anterior to posterior parallel pair (AP-PA); an anterior field with a posterior axillary boost (PAB); an anterior field with an anterior axillary boost (AAB); and an optimized PAB technique (OptPAB). The target coverage, hot spots, irradiated volume, and dose to organs at risk were evaluated and a statistical analysis comparison was performed. The AP technique delivered insufficient dose to the deeper AX nodes. The AP-PA technique produced larger irradiated volumes and higher mean lung doses than the other techniques. The PAB and AAB techniques originated excessive hot spots in most of the cases. The OptPAB technique produced moderate hot spots while maintaining a similar planning target volume (PTV) coverage, irradiated volume, and dose to organs at risk. This optimized technique combines the advantages of the PAB and AP-PA techniques, with moderate hot spots, sufficient target coverage, and adequate sparing of normal tissues. The presented technique is simple, fast, and easy to implement in routine clinical practice and is superior to the techniques historically used for the treatment of SC and AX lymph nodes.

  1. Mapping patterns of nodal metastases in esophageal carcinoma: rethinking the clinical target volume for supraclavicular nodal irradiation

    Science.gov (United States)

    Luo, Yijun; Liu, Yuhui; Wang, Xiaoli; Zhang, Bin; Yu, Jinming; Wang, Chengang; Huang, Yong

    2016-01-01

    Background To map detail distribution of metastatic supraclavicular (SCV) lymph nodes (LN) in esophageal cancer (EC) patients and determine the precise radiation therapy clinical target volume (CTV). Methods A total of 101 thoracic esophageal carcinoma patients after surgery experienced SCV LN metastasis were retrospectively examined. The SCV region is further divided into four subgroups. Using hand drawings registration, nodes were mapped to a template computed tomogram to provide a visual impression of nodal frequencies and anatomic distribution. Results In all, 158 nodes were considered to be clinical metastatic in the SCV region in the 101 patients, 74 on the left and 84 on the right. Seven of 158 (4.4%) positive LN were located in group I, 78 of 158 (49.37%) were located in group II, 72 of 158 nodes (45.6%) were located in group III, 1 of 158 (0.63%) located in group IV. Conclusions According to our results, the SCV group II and group III are considered to be the high risk regions of esophageal squamous cell carcinoma (ESCC) LN metastasis, which were defined as elective nodal irradiation (ENI) areas. PMID:28066592

  2. An optimized posterior axillary boost technique in radiation therapy to supraclavicular and axillary lymph nodes: a comparative study.

    Science.gov (United States)

    Hernandez, Victor; Arenas, Meritxell; Müller, Katrin; Gomez, David; Bonet, Marta

    2013-01-01

    To assess the advantages of an optimized posterior axillary (AX) boost technique for the irradiation of supraclavicular (SC) and AX lymph nodes. Five techniques for the treatment of SC and levels I, II, and III AX lymph nodes were evaluated for 10 patients selected at random: a direct anterior field (AP); an anterior to posterior parallel pair (AP-PA); an anterior field with a posterior axillary boost (PAB); an anterior field with an anterior axillary boost (AAB); and an optimized PAB technique (OptPAB). The target coverage, hot spots, irradiated volume, and dose to organs at risk were evaluated and a statistical analysis comparison was performed. The AP technique delivered insufficient dose to the deeper AX nodes. The AP-PA technique produced larger irradiated volumes and higher mean lung doses than the other techniques. The PAB and AAB techniques originated excessive hot spots in most of the cases. The OptPAB technique produced moderate hot spots while maintaining a similar planning target volume (PTV) coverage, irradiated volume, and dose to organs at risk. This optimized technique combines the advantages of the PAB and AP-PA techniques, with moderate hot spots, sufficient target coverage, and adequate sparing of normal tissues. The presented technique is simple, fast, and easy to implement in routine clinical practice and is superior to the techniques historically used for the treatment of SC and AX lymph nodes. © 2013 American Association of Medical Dosimetrists.

  3. Outcomes of patients with breast cancer who present with ipsilateral supraclavicular or internal mammary lymph node metastases.

    Science.gov (United States)

    Dellapasqua, Silvia; Bagnardi, Vincenzo; Balduzzi, Alessandra; Iorfida, Monica; Rotmensz, Nicole; Santillo, Barbara; Viale, Giuseppe; Ghisini, Raffaella; Veronesi, Paolo; Luini, Alberto; Morra, Anna; Goldhirsch, Aron; Colleoni, Marco

    2014-02-01

    The prognostic implications of internal mammary (IM) and supraclavicular (SC) node involvement in locally advanced breast cancer is still unclear. We evaluated 107 patients with IM (n = 65) or SC (n = 42) node involvement who underwent operation at the European Institute of Oncology between 1997 and 2009 to assess their prognostic features. We subsequently analyzed matched cohorts, using the 107 patients as cases and another group of patients as a control cohort, to evaluate prognostic differences between patients with and those without IM or SC node involvement. Five-year disease-free survival (DFS) was 84% in IM vs. 38.8% in SC node involvement (P node vs. 57.1% in SC node involvement (P node involvement. Conversely, a statistically significant difference in DFS and locoregional recurrence was observed in patients with SC node involvement compared with controls without SC node involvement. SC node involvement correlated with a significantly poorer outcome in patients with locally advanced breast cancer. Adequate staging, including biopsy of suspicious locoregional ipsilateral lymph nodes, is mandatory in these patients. Patients with IM or SC node involvement should be treated with curative intent using combined-modality treatments. Copyright © 2014 Elsevier Inc. All rights reserved.

  4. Supraclavicular and infraclavicular lymph node delineation in breast cancer patients: a proposal deriving from a comparative study.

    Science.gov (United States)

    Cucciarelli, Francesca; Kirova, Youlia M; Palumbo, Isabella; Aristei, Cynthia

    2015-01-01

    Current advances in radiotherapy for breast cancer require knowledge of the anatomy of irradiated areas to minimize geographic miss and spare organs at risk. This study aimed at defining a contouring approach for supraclavicular (SC) and infraclavicular (IC) nodes after mastectomy or conservative surgery in patients with breast cancer. In 15 patients, SC and IC nodes were contoured on computed tomography slices according to Madu et al and Dijkema et al. After analyzing relapse sites, as reported by Reed et al, our approach was defined. The 3 methods were compared in all patients, quantifying differences in contours by percentage overlap (PO). In our approach, SC node delineation is similar to Madu et al in the ventral and medial landmarks, but includes the lateral SC nodes described by Dijkema et al. The lateral landmarks are the scalenus anterior and medius muscle lateral border and the clavicle. Dorsal boundaries are the scalenus anterior and medius muscle ventral and lateral surfaces and the subclavian artery ventral border. In IC node delineation, major differences emerged in cranial and dorsal limits which, in our approach, are the pectoralis minor muscle upper edge and the subclavian axillary artery ventral side. Our mean and median volumes and POs were between the other 2 methods. This study contributes to standardizing draining node contouring, so as to reduce variability and minimize geographic miss.

  5. Proposed modifications of supraclavicular lymph node metastasis in the esophageal squamous cell carcinoma staging system for improved survival stratification.

    Science.gov (United States)

    Zheng, Yuzhen; Wang, Zhen; Wang, Feng; Huang, Qingyuan; Liu, Shuoyan

    2017-06-20

    The present study aims to investigate the clinical implication of supraclavicular lymph nodes (SCLNs) in thoracic esophageal squamous cell carcinoma (ESCC). A total of 1156 ESCC patients who underwent three-field lymphadenectomy with node metastasis were analyzed retrospectively. SCLNs were defined as regional nodes in the current system or as distant nodes in the modified system. Survival was analyzed using the Kaplan-Meier method, and values were compared using the log-rank test. Multivariate analysis was performed using the Cox proportional hazard model. The Akaike information criterion (AIC) and the concordance index (c-index) were applied to compare the two prognostic systems. Among 1156 patients, 183 (15.8%) patients were diagnosed with SCLN metastasis. Higher rate of SCLN metastasis was associated with upper tumor location, metastasis involving seven or more nodes, and positive recurrent laryngeal nerve node status. The current staging system was unable to stratify overall survival well in patients with N2, N3, and M1 status using a univariate analysis. In both the current staging system and the modified version, age, gender, pathological T status, and nodal status were independent prognostic factors in a multivariate analysis. The AIC value for the modified version was smaller than that for the current staging system; the c-index value for the modified version was larger than that for the current staging system. Based on the data from our single center, SCLNs should be reclassified as regional lymph nodes in thoracic ESCC for better stratification of overall survival.

  6. To determine block establishment time of supraclavicular brachial plexus block using blunt versus short bevel needle: A prospective randomized trial

    Directory of Open Access Journals (Sweden)

    V Ahuja

    2016-01-01

    Full Text Available Background: Unintentional intraneural injection under ultrasound guidance (USG with fine caliber needles and lower success rate with large caliber Tuohy needles in supraclavicular brachial plexus block (SCB have been reported. Materials and Methods: We undertook study to standardize the use of 20-gauge short versus blunt bevel needle for SCB. After approval of Institutional Ethics Committee and written informed consent, patients were randomized using computer-generated random number table to either of the two groups; blunt bevel needle group (n = 30: SCB under USG using 20-gauge Tuohy needle or short bevel needle group (n = 30: SCB under USG using 20-gauge short bevel needle. The primary outcome of the study was time to establishment of sensory and motor block of individual nerves, and secondary outcome was tolerability and any adverse effects. Results: The time to establishment of sensory and motor block in individual nerve territory was similar in both the groups. The complete sensory and motor anesthesia was achieved in 78.3% patients and complete sensory and motor anesthesia after supplementary block was achieved in 86.6% patients. Paresthesias during SCB were recorded in 15 patients. Out of these eight patients were of blunt bevel group and seven patients were of short bevel group. None of the patients experienced any neurological adverse effects. Conclusion: The establishment of sensory and motor blockade of individual nerves was similar to 20-gauge short and blunt bevel needle under ultrasound guide with no neurological adverse events.

  7. El exilio y la política de la transición : una reflexión sobre la continuidad de la izquierda parlamentaria

    Directory of Open Access Journals (Sweden)

    Abdón Mateos

    2000-01-01

    Full Text Available El autor propone la tesis de continuidad respecto al exilio en la trayectoria de la izquierda parlamentaria durante la transición. No hubo ruptura con el exilio y, por tanto, refundación del PSOE y del PCE debido a la presencia cualificada de históricos de la guerra civil y de miembros de la segunda generación del exilio/primera clandestinidad en los círculos de poder interno de ambos partidos. Pero, sobre todo, no hubo refundación del PSOE tras Suresnes por la continuidad de aspectos claves de su política y por el peso de la conciencia histórica del franquismo en la cultura política de los socialistas.The author aims to show that the evolution of tehe Parliamnetary left wing is ultimately roots on the exile. PSOE anf PCE never broke their links with the exile and therefore were never refounded, due to the leading presence of persons who played a role in the civil war as well as of members of the second generation of the exile and the first underground movements in the core of both partios. Over all, the PSOE was never refounded after Suresnes as the key features of its politics remaied unchanged and historical conscience of francoism played a decisive part in the Socialist political culture.

  8. Origen anómalo de la arteria coronaria izquierda originándose de la arteria pulmonar. Reporte de caso y revisión de literatura

    Directory of Open Access Journals (Sweden)

    José Jiménez Vega

    2007-01-01

    Full Text Available Se presenta el caso de un lactante de 2 meses de edad que consultó por tos y dificultad respiratoria; al ser admitido en el servicio de urgencias, el abordaje inicial fue de una infección respiratoria baja (bronquiolitis pero la evolución tórpida y la presencia de cardiomegalia hizo sospechar una cardiopatía, diagnosticándose origen anómalo de la arteria coronaria izquierda que nace de la arteria pulmonar, la cual fue tratada quirúrgicamente con resultado favorable.2 month old male who was brought to the emergency department with a history of non productive cold, was noticed with difficulty breathing. He was admitted with the possible diagnosis of bronquioloitis. The poor evolution of the patient, and the presence of cardiomegaly, made the physicians look for a cardiopathy, and a diagnosis of anomalous left coronary artery from the pulmonary artery was made. He was stabilized and then was taken to the operating room and had his anomalous coronary artery reimplanted to his aorta

  9. Pseudo-aneurisma post-traumático de tronco de arteria coronaria izquierda Post-traumatic false (pseudo aneurysm of the left main coronary artery

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    Melina M. Gallo

    2011-08-01

    Full Text Available El pseudo-aneurisma de arteria coronaria es extremadamente raro. Su historia natural es poco conocida y su tratamiento discutido. Se presenta el caso de un paciente con pseudo-aneurisma de tronco de la coronaria izquierda e infarto antero-apical del ventrículo izquierdo cinco años después de un paro cardíaco secundario a un traumatismo no penetrante de tórax. Se consideró entonces que la lesión no era pasible de corrección percutánea o quirúrgica por lo que se optó por tratamiento médico conservador. Una angiografía coronaria por tomografía computarizada multicorte realizada 10 años después del evento inicial mostró ausencia de progresión de la lesión.Coronary pseudo-aneurysm is an extremely rare entity. Its natural history is scarcely known and its treatment is controversial. We report a case of pseudo-aneurysm of the left main coronary artery associated with an antero-apical infarct of the left ventricle diagnosed five years after a cardiac arrest following a non-penetrating thoracic trauma. The patient was treated conservatively because percutaneous or surgical correction were not considered suitable for this lesion. A multidetector computed tomography coronary angiogram performed 10 years after the initial event showed no evidence of progression.

  10. Uso de sellantes de fosas y fisuras para la prevención de caries en población infanto-juvenil: Methodological review of clinical trials Use of pit and fissure sealants for preventing caries in child population

    Directory of Open Access Journals (Sweden)

    S Faleiros Chioca

    2013-04-01

    Full Text Available La caries dental es uno de los problemas más relevantes dentro del ámbito odontológico y de la Salud Pública. En Chile existe una alta prevalencia de caries en la población infanto-juvenil, siendo esta una de las prioridades de salud del país. Se constata la necesidad de utilizar métodos complementarios para su control. Los sellantes de fosas y fisuras representan una de las intervenciones preventivas más efectivas en odontología, siendo considerados como un aporte a la Salud Pública. Sin embargo, no existen evidencias consistentes acerca de su verdadera efectividad e impacto en la prevención de caries. Las inconsistencias encontradas podrían deberse a la presencia de sesgos o a la heterogeneidad de los estudios disponibles en la literatura. Así, se propone realizar una revisión sistemática con el fin de evaluar la calidad metodológica de los ensayos clínicos controlados que utilizan sellantes de fosas y fisuras. Se condujo una búsqueda de ensayos realizados entre 1990 y 2007, encontrándose trece que cumplieron con los criterios de inclusión y exclusión. Los estudios incluidos fueron obtenidos y evaluados por un único revisor. Se concluye que la evidencia que avala la utilización de esta intervención es metodológicamente muy pobre. Estos hallazgos debieran estimular a los profesionales a esclarecer la verdad referente a la efectividad de los sellantes, antes de aplicarlos indiscriminadamente. Se recomienda la realización de nuevos ensayos clínicos ejecutados con un adecuado diseño metodológico y de análisis estadístico, cuyos resultados sirvan como evidencia confiable para la toma de decisiones que guíen las políticas de Salud Pública.Dental decay is one of the most important problems within the Public Oral Health. Chile has a high prevalence of decay among children and adolescents, being this issue one of the priorities of public health in the country. Taking into account this context, there is a necessity of

  11. A Patient with Supraclavicular Lymphadenopathy and Anterior Mediastinal Mass Presenting as a Rare Case of Composite Lymphoma: A Case Report and Literature Review

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    Alex Raufi

    2016-12-01

    Full Text Available Composite lymphoma (CL is a rare disease with 2 distinct lymphomas concurrently arising in a single patient with an estimated incidence of 1–4.7% of newly diagnosed lymphomas per year. CL most commonly involves 2 B-cell non-Hodgkin lymphomas (NHL or a B-cell NHL with a Hodgkin lymphoma. Our case is unique in that it was a bilineage CL with both a T-cell and B-cell NHL, which has only been reported in a few case reports. A 49-year-old woman presented with several months of progressive cough, weight loss, dyspnea, and supraclavicular lymphadenopathy. Computed tomographic imaging done upon admission to the hospital found that she had extensive anterior and middle mediastinal lymphadenopathy as well as bilateral supraclavicular lymphadenopathy. The patient underwent an excisional biopsy on the supraclavicular lymph node and was found to have a composite lymphoma involving both a T-cell and B-cell NHL. Her final pathological diagnosis was peripheral T-cell lymphoma and lymphoplasmacytic lymphoma. The patient was found to have stage IIIB disease. Her HIV, hepatitis panel, and tuberculosis tests were all negative. She then underwent chemotherapy with dose-adjusted EPOCH-R (etoposide, prednisone, vincristine, cyclophosphamide, doxorubicin, and rituximab. The patient showed a complete response and was then referred to a bone marrow transplant center for an autologous hematopoietic stem cell transplant. CL is a rare disease composed of at least 2 distinct lymphomas concurrently arising in a single patient. Due to the complexity in having to treat multiple types of lymphoma simultaneously CL presents challenges with treatment and assessing prognosis.

  12. Contribution of ultrasound-guided fine-needle aspiration cell blocks of metastatic supraclavicular lymph nodes to the diagnosis of lung cancer.

    Science.gov (United States)

    Tian, Hai-Ying; Xu, Dong; Liu, Jun-Ping; Mao, Wei-Min; Chen, Li-Yu; Yang, Chen; Wang, Li-Ping; Shi, Kai-Yuan

    2015-11-01

    Routine smears of fine-needle aspiration (FNA) specimens of supraclavicular lymph nodes with ultrasound (US) real-time guidance have proven useful in lung cancer staging, but the clinical value of additional information from cell-block of FNA samples has been little researched. This study mainly focused on the contribution of cell block analysis to the diagnosis and staging in lung cancer. Clinical data about 211 lung cancer patients with supraclavicular lymph node enlargement admitted to ultrasonography in the Zhejiang Cancer Hospital and recommended a needle biopsy under US-guided, the adequacy of the specimens for preparing cell blocks was acquireded, and the additional immunohistochemistry or genetic information provided from cell block analysis was examined. In 211 lung cancer patients referred for US-guided FNA (median age 61.8 ± 10.0 years, range 30-88) 279 aspirations were performed. Conventional smears could be obtained from 185 aspirates (66.3%) and contained 176 (95.1%) diagnostic smears. Cell blocks could be obtained from 94 aspirates (33.7%) and contained diagnostic material in 88 (93.6%) aspirates. Above all, cell blocks also made epithelial growth factor receptor gene mutation analysis in 17 patients with FNA samples, and the positive rate was 70.6%. Overall, cell blocks provided clinically significant information for 51 of the 211 patients participating in the study (24.2%). Cell-block samples from US-guided FNA is a promising, relatively noninvasive technique to provide additional information in lung cancer diagnosis. Analysis of cell blocks allows for genetic analysis of the patients with supraclavicular lymph nodes metastasis.

  13. [Neurological complications associated with ultrasound-guided interscalene and supraclavicular block in elective surgery of the shoulder and arm. Prospective observational study in a university hospital].

    Science.gov (United States)

    Bilbao Ares, A; Sabaté, A; Porteiro, L; Ibáñez, B; Koo, M; Pi, A

    2013-01-01

    The incidence of postoperative neurological symptoms after performing interscalene block varies between 4 and 16%. The majority of cases are resolved spontaneously within a year, but some patients have their symptoms permanently. Our objective was to assess the incidence of postoperative neurological symptoms after performing the ultrasound-assisted interscalene and supraclavicular anaesthetic blocks. A prospective and observational study was conducted on consecutive patients who had undergone upper extremity surgery with an interscalene or supraclavicular block as an isolated technique, or as a complement to general anaesthesia. Seven days after the intervention, a telephone interview was conducted that focused on the detection of neurological symptoms in the operated limb. Further serial interviews were conducted on patients with symptoms (after the first, the third and the sixth month, and one year after surgery) until resolution of symptoms. Neurological evaluation was offered to those patients with persistent symptoms after one year. A total of 121 patients were included, on whom 96 interscalene blocks and 22 supraclavicular blocks were performed. Postoperative neurological symptoms were detected in 9.9% (95% CI, 5-15%) of patients during the first week. No significant differences were observed between interscalene (9%) and supraclavicular block (14%). After 3 months the symptoms persisted in 9 patients (7.4%), with symptoms remaining in 4 patients (3.3%) after 1.5 years. Electromyogram was performed on 3 patients who tested positive for nerve damage. A high incidence of postoperative neurological symptoms was observed, and a worrying percentage of permanence of them. There were no significant differences in incidence according to the type of block, or any features of the patient or the anaesthesia technique that were associated with the incidence of these symptoms, except a marginal relationship with age. These complications must be clearly explained to the

  14. Hypofractionated irradiation of infra-supraclavicular lymph nodes after axillary dissection in patients with breast cancer post-conservative surgery: impact on late toxicity.

    Science.gov (United States)

    Guenzi, Marina; Blandino, Gladys; Vidili, Maria Giuseppina; Aloi, Deborah; Configliacco, Elena; Verzanini, Elisa; Tornari, Elena; Cavagnetto, Francesca; Corvò, Renzo

    2015-08-20

    The aim of the present work was to analyse the impact of mild hypofractionated radiotherapy (RT) of infra-supraclavicular lymph nodes after axillary dissection on late toxicity. From 2007 to 2012, 100 females affected by breast cancer (pT1- T4, pN1-3, pMx) were treated with conservative surgery, Axillary Node Dissection (AND) and loco-regional radiotherapy (whole breast plus infra-supraclavicular fossa). Axillary lymph nodes metastases were confirmed in all women. The median age at diagnosis was 60 years (range 34-83). Tumors were classified according to molecular characteristics: luminal-A 59 pts (59%), luminal-B 24 pts (24%), basal-like 10 pts (10%), Her-2 like 7 pts (7%). 82 pts (82%) received hormonal therapy, 9 pts (9%) neo-adjuvant chemotherapy, 81pts (81%) adjuvant chemotherapy. All patients received a mild hypofractionated RT: 46 Gy in 20 fractions 4 times a week to whole breast and infra-supraclavicular fossa plus an additional weekly dose of 1,2 Gy to the lumpectomy area. The disease control and treatment related toxicity were analysed in follow-up visits. The extent of lymphedema was analysed by experts in Oncological Rehabilitation. Within a median follow-up of 50 months (range 19-82), 6 (6%) pts died, 1 pt (1%) had local progression disease, 2 pts (2%) developed distant metastasis and 1 subject (1%) presented both. In all patients the acute toxicity was mainly represented by erythema and patchy moist desquamation. At the end of radiotherapy 27 pts (27%) presented lymphedema, but only 10 cases (10%) seemed to be correlated to radiotherapy. None of the patients showed a severe damage to the brachial plexus, and the described cases of paresthesias could not definitely be attributed to RT. We did not observe symptomatic pneumonitis. Irradiation of infra-supraclavicular nodes with a mild hypofractionated schedule can be a safe and effective treatment without evidence of a significant increase of lymphedema appearance radiotherapy related.

  15. Reconstruction of cervical scar contracture using axial thoracic flap based on the thoracic branch of the supraclavicular artery.

    Science.gov (United States)

    Ma, Xianjie; Li, Yang; Wang, Lu; Li, Weiyang; Dong, Liwei; Xia, Wei; Su, Yingjun

    2014-09-01

    Cervical scar contracture causes both physical and psychological distress for burn patients. Many pedicle flaps or skin grafting have been suggested for reconstruction of cervical scar contracture with variable results in the literature. The authors present the axial thoracic flap based on the thoracic branch of the supraclavicular artery (TBSA) for reconstruction of cervical scar contracture. Postburn scar contractures in anterior neck region of 66 patients had been reconstructed with the axial pattern thoracic flaps based on the TBSA, including 1 expanded and 10 nonexpanded pedicle flaps, and 9 expanded and 46 nonexpanded island pedicle flaps, during 1988 through 2012. After removing and releasing the cervical scar contracture, the flap was designed in the thoracic region. The axial artery of the flap is the TBSA bifurcating from the intersection point of sternocleidomastoid muscle and omohyoid muscle with several concomitant veins as the axial veins. The flap can be designed in a large area within the borders of the anterior border of the trapezius muscle superiorly, the middle part of the deltoid muscle laterally, the midsternal line medially, and the level 3 to 4 cm below nipples inferiorly. After incisions were made along the medial, inferior, and lateral border, dissection was performed toward the pedicle. Donor site was closed directly in expanded cases and with skin grafting in nonexpanded cases. Cervical scar contractures were repaired with good functional and cosmetic results in 64 cases among this cohort. Flap tip necrosis in other 2 cases, caused by postoperative hematoma, was repaired by skin grafting. The color and texture of all flaps were fitted with those of the surrounding skin. The donor sites all healed primarily. The flap sensation in the thoracic region regained in the early stage postoperatively and that in cervical area recovered completely after 6 months according to the report of the patients. With reliable blood supply based on the

  16. Mapping Patterns of Ipsilateral Supraclavicular Nodal Metastases in Breast Cancer: Rethinking the Clinical Target Volume for High-risk Patients

    Energy Technology Data Exchange (ETDEWEB)

    Jing, Hao [Department of Radiation Oncology, Cancer Hospital and Institute, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing (China); Wang, Shu-Lian, E-mail: wsl20040118@yahoo.com [Department of Radiation Oncology, Cancer Hospital and Institute, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing (China); Li, Jing; Xue, Mei; Xiong, Zu-Kun [Department of Radiology, Cancer Hospital and Institute, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing (China); Jin, Jing; Wang, Wei-Hu; Song, Yong-Wen; Liu, Yue-Ping; Ren, Hua; Fang, Hui; Yu, Zi-Hao; Liu, Xin-Fan [Department of Radiation Oncology, Cancer Hospital and Institute, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing (China); Li, Ye-Xiong, E-mail: yexiong12@163.com [Department of Radiation Oncology, Cancer Hospital and Institute, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing (China)

    2015-10-01

    Purpose: To map the location of metastatic supraclavicular (SCV) lymph nodes (LNMs) in breast cancer patients with SCV node involvement and determine whether and where the radiation therapy clinical target volume (CTV) of this region could be modified in high-risk subsets. Methods and Materials: Fifty-five patients with metastatic SCV LNMs were eligible for geographic mapping and atlas coverage analysis. All LNMs and their epicenters were registered proportionally by referencing the surrounding landmarks onto simulation computed tomography images of a standard patient. CTVs based on selected SCV atlases, including the one by the Radiation Therapy Oncology Group (RTOG) were contoured. A modified SCV CTV was tried and shown to have better involved-node coverage and thus theoretically improved prophylaxis in this setting. Results: A total of 50 (91%) and 45 (81.8%) patients had LNMs in the medial and lateral SCV subregions, respectively. Also, 36 patients (65.5%) had LNMs located at the junction of the jugular-subclavian veins. All nodes were covered in only 25.5% to 41.8% of patients by different atlases. The RTOG atlas covered all nodes in 25.5% of patients. Stratified by the nodes in all the patients as a whole, 49.2% to 81.3% were covered, and the RTOG atlas covered 62.6%. The lateral and posterior borders were the most overlooked locations. Modification by extending the borders to natural anatomic barriers allowed the new CTV to cover all the nodes in 81.8% of patients and encompass 96.1% of all the nodes. Conclusions: According to the distribution of SCV LNMs, the extent of existing atlases might not be adequate for potential metastatic sites in certain groups of patients. The extension of the lateral and posterior CTV borders in high-risk or recurrent patients might be a reasonable approach for increasing coverage. However, additional data in more homogeneous populations with localized disease are needed before routine application.

  17. ANGIOPLASTIA PERCUTÁNEA CON STENT EN EL TRONCO PRINCIPAL DE LA ARTERIA CORONARIA IZQUIERDA / Percutaneous angioplasty with stent in the left main coronary artery

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    Javier Almeida Gómez

    2012-10-01

    Full Text Available ResumenIntroducción y objetivos: La afectación significativa del tronco común izquierdo, es la más letal de las presentaciones de la enfermedad arterial coronaria. El tratamiento de elección, es la cirugía de derivación aorto-coronaria. En varios estudios multicéntricos, se sugiere la posibilidad de tratar la enfermedad de tronco mediante el intervencionismo coronario percutáneo con implantación de prótesis endoluminal o stent. El objetivo de esta investigación fue caracterizar la angioplastia percutánea con stent en el tronco principal de la arteria coronaria izquierda. Método: Se realizó un estudio observacional, descriptivo y transversal en 21 pacientes con angioplastia percutánea con stent en el tronco principal de la arteria coronaria izquierda, realizadas en el laboratorio de Hemodinámica y Cardiología Intervencionista del Hospital "Hermanos Ameijeiras", entre enero 2010 y julio 2011. Resultados: No existió diferencia significativa en el sexo. Predominó el grupo de edad entre 50-64 años (47,6 % y el color de la piel blanca (76,19 %. El factor de riesgo cardiovascular más encontrado fue la HTA (85,71 %, seguido de dislipidemia (47,61 %. El diagnóstico más observado fue la angina de esfuerzo estable, 14 casos (66,66 %. La lesión en el cuerpo del tronco (12 pacientes, 57,1 %, fue la más encontrada, seguida de la ostial (8 casos. El tipo de stent más utilizado fue el liberador de fármacos (61,9 %, y solamente 4 pacientes presentaban troncos protegidos quirúrgicamente. Conclusiones: La mayor cantidad de casos fueron electivos, con predominio de los troncos no protegidos. El factor de riesgo coronario más encontrado fue la HTA. Se encontró asociación significativa entre la diabetes mellitus y la localización ostial de la lesión tratada. / AbstractIntroduction and Objectives: Significant impairment of the left main coronary artery is the most lethal presentation of coronary artery disease. The treatment of choice

  18. EVALUACIÓN ECOCARDIOGRÁFICA DE LA FUNCIÓN VENTRICULAR IZQUIERDA EN CENTENARIOS / Echocardiographic assessment of left ventricular function in centenarians

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    Vanessa Peña-Bofill

    2013-10-01

    Full Text Available Resumen Introducción: El envejecimiento poblacional es un fenómeno mundial y constituye un logro de la humanidad. Objetivo: Caracterizar ecocardiográficamente la función ventricular izquierda de pacientes ambulatorios mayores de 100 años del municipio Plaza de la Revolución, en el período de septiembre del 2009 a septiembre del 2010. Método: Se realizó un estudio descriptivo de corte transversal con 20 longevos, en el Departamento de Ecocardiografía del Hospital Universitario "General Calixto García", a los cuáles se les realizó ecocardiograma para evaluar la función ventricular izquierda. Resultados: La edad media fue de 102 años, predominó el sexo femenino con 15 pacientes (75 % y el 50 % tenía color de piel blanco. El factor de riesgo coronario de mayor prevalencia fue la hipertensión arterial (40 %; la diabetes mellitus tipo 2, el tabaquismo y la dislipidemia le sucedieron en orden. Los centenarios tenían conservada la función sistólica del ventrículo izquierdo (90 % con poca tendencia a la supernormalidad, una paciente presentó trastornos segmentarios de la contractilidad en cara inferior, lo que correspondía a antecedentes de infarto de miocardio. Cuatro centenarios tenían patrón de llenado normal, 11 presentaron alteración de la relajación ventricular y cinco patrones pseudonormales. Conclusiones: En los centenarios estudiados se mantiene una función sistólica del ventrículo izquierdo evaluada por ecocardiografía, dentro de parámetros normales, con signos de disfunción diastólica leve. / Abstract Introduction: Population aging is a global phenomenon and an achievement of mankind. Objective: To characterize left ventricular function by echocardiography in ambulatory patients over 100 years old in Plaza de la Revolution Municipality, between September 2009 and September 2010. Method: A descriptive cross-sectional study was carried out with 20 long-lived people, in the Department of Echocardiography of

  19. Las invasiones de tierras y la izquierda en la ciudad: Montevideo, Uruguay, 1984-2011 Squatter Settlements and the Left in the City: Montevideo, Uruguay, 1984-2011

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    MARÍA JOSÉ ALVAREZ RIVADULLA

    2012-01-01

    Full Text Available En la última década del siglo XX la ciudad de Montevideo sufrió cambios drásticos. El número de barrios informales creció como nunca en la historia de la ciudad. Muchos de esos barrios se formaron a partir de invasiones organizadas, es decir, mediante un proceso en el que un grupo identificó un terreno disponible, lo invadió, trazó calles y lotes, negoció con las autoridades y se organizó para demandar servicios públicos. Este artículo se pregunta qué explica la ola de invasiones de tierra planificadas en torno a 1990 en Montevideo. A partir de análisis cuantitativo y cualitativo de eventos de invasión a través del tiempo, argumenta que el aumento de la competencia electoral y la llegada de la coalición de izquierda Frente Amplio al gobierno de la ciudad, constituyeron una oportunidad política clave para los pobres urbanos.The city of Montevideo changed drastically during the last decade of the twentieth century. The number of informal neighborhoods increased in an unprecedented manner. Many of these neighborhoods started as organized land invasions, that is, with a group identifying a piece of land, invading it, outlining streets and plots, negotiating with authorities and organizing to demand public services. This article asks what explains the wave of organized land invasions in Montevideo around 1990. Using qualitative and quantitative analysis of squatting events over time, it argues that the rising electoral competition and the arrival of the leftist coalition Frente Amplio to the city government, constituted a key political opportunity for the urban poor.

  20. Geografías de la protesta armada: Nueva izquierda y latinoamericanismo en el cono sur. El ejemplo de la Junta de Coordinación Revolucionaria

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    Aldo Marchesi

    2009-11-01

    Full Text Available El artículo recorre la trayectoria de militantes argentinos, bolivianos, chilenos y uruguayos que desarrollaron una red regional de organizaciones armadas de izquierda. Los intercambios entre estas organizaciones que demoraran más de diez años, comenzaron con las redes de apoyo a la incursión del Che Guevara a Bolivia en 1966 y finalizaron en los tardíos setentas cuando el golpe de estado en Argentina canceló el último refugio en la región. Para entender la evolución que culminó en el desarrollo de una estrategia continental se examina la confluencia del ERP Argentino, el ELN Boliviano, el uruguayo MLN-Tupamaros y el chileno MIR a través de eventos críticos que definieron la experiencia de esta red de militantes: el impacto de la guerrilla boliviana del Che, los intercambios políticos y culturales desarrollados entre militantes de estas organizaciones en el Chile de Allende, y la creación de una organización regional llamada la Junta de Coordinación Revolucionaria. Este articulo usa una perspectiva transnacional para examinar un tema que hasta ahora ha sido examinado mayoritariamente desde una perspectiva nacional o comparativa. El artículo busca mostrar cómo la región fue un espacio central de experimentación en la constitución de identidades políticas. Asimismo, defiende que solo un enfoque transnacional puede ayudar a dar una más completa explicación acerca de la emergencia de estos movimientos políticos radicales durante el período

  1. Ultrasound, computed tomography, or the combination for the detection of supraclavicular lymph nodes in patients with esophageal or gastric cardia cancer: a comparative study.

    Science.gov (United States)

    van Vliet, Evelyn P M; van der Lugt, Aad; Kuipers, Ernst J; Tilanus, Hugo W; van der Gaast, Ate; Hermans, John J; Siersema, Peter D

    2007-09-01

    Both ultrasound (US) and computed tomography (CT) can be used to detect supraclavicular lymph node metastases. Aim was to compare US, US plus fine-needle aspiration (US-FNA), CT, US + CT, and US-FNA + CT for the detection of these metastases in esophageal or gastric cardia cancer patients. Between 1994 and 2004, 567 patients underwent US and CT for esophageal or gastric cardia cancer staging. Gold standard was postoperative detection of lymph nodes in the resected specimen, FNA, or a radiological result with follow-up. Sensitivities of US (75%), US-FNA (72%), US + CT (80%), and US-FNA + CT (79%) were higher than sensitivity of CT alone (25%) (P lymph nodes, CT was positive with US and/or US-FNA being negative. However, in 36/65 (55%) patients, US and/or US-FNA were positive with CT being negative. US-FNA seems the preferred diagnostic modality for the detection of supraclavicular lymph node metastases in patients with esophageal or gastric cardia cancer. Sensitivity of metastases detection only slightly improves if US-FNA is combined with CT. A prospective, comparative study is however needed. (c) 2007 Wiley-Liss, Inc.

  2. Aneurisma de tronco de coronaria izquierda y síndrome antifosfolípido: sobrevida a 12 años. Informe de un caso y revisión de la literatura

    OpenAIRE

    Paz Soldán-Patiño,Claudia Patricia; Rojas-Velasco,Gustavo; Arias-Mendoza,María Alexandra; Enríquez-Gómez,Edmundo; Meave-González,Aloha; Álvarez-Sangabriel,Amada; Amigo,Mary Carmen; Vargas-Barrón,Jesús; Martínez-Sánchez,Carlos Rodolfo

    2012-01-01

    Los aneurismas coronarios son una patología poco frecuente, con una incidencia anual del 1% a 2%. Su origen puede ser atereosclerótico, congénito o deberse a otras causas menos habituales. Su manifestación inicial puede ser el infarto de miocardio y la muerte súbita, como consecuencia de su rotura o por la existencia de trombos intracoronarios. Los aneurismas coronarios de gran tamaño, no ateroscleróticos y localizados en el tronco común de la arteria coronaria izquierda son excepcionales. El...

  3. Attitudes, Ideological Associations and the Left–Right Divide in Latin America Actitudes, Asociaciones Ideológicas y la Dimensión de Izquierda-Derecha en América Latina

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    Nina Wiesehomeier

    2012-01-01

    Full Text Available Do Latin American citizens share a common conception of the ideological left–right distinction? And if so, is this conception linked to individuals’ ideological self-placement? Selecting questions from the 2006 Latinobarómetro survey based on a core definition of the left–right divide rooted in political theory and philosophy, this paper addresses these questions. We apply joint correspondence analysis to explore whether citizens who relate to the same ideological identification also share similar and coherent convictions and beliefs that reflect the ideological content of the left–right distinction. Our analysis indicates that theoretical conceptions about the roots of, and responsibility for, inequality in society, together with the translation of these beliefs into attitudes regarding the state versus market divide, distinguish those who self-identify with the left and those who self-identify with the right.¿Comparten los ciudadanos de América Latina una concepción común de la dimension ideológica izquierda-derecha? Y si es así, ¿estará esta concepción vinculada a la auto-identificación ideológica de los individuos? Este trabajo aborda estos planteamientos seleccionando preguntas del Latinobarómetro del año 2006, con base en una definición básica de la división izquierda-derecha que se arraiga en la teoría y filosofía política. Utilizamos el análisis de correspondencia conjunto para explorar si los ciudadanos que comparten la misma identificación ideológica también poseen convicciones y creencias similares y coherentes que reflejan el contenido ideológico de la dimensión izquierda-derecha. Nuestro análisis indica que las concepciones teóricas acerca de las raíces de, y de la responsabilidad para, la desigualdad en la sociedad, junto con la traducción de estas creencias en actitudes con respecto a la distinción estado-mercado, distinguen a aquellos que se identifican con la izquierda de los que se

  4. Estudio integral de la disfunción ventricular izquierda mediante tomografía computerizada. Comparación con la coronariografía invasiva y la cardio-resonancia

    OpenAIRE

    2013-01-01

    Introducción. Dada la alta prevalencia de enfermedad coronaria (EC) entre los pacientes con insuficiencia cardiaca (IC) y disfunción sistólica ventricular izquierda (DSVI), el estudio etiológico se basa en la exclusión de EC subyacente mediante coronariografía invasiva que aunque con un riesgo bajo de complicaciones éstas pueden ser serias. Por ello sería deseable una aproximación no invasiva especialmente en pacientes con baja probabilidad a priori de EC. Hipótesis. La tomografía compute...

  5. La izquierda fuera de quicio en el país del desquicio. Imagen, autorrepresentación, ideología y política del socialismo argentino

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    Héctor Fabián Ghiretti

    2015-06-01

    Full Text Available En un país como la Argentina, la identidad de las organizaciones de izquierda y su discurso adoptan modulaciones inesperadas, atípicas. Tales distorsiones no son únicas: puede decirse que siguen las líneas de configuración y de conflicto de la mayoría de los países de la región. Estudiamos aquí el caso del Partido Socialista, cuyas estrategias comunicativas son un valioso elemento para indagar en su ideología y su proyecto político.

  6. Compare of Saber incision and Supraclavicular incision treatment of clavicular fracture efficacy%Saber切口与锁骨上切口治疗锁骨骨折的临床疗效

    Institute of Scientific and Technical Information of China (English)

    于新忠; 杨恩广; 宋爽; 杨建军; 贾立军

    2011-01-01

    目的 比较Saber切口与锁骨上切口治疗锁骨骨折的临床疗效.方法 选取138例锁骨骨折患者,分为锁骨上切口者56例,Saber切口者82例,观察两组患者术中及术后情况.结果 两组患者的切口长度,手术时间,出血量,并发症比较,差异均有统计学意义(P<0.05),Saber切口组优于锁骨上切口组.结论 锁骨骨折患者术中使用Saber切口优于使用锁骨上切口.%Objective To compare Compare of Saber incision and Supraclavicular incision treatment of clavicular fracture efficacy.Methods 136 patients with Clavicle fracture.divided into Supraclavicular incision group(56cases)and Saber incision group(82cases).observed the condition of two groups’patients during and after operation.Results Saber incision group was higher than the supraclavicular incision group.Conclusion clavicular fracture patiens during operation ues Supraclavicular incision better than ues Saber incision.

  7. Nota biobibliográfica + poética + creaciones («Fosas españolas 2013—Estaremos comiendo tierra hasta que os desenterremos», «Sala de armas», «Una copa de letras para la oscuridad», «Buenos días censura», «Atrapando el azar» Y «Derecho a la educación» + cu

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    Julia Otxoa

    2014-03-01

    Full Text Available Nota biobibliográfica + poética + creaciones («Fosas españolas 2013—Estaremos comiendo tierra hasta que os desenterremos», «Sala de armas», «Una copa de letras para la oscuridad», «Buenos días censura», «Atrapando el azar» Y «Derecho a la educación» + cuestionario (Victoria Pineda

  8. Evidencias de actividad paleosísmica en la fosa de Loncopué y faja plegada y corrida del Agrio (depocentro del Huecú, provincia de Neuquén

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    Emilio A Rojas Vera

    2010-10-01

    Full Text Available Se hallaron depósitos lacustres cuaternarios dentro de los cuales se identificó un nivel que muestra signos de licuefacción, en el depocentro del Huecú, ubicado en el sector central de la fosa de Loncopué en sector noroeste de la provincia de Neuquén. Hacia el este sobre el ámbito de la faja plegada y corrida del Agrio depósitos con similares características fueron identificados en el río Pichaihue. Entre estas dos ocurrencias, sobre el sistema de fallas neotectónicas de Loncopué oriental, gravas fracturadas y diques clásticos fueron descriptos en depósitos lacustres cuaternarios. A partir de sus características morfológicas y el marco neotectónico en el cual se inscriben, estas estructuras son interpretadas como sismitas. Este es el primer registro paleosismológico en el área. No se descartan fuentes remotas para su ocurrencia a partir del desarrollo del último gran megaterremoto en este segmento correspondiente al registrado con epicentro en el Maule el 27 de febrero de 2010. La magnitud del mismo registrada en el retroarco permite una explicación posible para los rasgos de licuefacción descriptos, mientras que los depósitos de gravas intruidas y fracturadas solo pueden ser explicados por un evento sísmico de carácter local. En base a relaciones empíricas propuestas por otros autores se delimitaron áreas potenciales de los paleoterremotos, asumiendo fuentes locales y comunes. De esta manera se identifica al sistema de fallas oriental de Loncopué, como posible candidato a producir actividad sísmica en esta región, lo cual es compatible con estudios previos sobre la neotectónica del área y la ocurrencia de gravas fracturadas y diques clásticos.

  9. Claves metodológicas en el proceso de exhumación e identificación de los restos humanos de la fosa común de la Guerra Civil española de La Granja (Quintanilla de las Viñas, Burgos: aportes desde una perspectiva bio-arqueológica.

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    Montero Gutiérrez, Juan

    2011-01-01

    Full Text Available En este trabajo se presentan los resultados obtenidos en la exhumación de una fosa común de la Guerra Civil española localizada en Quintanilla de las Viñas (Burgos. En la misma se recuperaron los restos esqueléticos de un total de seis individuos, vecinos de Castrillo de la Reina, asesinados como resultado de la represión de las fuerzas sublevadas a comienzos de la Guerra Civil. En este sentido, se analiza el proceso de investigación a partir de los datos facilitados a través de los testimonios orales de los familiares de las víctimas y de la información recabada en diferentes archivos. Asimismo, se detalla el protocolo de actuación seguido en la exhumación e identificación de los restos óseos humanos recuperados en dicha fosa conforme a las técnicas y métodos de la Arqueología y la Antropología Forense.

  10. Vena cava superior izquierda persistente: Implicaciones en la cateterización venosa central Persistent left superior vena cava: Implications in central venous catheterisation

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    G. Lacuey

    2009-04-01

    Full Text Available La colocación de catéteres centrales por vía venosa subclavia y yugular se puede complicar con la canalización de una arteria o de una vía venosa aberrante. La anomalía más frecuente del desarrollo embriológico de la vena cava es la persistencia de la vena cava superior izquierda (VCSI. La implantación de catéteres en la VCSI se puede sospechar por el recorrido anómalo del mismo en la radiografía de tórax. La gasometría y la curva de presión del vaso permiten descartar una cateterización arterial. La confirmación diagnóstica se obtiene mediante angiografía, ecocardiografía, tomografía computerizada o cardio-resonancia. El médico que implanta habitualmente catéteres venosos centrales, debe estar familiarizado con la anatomía del sistema venoso, sus variantes y sus anomalías, ya que su presencia puede influir en el manejo del paciente.The placement of central catheters through the subclavian and jugular venous path can be complicated by the cannulation of an artery or an aberrant venous path. The most frequent anomaly of the embryological development of the caval vein is the persistence of the left superior vena cava (LSVC. The implantation of catheters in the LSVC can be suspected by its anomalous route in thorax radiography. Gasometry and the pressure curve of the vessel make it possible to rule out an arterial catheterisation. Diagnostic confirmation is obtained through angiography, echocardiography, computerised tomography or cardiac resonance. The doctor who regularly implants central venous catheters must be familiar with the anatomy of the venous system and its variants and anomalies, since their presence might influence the handling of the patient.

  11. Discordant lymphoma consisting of mediastinal large B-cell lymphoma and nodular sclerosis Hodgkin lymphoma in the right supraclavicular lymph nodes: a case report.

    Science.gov (United States)

    Zhang, Chun; Yi, Yuanxue; Chen, Chunyan; Wang, Jianrong; Liu, Zhu

    2015-12-29

    Discordant lymphoma is defined by the simultaneous presence of two or more distinct types of lymphomas at different anatomic sites. With fewer than 20 studies reporting cases of discordant lymphoma to date, the incidence of this condition is believed to be very low. Here, we report a case of discordant lymphoma in a 34-year-old female patient that involved mediastinal large B-cell lymphoma and nodular sclerosis Hodgkin lymphoma in the right supraclavicular lymph nodes. The patient presented with a mass in the mediastinum and enlargement of the right supraclavicular lymph nodes, but no obvious signs of lymphoma. Histological examination revealed that the encapsulated mediastinal mass contained medium- or large-size tumor cells with lightly stained cytoplasm and round vesicular nuclei as well as a high percentage of mitotic cells; strongly positive immunohistochemical staining for PAX5, CD20, and CD79a also was observed. Examination of biopsied right supraclavicular lymph node tissues revealed separation by collagen fibers, extensive inflammatory cell infiltration, and large-size tumor cells, such as Reed-Sternberg cells. These tissues stained strongly positive for PAX5 and CD30, weakly positive for CD15, and negative for Epstein-Barr viral RNA. We also found monoclonal gene rearrangement in the immunoglobulin heavy chain gene in the mediastinal large B-cell lymphoma, but no monoclonal gene rearrangement in the nodular sclerosis Hodgkin lymphoma. These findings suggested that these two lymphomas were not of a common clonal origin. The patient was treated by surgical excision of the mediastinal mass followed by radio-chemotherapy, and no metastasis or recurrence occurred during a follow-up period of 32 months. A review of previously reported cases indicated that the clinical manifestations and pathological features of discordant lymphoma are diverse due to variation in the types of lymphomas involved. Physicians must have an awareness of discordant lymphoma to avoid

  12. Single-isocenter hybrid IMRT plans versus two-isocenter conventional plans and impact of intrafraction motion for the treatment of breast cancer with supraclavicular lymph nodes involvement.

    Science.gov (United States)

    Amoush, Ahmad; Murray, Eric; Yu, Jennifer S; Xia, Ping

    2015-07-08

    The purpose of this study was to compare the single-isocenter, four-field hybrid IMRT with the two-isocenter techniques to treat the whole breast and supraclavicular fields and to investigate the intrafraction motions in both techniques in the superior direction. Fifteen breast cancer patients who underwent lumpectomy and adjuvant radiation to the whole breast and supraclavicular (SCV) fossa at our institution were selected for this study. Two planning techniques were compared for the treatment of the breast and SCV lymph nodes. The patients were divided into three subgroups according to the whole breast volume. For the two-isocenter technique, conventional wedged or field-within-a-field tangents (FIF) were used to match with the same anterior field for the SCV region. For the single-isocenter technique, four-field hybrid IMRT was used for the tangent fields matched with a half blocked anterior field for the SCV region. To simulate the intrafraction uncertainties in the longitudinal direction for both techniques, the treatment isocenters were shifted by 1 mm and 2 mm in the superior direction. The average breast clinical tumor volume (CTV) receiving 100% (V(100%)) of the prescription dose (50 Gy) was 99.3% ± 0.5% and 96.4% ± 1.2% for the for two-isocenter and single-isocenter plans (р 20 Gy (V(20Gy)) and the heart receiving > 30 Gy (V(30Gy)) were 13.6% vs. 14.3% (р = 0.03) and 1.25% vs. 1.2% (р = 0.62), respectively. Shifting the treatment isocenter by 1 mm and 2 mm superiorly showed that the average maximum dose to 1 cc of the breast volume was 55.5 ± 1.8 Gy and 58.6 ± 4.3 Gy in the two-isocentric technique vs. 56.4 ± 2.1 Gy and 59.1 ± 5.1 Gy in the single-isocentric technique (р = 0.46, 0.87), respectively. The single-isocenter technique using four-field hybrid IMRT approach resulted in comparable plan quality as the two-isocentric technique. The single-isocenter technique is more sensitive to intra-fraction motion in the superior direction compared to

  13. Effect of buprenorphine as an adjunct with plain local anesthetic solution in supraclavicular brachial plexus block on quality and duration of postoperative analgesia

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    Surekha Patil

    2015-01-01

    Full Text Available Background and Aims: Supraclavicular brachial plexus block is ideal for upper limb surgical procedures. Buprenorphine, an agonist antagonist opioid has been used as an adjunct to prolong analgesia. We aimed to evaluate the quality and duration of postoperative analgesia by addition of buprenorphine to local anesthetic solution. Material and Methods: A prospective, randomized, double-blind control study was conducted on 50 healthy patients of ASA Grade I/II of age group 20-70 years scheduled for orthopedic and reconstructive surgery of upper limb under supraclavicular brachial plexus block. Patients were allocated into two groups, 25 in each group viz.: Group B (buprenorphine group received 20 ml 0.5% bupivacaine + 15 ml 2% lignocaine with adrenaline (1:200,000 + 4 ml normal saline + 1500 units hyaluronidase + 3 μg/kg buprenorphine diluted to 1 ml normal saline. Group C (control group received 20 ml 0.5% bupivacaine + 15 ml 2% lignocaine with adrenaline (1:200,000 + 4 ml normal saline + 1500 units hyaluronidase + 1 ml normal saline. The parameters observed were onset and duration of sensory and motor block, quality and duration of analgesia and side-effects. Results: The mean duration of postoperative analgesia was significantly longer in Group B (16.04 ± 3.19 h than in Group C (6.20 ± 0.74 h. There was no difference between two groups on mean onset of sensory block. The mean duration motor block was significantly longer in Group B (4.93 ± 0.94 h than in Group C (2.25 ± 0.62 h [P < 0.05]. The mean duration of sensory block was also significantly longer in Group B (5.71 ± 0.94 h than in Group C (4.94 ± 0.70 h with P < 0.05. Conclusion: Addition of 3 μg/kg buprenorphine to 0.5% bupivacaine for supraclavicular brachial plexus block prolonged duration of postoperative analgesia and sensory blockade without an increase in side effects.

  14. Reconstruction of facial and cervical scar with the expanded supraclavicular island flaps%扩张的锁骨上皮瓣修复面颈部瘢痕

    Institute of Scientific and Technical Information of China (English)

    杨艳清; 任军; 庞星原; 白彦; 袁伟; 徐威

    2015-01-01

    目的 探讨扩张的锁骨上皮瓣修复面颈部瘢痕的治疗效果.方法 2010年10月至2013年11月,对16例面颈部瘢痕畸形患者,采用以颈横动脉锁骨上皮支为血管蒂的扩张锁骨上皮瓣修复.一期在前胸部埋置扩张器(400 ~600) ml,二期行瘢痕切除、松解及扩张皮瓣修复术,供瓣区直接拉拢缝合.结果 本组16例患者的皮瓣切取面积为12 cm×7 cm ~ 22 cm×11 cm,皮瓣均存活,仅1例患者出现血肿,经行血肿清除术后痊愈.术后经3 ~12个月的随访,皮瓣颜色和质地与受区周围正常皮肤一致,外观无臃肿、切口瘢痕增生不明显.结论 应用扩张的锁骨上皮瓣修复面颈部瘢痕,外形及功能恢复良好,是一种理想的修复方法.%Objective To observe the therapeutic effect of expanded supraclavicular island flaps for facial and cervical scar.Methods From Oct.2010 to Nov.2013,a series of 16 patients with facial and cervical scars were treated by the expanded supraclavicular island flaps,pedicled by the supraclavicular cutaneous branch of transverse cervical artery.In the first stage,the soft tissue expanders (ranging from 400 ml to 600 ml in volume) were implanted in the anterior thoracic region.In the second stage,the facial and cervical scars were removed and the contructures were released,the expanded flap was transferred to cover the defects.The wounds at the donor sites were closed directly.Results The flaps size ranged from 12 cm × 7 cm to 22 cm × 11 cm.All flaps survived with no flap necrosis.Hematoma occurred in one case and healed by debridement.16 patients were followed up for 3-12 months.The color and texture of all flaps matched well with the surrounding skin tissue,no bulky appearance or hypertrophic scar were noticed.Conclusions The expanded supraclavicular island flap is a good choice for repairing facial and cervical scar.The appearance and function can be improved.

  15. Prophylactic placement of a covered nitinol stent to prevent carotid blowout in a patient with supraclavicular lymph node metastasis from esophageal cancer.

    Science.gov (United States)

    Fujita, Takeshi; Ito, Katsuyoshi; Tanabe, Masahiro; Matsunaga, Naofumi

    2015-01-01

    Enlargement of primary tumor and metastatic lymph nodes in patients with head and neck cancer can be progressive and invade the surrounding vessels despite intensive treatment. Carotid blowout (CBS) tends to occur in these patients, and prompt treatment is required. Surgical management of carotid blowout is technically troublesome because exploration and repair of the previously irradiated or tumor-invaded field are difficult. Endovascular therapy with stent deployment is a good alternative to surgery. Even with such interventional procedures as stent grafting, it is sometimes difficult to obtain favorable outcomes in end-stage patients with poor general conditions. The prophylactic placement of a covered nitinol stent was performed to prevent carotid blowout in a patient with supraclavicular lymph node metastasis from esophageal cancer, and fatal bleeding due to carotid blowout was avoided. The usefulness of the prophylactic placement of a covered nitinol stent for preventing carotid blowout in an end-stage patient is presented.

  16. [Combination chemotherapy of S-1, docetaxel and CDDP produces a remarkable response in a patient with metastases of supraclavicular lymph nodes and gingival carcinoma of the mandible].

    Science.gov (United States)

    Ishii, Shoichiro; Ueda, Takashi; Higuchi, Masataka; Mima, Takashi; Yakushiji, Noboru

    2010-09-01

    We report a 53-year-old female patient with an unresectable metastasis to the supraclavicular lymph node from a primary gingival carcinoma of the mandible. The patient had a history of tongue carcinoma and had undergone a radical neck dissection for the treatment of gingival carcinoma. She underwent combined chemotherapy consisting of S-1 (80 mg on days 1-14, followed by a 7-day rest), docetaxel (35mg/m2 by intravenous infusion on days 1 and 8), and CDDP (10mg/m2 by intravenous infusion on days 1 and 8) every 3 weeks. After three courses of the above chemotherapy regimen, a computerized tomography examination revealed a complete response. The patient did not experience any severe side effects during the course of chemotherapy. Combined S-1, docetaxel, and CDDP chemotherapy can thus be effective for unresectable recurrences of oral cancer in lymph nodes.

  17. Supraclavicular Brachial Plexus Block For Upper Limb Orthopedic Surgery: A Randomized, Double Blinded Comparison Between 0.5%Ropivacaine And 0.5% Bupivacaine.

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    Dr.Jigisha Prahladrai Badheka

    2016-08-01

    Full Text Available Purpose: This prospective double blinded study designedwith the aim of comparing the onset, duration of sensory and motor block and analgesic effect of ropivacaine 0.5%with bupivacaine 0.5% when used in supraclavicular brachial plexus block in patients undergoing upper limb orthopedic surgeries. Materials and method: 60 patients of either sex, aged 20-66 yrs, scheduled for elective upper limb orthopedic surgeries under supraclavicular brachial plexus block, were randomly divided into two groups containing 30 patients in each. Group B received 0.5% 30ml bupivacaine and group R received 0.5% 30ml ropivacaine. Patients were observed for onset, duration of sensory and motor blockade, post-operative analgesia using visual analogue scale and complications if any. Results: In comparison to equal volume of 0.5% bupivacaine, 0.5% ropivacaine provides significant earlier onset of sensory block (9.5±2min& 7.46 ±2.54 min respectively and motor block (12.6±2.2min& 10.66±2.24 min respectively.There is statistically significant longer duration of motor block with bupivacaine (486.16±56.74as compared to ropivacaine (359±55.66 min. However duration of sensory blockade, duration of analgesia and haemodynamics were comparable in both groups. We observed convulsions in one patient in bupivacaine group which was successfully managed. No complications were encountered in ropivacaine group.Conclusion: Ropivacaine provides faster onset of sensory and motor block with less duration of motor block, equal postoperative analgesia and higher safety profile as compared to bupivacaine.

  18. COMPARISON OF BUTORPHANOL AND BUPRENORPHINE AS AN ADJUVANT TO LOCAL ANAESTHESIA IN SUPRACLAVICULAR BRACHIAL PLEXUS BLOCK FOR POST-OPERATIVE ANALGESIA

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    Vinod

    2014-04-01

    Full Text Available BACKGROUND: Supraclavicular brachial plexus block provides anesthesia for surgeries around elbow, forearm and hand. With advent of opioid receptors, variety of opioid agents is used for postoperative analgesia via brachial plexus block. Butorphanol and Buprenorphine can be used along with local anesthetics to provide post op analgesia. AIMS: 1 To study the onset and extent of sensory and motor blockade. 2 To compare the duration of postoperative analgesia in two groups. METHODOLOGY: A study was carried out in 30 patients aged 18-60yr of ASA grade I & II of either sex in each group undergoing orthopedic upper limb surgeries via supraclavicular brachial plexus block. Injection Butorphanol 1mg (Group-I and Buprenorphine150µg (Group-II were added to local anesthetic mixture. Onset of sensory and motor blockade, extent of blockade and occurrence of any complications were studied in both the groups. All patients were observed for analgesia hourly until patient demanded analgesia post-operatively by VAS pain score. RESULTS: In Group II (Buprenorphine onset of sensory, motor blockade and complete blockade was delayed as compared to Group I (Butorphanol. In Group I patients, VAS score was 39.44  16.66 at the end of 5 hours while in Group II patients 50.35  25.65 VAS score at the end of 8 hours. So the duration of analgesia was upto 5-6 hours in Group I, where it was upto 8-9 hours in Group II. CONCLUSION: Both drugs are potent analgesic in brachial plexus block, but Buprenorphine is more potent and produces longer duration of postoperative analgesia than Butorphanol.

  19. Effect of ketamine as an adjuvant in ultrasound-guided supraclavicular brachial plexus block: A double-blind randomized clinical trial study

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    Mohammadreza Lashgarinia

    2014-01-01

    Full Text Available Background: Supraclavicular brachial plexus block is one of the most effective anesthetic procedures in operations for the upper extremity. Ketamine has been reported to enhance the analgesic effects of local anesthetics. We have conducted this study to assess whether coadministration of ketamine can prolong the local analgesic effect of lidocaine in the supraclavicular brachial plexus block for patients undergoing elective upper extremity surgery. Materials and Methods: Sixty adult patients undergoing elective surgery of the elbow, forearm, wrist or hand were randomly allocated in two groups of 30 patients each. Group 1 (ketamine group received 5 mg/kg lidocaine 1.5% plus 2 mg/kg ketamine, Group 2 (control group received 5 mg/kg lidocaine 1.5% and saline. The outcome measures included severity of pain by using visual analog scale (VAS, 0 = no pain 10 cm = the most severe pain, time of first request for analgesia, and total dose of postoperative opioid administration. The data was analyzed using the χ2 test, student′s t-test, Kaplan-Meier survival analysis, and Multivariate analysis tests. Results: Patients in the control group had a higher VAS than patients who received ketamine, at all time points during the first 24 hours after surgery (all P < 0.05. The time of first request for analgesia in the ketamine group was significantly more than in the control group (8.93 ± 1.0 vs. 7.30 ± 1.9, respectively, P < 0.001. Conclusion: The addition of ketamine to lidocaine in the ultrasound-guided brachial plexus block could decrease the postoperative pain and need for analgesic. Therefore, it could be considered as an option in the brachial plexus block to enhance the analgesic action of lidocaine.

  20. The value of ultrasound-guided biopsy of fluorodeoxy-glucose positron emission tomography (FDG-PET)-positive supraclavicular lymph nodes in patients with suspected lung cancer.

    Science.gov (United States)

    Werner, Lennart; Keller, Franziska Aebersold; Bhure, Ujwal; Roos, Justus Egidius; Tornquist, Katharina; Del Sol Pèrez-Lago, Maria; Gautschi, Oliver; Strobel, Klaus

    2017-07-11

    Accurate lymph node staging is essential for adequate prognostication and therapy planning in patients with non-small cell lung cancer (NSCLC). FDG-PET/CT is a sensitive tool for the detection of metastases, including non-palpable supraclavicular lymph node (SCLN) metastases. Histological proof of metastatic spread and mutation analysis is crucial for optimal staging and therapy. The aim of this study was to investigate the value of ultrasound-guided fine needle aspiration cytology (FNAC) and core biopsy (CB) of FDG active, non-palpable SCLN's in patients with suspicion for lung cancer. Twelve consecutive patients with suspected lung cancer and FDG-positive SCLN underwent FNAC (n = 11) and/or CB (n = 10) and were included and evaluated retrospectively in this study. Cytologic and/or histologic evaluation was performed to confirm initially suspected diagnosis (lung cancer), to confirm N3 stage, and to screen for driver mutations in lung adenocarcinoma. FNAC alone showed diagnostic success in 11/11 cases (100%), CB alone in 9/10 patients (90%), and the combination of both procedures was successful in 12/12 cases (100%). Lymph node metastases from NSCLC (7 adenocarcinoma, 2 squamous cell carcinoma) could be confirmed in 9 patients. Other diagnoses were small cell lung cancer (SCLC), breast cancer and sarcoidosis. There was enough material for immunhistochemistry in all patients. For molecular testing, material from this lymph node biopsies and lung biopsy was used. In two patients with adenocarcinoma of the lung driver mutations were detected (EGFR Exon 19 deletion and ALK rearrangement) out of the lymph node metastasis. US-guided combined FNAC and CB of FDG positive supraclavicular lymph nodes in patients with suspected lung cancer is a safe and effective procedure to confirm N3-stage and to obtain representative material for molecular testing.

  1. Toward an evidence-based proposal for the best minimal immunohistochemical panel to infer lung carcinoma in metastatic supraclavicular lymph node.

    Science.gov (United States)

    Kumar, Rajiv; Jambhekar, Nirmala Ajit; Marchevsky, Alberto M; Pramesh, C S; Karimundackal, George; Agarwal, J P; Dikshit, Rajesh

    2014-04-01

    Carcinomas from either pulmonary or extrapulmonary sites can metastatise to supraclavicular lymph nodes. Immunohistochemistry (IHC) is invaluable to comment on the possible primary site. However, the optimal number of antibodies to be tested is debatable. Seven antibodies were tested on 135 metastatic supraclavicular lymph node biopsies to propose a "best minimal" IHC panel to infer lung carcinoma, incorporating the principles of "evidence-based medicine." The 135 cases were divided into the following: category I (110 cases), wherein the primary was in the lung based on histologic analysis (Ia, n = 14 [12.7%]), cytologic analysis (Ib, n = 43 [39.1%]), or strong clinicoradiologic evidence (Ic, n = 53 [48.2%]), and category II (25 cases) with a histologically proven extrapulmonary primary site. Categories Ia and Ib were together designated as the "control group," and category Ic was designated as the "test group." The antibodies tested were cytokeratin (CK 7, CK20), epithelial membrane antigen, carcinoembryonic antigen, thyroid transcription factor-1 (TTF-1), surfactant protein B (SPB), and vimentin. Results of both individual and panels of antibodies were statistically evaluated. The sensitivity and specificity of single antibodies for inferring a lung primary was as follows: CK7 (90%/56%), CK20 (98%/40%), epithelial membrane antigen (90.9%/4%), carcinoembryonic antigen (80.9%/36%), TTF-1 (62.7%/100%), SPB (65.6%/100%), and vimentin (60.9%/60%). The highest sensitivity (85%) and specificity (100%) were seen with a 4-antibody panel: CK7, CK20, TTF-1, and SPB. This panel revealed the highest binomial probability (.8), for diagnosing lung cancer. The results were validated using a "split sample method," and a high concordance was noted between the control and test groups. To conclude, such evidence-based validated studies analyzing IHC results would be invaluable to guide the practice of surgical pathology in the future. Copyright © 2014 Elsevier Inc. All rights

  2. El encuentro de la izquierda cubana con la Revolución Rusa: el Partido Comunista y la Comintern /The Encounter between the Cuban Left and the Russian Revolution: The Communist Party and the Comintern/O encontro da esquerda cubana com a Revolução Russa: o Partido Comunista e a Comintern

    National Research Council Canada - National Science Library

    Víctor Jeifets; Lazar Jeifets

    2017-01-01

    ..., Rusia (Thesaurus); Partido Comunista de Cuba, Comintern, izquierda (Autores). The Encounter between the Cuban Left and the Russian Revolution: The Communist Party and the Comintern Abstract: This article analyzes the background and evolution of the affiliation of the Cuban left with the Comintern (Communist International), from their first contacts ...

  3. Efecto de la elastancia arterial efectiva sobre la función sistólica ventricular izquierda en la estenosis aórtica grave

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    Ricardo A. Migliore

    2006-01-01

    Full Text Available AntecedentesLa disfunción ventricular izquierda en la estenosis aórtica (EAo está relacionada con el exceso de poscarga. El aumento de la poscarga puede deberse a la reducción del área valvular aórtica (AVA, a cambios en la geometría ventricular y a las características de la vasculatura arterial. La elastancia arterial efectiva (Ea es un índice de carga vascular que incorpora la impedancia característica, la resistencia y la distensibilidad arterial.ObjetivoEvaluar el efecto de la Ea sobre la función sistólica del ventrículo izquierdo en la EAo grave.Material y métodosSe estudiaron prospectivamente 54 pacientes con EAo grave evaluados mediante los gradientes transvalvulares, el AVA, la resistencia valvular y el índice de pérdida de energía. La Ea se calculó mediante el cociente entre la presión de fin de sístole y el volumen sistólico. La presión de fin de sístole se obtuvo a partir del pulso carotídeo calibrado con la presión arterial medida con esfigmomanómetro. Como medida de la poscarga global, se calculó la impedancia valvuloaórtica (Zva, definida por: (presión sistólica + gradiente medio neto / índice de volumen sistólico. La Zva tiene en cuenta el efecto de la EAo y la Ea. Los pacientes se dividieron en tres grupos: G1, EAo con insuficiencia cardíaca (NYHA III-IV (n = 13, G2, EAo sintomática pero sin insuficiencia cardíaca (n = 13 y G3, EAo asintomática (n = 28. ResultadosLa fracción de eyección (Fey (% fue menor en el G1 (33 ± 15 en comparación con el G2 (42 ± 16 y el G3 (65 ± 14; p < 0,01. La Ea (mm Hg/ml fue mayor en el G1 (2,46 ± 0,8 con respecto al G2 y el G3 (1,83 ± 0,52 y 1,73 ± 0,47; p < 0,01, al igual que la Zva (mm Hg/ml/ m2: G1 (6,5 ± 2,2, G2 y G3 (4,8 ± 1,0 y 4,7 ± 1,5; p < 0,01. En el análisis univariado, la Zva se correlacionó con la Ea (r = 0,88; p < 0,0001 y la Fey (r = -0,41; p < 0,01. En el análisis multivariado, la Ea y la Zva fueron predictores independientes de la

  4. DISFUNCIÓN VENTRICULAR IZQUIERDA EN PACIENTES CON INFECCIÓN POR VIRUS DE INMUNODEFICIENCIA HUMANA / Left ventricular dysfunction in patients with human immunodeficiency virus infection

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    Angélica M. Reyes Pérez

    2013-04-01

    Full Text Available Resumen: La infección por el virus de inmunodeficiencia humana es una de las principales causas de cardiopatía adquirida, especialmente de disfunción ventricular izquierda sintomática. Se realizó una revisión bibliográfica para profundizar en los diversos elementos clínicos, fisiopatológicos y diagnósticos que caracterizan a estos pacientes. La patogénesis de la disfunción del ventrículo izquierdo se relaciona con diversos agentes causales como: la infección miocárdica por el propio virus, las infecciones oportunistas o por otros virus, mecanismos autoinmunes, deficiencias nutricionales, sobreexpresión de citocinas y toxicidad inducida por fármacos. La disfunción sistólica sintomática es una manifestación tardía de afectación cardíaca mientras que una proporción importante de pacientes presentan alteraciones clínicamente silentes. La disfunción diastólica cursa con una alteración precoz de la relajación miocárdica y de la dinámica de llenado del ventrículo izquierdo. La ecocardiografía es útil para el diagnóstico. El tratamiento antirretroviral actual incrementa la supervivencia de pacientes con infección por el virus de inmunodeficiencia humana, lo cual presumiblemente producirá un aumento en la prevalencia de complicaciones cardíacas. Se requiere de nuevos estudios prospectivos observacionales que determinen la susceptibilidad de desarrollar enfermedad cardíaca sintomática en los pacientes infectados por este virus. / Abstract: Infection with the human immunodeficiency virus is a major cause of acquired heart disease, especially symptomatic left ventricular dysfunction. A literature review was conducted to deepen the understanding of the various clinical, pathophysiological and diagnostic aspects that characterize these patients. The pathogenesis of left ventricular dysfunction is related to various causative agents such as: myocardial infection by the virus itself, opportunistic infections or by other

  5. Resina fluida autoadhesiva utilizada como sellante de fosas y fisuras: Estudio de microinfiltración Self-adhesive flowable composite-resin as a fissure sealant: A microleakage study

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    D De Nordenflycht

    2013-04-01

    Full Text Available Objetivo: Evaluar la capacidad de sellado de una resina fluida autoadhesiva (Fusio Liquid Dentin, Pentron Clinical utilizada como sellante de fosas y fisuras con distintos acondicionamientos de la superficie de esmalte. Materiales y Métodos: Se seleccionaron 140 terceros molares recientemente extraídos, los que fueron distribuidos aleatoriamente en cuatro grupos (n=35 y recibieron una técnica de acondicionamiento del esmalte y aplicación de un sellante. Se establecieron los siguientes grupos: Grupo 1, grabado ácido y aplicación de sellante (Clinpro, 3M ESPE; Grupo 2, grabado ácido y aplicación de resina autoadhesiva (Fusio Liquid Dentin, Pentron Clinical; Grupo 3, aplicación de resina autoadhesiva; Grupo 4, microarenado del esmalte y aplicación de resina autoadhesiva. Los dientes sellados fueron termociclados (500 ciclos, 5-55°C, y posteriormente sumergidos en solución de nitrato de plata amoniacal por 24 h (pH=14 y luego en revelador radiográfico (GBX, Kodak por 8h. Posteriormente, los dientes fueron cortados para obtener 2 láminas por diente que fueron observadas bajo magnificación (4x y analizadas digitalmente para evaluar la microinfiltración y la penetración en la fisura. Los resultados fueron analizados estadísticamente (ANOVA, Dunnett, pAim: To evaluate the sealing ability of a self-adhesive flowable composite-resin (Fusio Liquid Dentin, Pentron Clinical with different conditioning treatments of the enamel surface used as a fissure sealant. Materials and Method: 140 recently extracted human third molars were selected and randomly divided into four groups (n=35. Each group received an enamel conditioning treatment and a sealant application. The following groups were established: Group 1, acid etching and sealant application (Clinpro, 3M ESPE; Group 2, acid etching and self-adhesive flowable composite-resin (Fusio Liquid Dentin, Pentron Clinical; Group 3, self-adhesive flowable composite-resin; Group 4, sandblasting and

  6. Gobiernos democráticos del Estado español frente la persistencia de la memoria y la historia de las fosas de la guerra civil española. La actuación de la Generalitat en Cataluña (2004-2015

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    Queralt Solé

    2016-01-01

    Full Text Available Desde el año 2002 en Cataluña ha existido la demanda social para la localización de personas desaparecidas durante la Guerra Civil, algunas de ellas aún hoy en día enterradas en fosas comunes que se han mantenido hasta la actualidad. La Generalidad de Cataluña, a diferencia de otros gobiernos autonómicos, ha llevado a cabo diversas exhumaciones y recogida de restos en superficie con diferentes resultados. El presente artículo, realizando un recorrido que va de historia a la arqueología, expone como se desarrollaron estas actuaciones y analiza cuales fueron los resultados de cada una de ellas.

  7. Asociación de la microalbuminuria con la disfunción ventricular izquierda en personas normotensas con diabetes mellitus tipo 1 Microalbuminuria and its association with left ventricular dysfunction in normotensive subjects presenting with type 1 diabetes mellitus

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    Manuel Emiliano Licea Puig

    2009-04-01

    Full Text Available ANTECEDENTES: la disfunción ventricular izquierda es una complicación frecuente en las personas con diabetes mellitus 1. OBJETIVO: determinar si la excreción urinaria de albúmina se asocia a la presencia de disfunción ventricular izquierda en personas normotensas con diabetes mellitus 1 de largo tiempo de evolución. MÉTODOS: se realizó un estudio transversal y descriptivo en 80 diabéticos normotensos tipo 1 con 10 años o más de evolución de la diabetes mellitus 1, atendidos consecutivamente en nuestro centro, en edades entre los 15 y los 40 años. Se excluyeron otras enfermedades o condiciones que provoquen por sí mismas disfunción ventricular izquierda y proteinuria. Se estudió: edad, sexo, índice de masa corporal, hábito de fumar, presión arterial, evolución de la diabetes mellitus 1, retinopatía diabética, nefropatía diabética incipiente, glucemia en ayunas y posprandial de 2 h, hemoglobina glucosilada (HbA1, excreción urinaria de albúmina de 24 h, creatinina, electrocardiograma y ecocardiograma modo M bidimensional con Doppler pulsado. RESULTADOS: se comprobó disfunción ventricular izquierda en el 26,3 % y alteraciones estructurales en el 16,2. La frecuencia de nefropatía diabética incipiente fue mayor (pBACKGROUNDS: left ventricular dysfunction is a frequent complication in persons presenting with type 1 diabetes mellitus. OBJECTIVE: to determine if albumin urinary excretion is associated with the presence of left ventricular dysfunction (LVD in normotensive persons presenting with type diabetes mellitus of a long evolution. METHODS: we made a descriptive and cross-sectional study in 80 normotensive type 1 diabetic patients aged between 15 and 40 with a ³10 years of type 1 diabetes mellitus evolution seen in a consecutive way in our service. Other diseases were excluded or those conditions provoking per se left ventricular dysfunction and proteinuria. Study includes: age, sex, body mass index (BMI, smoking

  8. Análisis ecocardiográfico de la geometría ventricular izquierda en ratas espontáneamente hipertensas Echocardiographic study of left ventricular geometry the in spontaneously hypertensive rats

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    Eduardo M. Escudero

    2009-06-01

    Full Text Available El presente trabajo fue diseñado para analizar ecocardiográficamente la geometría del ventrículo izquierdo en ratas espontáneamente hipertensas (SHR. Se estudiaron 114 ratas macho de 4 meses de edad, 73 SHR y 41 Wistar (W a las que se les registró la presión arterial, la frecuencia cardíaca y se les realizó un ecocardiograma. Con las mediciones de diámetros y espesores de la pared ventricular izquierda se calcularon el espesor parietal relativo (h/r, el índice de masa del ventrículo izquierdo (IMVI, el volumen minuto, y el acortamiento medio ventricular. La geometría ventricular izquierda normal fue definida analizando el grupo de ratas normotensas y fijando los límites de IMVI y h/r a partir de la media más 2 desvíos estándar. Los patrones de geometría anormal se definieron como: remodelado concéntrico (RC: IMVI 0.71; hipertrofia excéntrica (HE: IMVI>2.06 mg/g - h/r 2.06 mg/g - h/r > 0.71. La presión arterial sistólica y el volumen minuto se utilizaron para estimar la resistencia periférica total (RPT. Doce por ciento de SHR presentaron geometría ventricular izquierda normal; 18% RC; 33% HC y 37% HE. El RC mostró el volumen latido más pequeño y la RPT más alta de cualquier grupo. HE presentó presión arterial sistólica similar a la de los otros grupos de SHR, volumen latido más alto y la RPT más baja. Estos hallazgos en SHR exhibiendo diferentes patrones de geometría ventricular izquierda, similares a los referidos en humanos, intensifican las similitudes entre la hipertensión esencial humana y las SHR.The purpose of this study was to analyze by echocardiogram left ventricular (LV geometry in spontaneously hypertensive rats (SHR. Echocardiographic study, systolic blood pressure and heart rate were obtained in 114 male, 4-month old rats, 73 SHR and 41 Wistar (W. Left ventricular mass index (LVMI, relative wall thickness (RWT, stroke volume, and mid ventricular shortening were calculated with echocardiographic

  9. Klaus Meschkat y José María Rojas, compiladores. Liquidando el pasado. La izquierda colombiana en los archivos de la Unión Soviética

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    Mauricio Archila Neira

    2009-01-01

    Full Text Available El voluminoso libro que compilan Klaus Meschkat y José María Rojas cubre más de 170 documentos sobre las relaciones de la izquierda colombiana con la Internacional Comunista entre 1927 y 1933, seleccionados de los archivos de la ex Unión Soviética (y unos pocos del archivo del, por ese entonces, ministro Ignacio Rengifo. Las primeras 80 páginas corresponden a dos introducciones de los compiladores en las que presentan el contexto del texto y algunos rasgos del liderazgo revolucionario de esos años. Por tanto, el grueso del libro, casi 750 páginas, corresponde a los mencionados documentos organizados en once capítulos.

  10. EFFECT OF ADDITION OF DEXMEDETOMIDINE TO ROPIVACAINE HYDROCHLORIDE (0.75% IN BRACHIAL PLEXUS BLOCK THROUGH SUPRACLAVICULAR ROUTE IN UPPER LIMB SURGERIES: A CLINICAL COMPARATIVE STUDY

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    Neelesh

    2014-10-01

    Full Text Available Brachial plexus block is a popular and widely employed regional nerve block of upper extremity which avoids the unwanted effect of anesthetic drugs used during general anesthesia, there complication and the stress of laryngoscopy and tracheal intubation. Patients also have a post-operative period free from nausea, vomiting, cerebral depression and immediate post-operative pain. The brachial plexus via supraclavicular approach block provide safe, effective, low cost complete anesthesia or analgesia of the upper extremity and is carried out at the level of the distal trunks/divisions of the brachial plexus, where it is in its tightest formation thus allowing for rapid and completed anesthesia or analgesia of the upper limb. The present single Centre, prospective, randomized, double blind study was undertaken to compare the effects of Ropivacaine and Ropivacaine-Dexmedetomidine combination in brachial plexus block via supraclavicular route with respect to its onset, duration of action. A total of 60 patients of ASA grading I &II and age ranging 18-50 year of either sex underwent various elective upper limb surgeries were divided in two equal groups Group A (n=30: Received brachial plexus block with 30 ml Ropivacaine (0.75%. Group B (n=30: Received brachial plexus block with 29 ml Ropivacaine (0.75% + 1 ml Dexmedetomidine (50μg. After performing supraclavicular block the following observations were made: 1. Onset of sensory blockade. 2. Duration of sensory blockade. 3. Onset of motor blockade. 4. Duration of motor blockade. 5. Duration of analgesia. The onset and duration of sensory blockade was assessed by pin prick response on area of all four nerves of upper limbs. The onset and duration of motor blockade was assessed by Modified Bromage Scale. The onset and duration of analgesia was assessed by response to pin prick and time of first request of analgesic dose. The observations were as follow: - The average time of onset of sensory blockade was

  11. A COMPARATIVE CLINICAL STUDY TO EVALUATE THE EFFICACY OF LEVOBUPIVACAINE WITH CLONIDINE AND LEVOBUPIVACAINE WITH DEXMEDETOMIDINE IN SUPRACLAVICULAR BRACHIAL PLEXUS BLOCK

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    Neelima

    2016-03-01

    Full Text Available OBJECTIVE The objective of this study is to compare clonidine and dexmedetomidine as an adjuvant to levobupivacaine in supraclavicular brachial plexus block with respect to onset, duration of sensory and motor block and duration of analgesia. MATERIALS AND METHODS A total of 90 ASA grade I and II patients of either sex, aged 18-60 yrs. scheduled for elective upper limb surgeries under supraclavicular brachial plexus block were divided into 3 equal groups in a randomized fashion. Group L (n=30 received 1 mL NS, group LC (=30 received 1 mL (150 g clonidine and group LD (n=30 received 1 mL (100 g dexmedetomidine added to 30 mL of 0.5% levobupivacaine. Onset and recovery time of sensory and motor block, duration of analgesia and quality of block were studied in all three groups. RESULTS Onset time of sensory and motor blockade was 12.43±2.56 min and 17.96±3.05 min respectively in group L, 9.03±1.60 min and 15.00±2.40 min respectively in group LC and 8.13±2.51 min and 12.13±2.89 min respectively in group LD. Duration of sensory and motor blockade was 660.16±44.28 min and 535.33±50.66 min respectively in group L, 880.16±55.48 min and 771.83±54.19 min respectively in group LC and 930.66±48.02 min and 811.83±52.08 min respectively in group LD. Time of rescue analgesia was 728.86±45.12 min in group L, 1013.5±59.01 min in group LC and 1159.8±56.8 min in group LD (pLC>C.

  12. THE EFFICACY OF CLONIDINE ADDED TO BUPIVACAINE AS COMPARED WITH BUPIVACAINE ALONE USED IN SUPRACLAVICULAR BRACHIAL PLEXUS BLOCK FOR UPPER LIMB SURGERIES

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    Suchismita

    2014-09-01

    Full Text Available : INTRODUCTION: Clonidine when added to local anesthetic solutions improved peripheral nerve blocks by reducing the onset time, improving the efficacy of the block during surgery and extending postoperative analgesia. MATERIALS AND METHODS: Sixty patients aged 18 to 60 years, scheduled for elective orthopedic operations in the upper limb, of ASA Grade I or II were included in the study. We conducted the study with 2 groups consisting of 30 patients each to compare the effects of Clonidine added to Bupivacaine with Bupivacaine alone in supraclavicular brachial plexus block. First group received 40 ml of Bupivacaine 0.25% plus 0.15mg (1ml of Clonidine, second group had 40 ml of Bupivacaine 0.25% plus 1 ml 0.9% Saline respectively. The onset as well as duration of sensory and motor block along with monitoring of heart rate, NIBP, oxygen saturation were recorded. The level of sedation and side effects were also noted. RESULTS: In this study the addition of Clonidine to Bupivacaine resulted in faster onset (study group 15.2±1.44, control group 20.4±1.12, p˂0.001 and longer duration of sensory block (study group 544±31.2, control group 302±34.4, p=0.0363 as well as analgesia (study group 561.2±30.96, control group 324.4±34.08, p=0.0001 without any adverse hemodynamic changes.

  13. Efficacy of Tramadol or Dexamethasone as an Adjuvant to Levobupivacaine in Ultrasound-guided Supraclavicular Plexus Block for Upper Limb Surgery: A Randomized Double-blinded Controlled Study.

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    Raj, S Aravind; Singh, Dewan Roshan; Charles, S Antony John; Krishnaveni, N

    2017-01-01

    To evaluate the efficacy of tramadol or dexamethasone as an adjuvant to levobupivacaine in ultrasound-guided supraclavicular brachial plexus block in terms of onset time of complete sensory and motor blockade, duration of motor blockade, duration of analgesia, and any complication. This was a randomized controlled trial conducted in the Department of Anesthesiology, a tertiary care hospital. Sixty consecutive patients of the American Society of Anesthesiologists physical status Class I and II who were posted for upper limb surgeries were recruited. Patients were divided into two groups of thirty patients each. Group T (tramadol) received 20 ml of 0.5% levobupivacaine with 100 mg tramadol, and Group D (dexamethasone) received 20 ml of 0.5% levobupivacaine with 8 mg dexamethasone under ultrasound guidance. Sensory and motor block assessment was done every 2 min until the development of complete sensory and motor block till 45 min. Verbal numerical rating scale score was assessed in postoperative ward at regular intervals. Patients were followed up to check for any residual neurological deficits. There was no statistical difference in demographic data between the two groups. The onset time of sensory and motor blockade shows no significant difference between groups. The mean time duration of motor blockade in Group T was 764.63 min and for Group D was 1150.27 min which was statistically significant (P tramadol and provides excellent postoperative pain-free period without any neurological deficits.

  14. Reliable EGFR mutation testing in ultrasound-guided supraclavicular lymph node fine-needle aspirates: a cohort study with diagnostic performance analysis.

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    Awwad, Amir; Tiwari, Sandeep; Sovani, Vishakha; Baldwin, David R; Kumaran, Maruti

    2015-01-01

    15-30% of patients with lung cancer will have supraclavicular and cervical lymphadenopathy (SCLN). Ultrasound (US)-guided fine-needle aspiration (FNA) cytology is regarded as an effective diagnostic tool in small size lymph nodes (LNs) and impalpable positron emission tomography detected nodes. We evaluated our diagnostic service performance in relation to the adequacy of samples for epidermal growth factor receptor (EGFR) mutation. Retrospective data analysis from electronic records, searching for all suspected lung cancer referrals that underwent US of the neck±FNA, over a continuous period of 4 years. Of 306 cases with suspected lung cancer referred to our department for US FNA of SCLN, 228 patients underwent the procedure. Of the remaining 78 patients, LNs were not detected in 52 cases and appeared benign in 26. Cytological diagnosis was established in 171 patients (75%) for treatment decisions without further investigations. The remaining 57 patients had further investigations; 45 reconfirmed the US-guided FNA diagnosis. The average LN size was 12.9 mm, and positive cytology was obtained in LNs ranging from 3 to 45 mm. Of 57 adenocarcinoma cases, 34 were tested for EGFR confirming 4 positive, 25 negative and 5 insufficient samples. No complications were recorded. US-guided FNA of SCLN remains an important diagnostic tool in lung cancer. Adequate tissue can be obtained for reliable diagnosis from LNs and for EGFR mutational analysis, without the need for more invasive and expensive investigations in more than 80% of cases.

  15. Quality assurance in the EORTC randomized trial 22922/10925 investigating the role of irradiation of the internal mammary and medial supraclavicular lymph node chain works

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    Poortmans, P.; Venselaar, J.L.M. [Dept. of Radiotherapy, Dr. Bernard Verbeeten Inst., Tilburg (Netherlands); Kouloulias, V. [Dept. of Radiotherapy, Univ. Hospital, U.H. Attikon, Xaidari (Greece); Tienhoven, G. van [Dept. of Radiotherapy, Academic Medical Center, Amsterdam (Netherlands); Collette, L. [EORTC, Data Center, Radiotherapy and Breast Group, Brussels (Belgium); Struikmans, H. [Dept. of Radiotherapy, Leiden Univ. Medical Center, Leiden (Netherlands); Bogaert, W. van den [Dept. of Radiotherapy, Univ. Hospital Gasthuisberg, Leuven (Belgium); Davis, J.B. [Radiation Oncology, Univ. Hospital, Zurich (Switzerland); Lambin, P. [Dept. of Radiotherapy, Maastro Clinic-GROW, U.H. Maastricht (Netherlands)

    2006-10-15

    Background and purpose: a quality assurance (QA) program in conjunction with the EORTC trial investigating the role of adjuvant internal mammary and medial supraclavicular irradiation in stage I-III breast cancer is presented. The results of a dummy run procedure and of an individual case review are compared to each other. The effects of recommendations based on QA procedures on the protocol compliance are evaluated. Material and Methods: prior to protocol activation all participating institutes were asked to produce treatment plans according to the guidelines of the protocol based on manual outlines of an average patient. Thereafter, they were asked to provide data on each of their first six randomized patients. Results: the dummy run provided a lot of information on specific treatment techniques. In the individual case review, additional patient- and tumor-related data were collected, showing the use of anatomic information for treatment planning. A comparison between both procedures revealed that the individual case reports concurred more accurately with protocol guidelines than the dummy run. Conclusion: it was observed that the number of systematic protocol deviations was substantially decreased in trial patients compared to the dummy run case. Therefore, it is concluded that this extensive QA program had a positive effect on the consistency of all institutes participating in the trial. (orig.)

  16. The use of supraclavicular free flap with vascularized lymph node transfer for treatment of lymphedema: A prospective study of 100 consecutive cases.

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    Mardonado, Andres A; Chen, Ru; Chang, David W

    2017-01-01

    Vascularized lymph node transfer (VLNT) is gaining popularity for treatment of lymphedema. The purpose of this study was to evaluate the flap and the donor site morbidity of the supraclavicular (SC) VLNT. A review of a prospective database was performed for patients who had undergone SC VLNT to treat upper or lower extremity lymphedema. Flap and donor site complications were registered for each patient. A detailed technical surgical approach is explained. One hundred consecutive patients with lower or upper extremity lymphedema underwent SC VLNT (84% from the right side) with a mean of 11-months follow-up (range 3-19 months). There were no flap loss but three flaps (3%) required re-exploration due to venous congestion of the skin paddle. Two patients had local infection and three patients developed chyle leak (3%) at the donor site but resolved spontaneously. No donor site secondary lymphedema was noted. This is the largest prospective series of SC free flap VLNT for treatment of lymphedema. Low flap and donor site morbidity makes this flap an appealing source of lymph node transfer for lymphedema treatment. J. Surg. Oncol. 2017;115:68-71. © 2016 Wiley Periodicals, Inc. © 2016 Wiley Periodicals, Inc.

  17. Semi-radical chemoradiotherapy for 53 esophageal squamous cell carcinomas with supraclavicular lymph node metastasis in a single institutional retrospective study.

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    Yamashita, Mami; Takenaka, Hideomi Yamashita Ryousuke; Nakagawa, Keiichi

    2014-10-01

    Outcomes were examined for the cases that received radiotherapy (RT) for esophageal cancer with metastasis to supraclavicular lymph nodes (ScLN) in a single institutional retrospective study. Cases examined were 53 consecutive patients with pathologically confirmed esophageal cancer enrolled from our institution who received semi-radical RT from 2001 to 2013. Radiotherapy consisted of a total dose of from 50-50.4 Gy given in 25-28 fractions of 1.8-2.0 Gy with five fractions per week. The chemotherapy regimen included nedaplatin and 5-fluorouracil. All had ScLN metastasis, and all diseases were included in the RT field. The median follow up time was 42 months for survival patients. Overall survival (OS) and progression free survival (PFS) for 1-, 2-, and 3 years were 39%, 19%, and 12% and 14%, 9%, and 6%, respectively. Acute grade 3-5 esophagitis and neutropenia was seen in 11% and 81%, respectively. Late grade 3-5 toxicity in esophagus, lung, and heart was seen in 4%, 0%, and 0%. Five patients (9%) survived more than 4 year. Although the 2-year PFS was less than 10% and very poor, long term survival for over 4 year was seen in 9% cases. In other words, despite the poor results, the fact remains that some patients were cured with CRT.

  18. La orejuela izquierda como fuente de accidentes cerebrovasculares: cerrar (y cómo, o no cerrar (y por qué Left atrial appendage as a source of stroke: to close (and how, or not to close (and why

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    R. Hernández-Estefanía

    2012-04-01

    Full Text Available La orejuela izquierda se considera la principal fuente de émbolos en los accidentes cerebrovasculares que se producen en pacientes con fibrilación auricular. El tratamiento con anticoagulantes orales reduce significativamente el riesgo de accidentes embólicos cerebrales en relación con la aspirina, pero se asocia a riesgo de complicaciones hemorrágicas, por lo que no siempre son utilizados. Se ha descrito que el cierre de la orejuela izquierda reduce la tasa de accidentes tromboembólicos y en la actualidad se recomienda en pacientes en fibrilación auricular sometidos a cirugía mitral, pero la formación de émbolos en estos pacientes puede deberse a otras causas, y la implicación de la orejuela podría ser menor de la que se presupone. Además, no todos los pacientes son candidatos para la anticoagulación oral, y no todos se mantienen en un rango terapéutico adecuado, lo que podría justificar la formación de trombos auriculares. Existen diversos métodos para el cierre de la orejuela: sutura directa, exclusión epicárdica mediante grapadora o clip, u oclusión mediante los recientes dispositivos endovasculares de aplicación percutánea. Pero, según la bibliografía, la efectividad de estos métodos para ocluir completamente la orejuela, así como su seguridad y eficacia para la prevención de accidentes embólicos cerebrales, pueden presentar resultados dispares. Para aumentar la controversia, algunos métodos de cierre con sutura no revelan un claro beneficio e, incluso, en algunos se describe un aumento del riesgo de tromboembolismo. Se presenta una revisión sobre la necesidad de cierre de la orejuela izquierda para la prevención de accidentes vasculares cerebrales, así como los diversos procedimientos descritos.Left atrial appendage is considered the main source of emboli in stroke for patients with atrial fibrillation. Oral anticoagulant therapy significantly reduces the risk of cerebral embolic events as compared with

  19. La influencia de la iconografía soviética en el imaginario colectivo de la izquierda española de los años 30

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    Inmaculada Colomina Limonero

    2009-01-01

    Full Text Available En la presente exposición vamos a conocer no solamente cual fue la imagen de la Unión Soviética en la España de la década de 1930, sino que también prestaremos especial atención al «otro lado» pues conoceremos la imagen que proyectaba España en la Unión Soviética durante la misma época. Combinando la investigación histórica y diversos materiales de archivo extraídos de la antigua Unión Soviética, se analiza el impacto causado sobre algunos sectores de la izquierda española de películas soviéticas que gozaron de éxito en esos años.This article not only analyses the image of the Soviet Union held in Spain during the 1930s, but also pays special attention to the image held of Spain at the «other side», that is, the Soviet Union, during the same period. Combining historical research based on the examination of a diversity of materials from files extracted from different sources, including the archives of the former Soviet Union, the article analyses the impact and popularity of soviet films amongst some sectors of the Spanish left.

  20. Tronco de coronária esquerda ocluso secundário a Lues terciária Tronco de coronaria izquierda ocluido secundario a Lúes terciaria Occlusion of the left coronary trunk secondary to tertiary syphilis

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    Ricardo Wang

    2009-09-01

    Full Text Available Paciente de 27 anos, portador de sífilis terciária, manifestando isquemia miocárdica, com angina instável, secundária à oclusão do tronco da coronária esquerda. O diagnóstico foi confirmado pelos achados da sorologia e da patologia do fragmento da aorta.Paciente de 27 años, portador de sífilis terciaria, manifestando isquemia miocárdica, con angina inestable, secundaria a la oclusión del tronco de la coronaria izquierda. El diagnóstico fue confirmado por los resultados de la serología y de la patología del fragmento de la aorta.A 27-year-old patient with tertiary syphilis, manifested as myocardial ischemia, presenting unstable angina, secondary to left coronary trunk occlusion. The diagnosis was confirmed by the serological findings and the pathological assessment of the aorta fragment.

  1. La recepción de la huelga de Asturias en la prensa de izquierdas de Nueva York: nuevos datos sobre María Teresa León y Rafael Alberti en 1935

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    Pulido Mendoza, Manuel

    2010-06-01

    Full Text Available Although the Alberti-León couple’s long voyage in the year of 1935 is well known, still are some questions to answer about the labour developed by both writers during the month they visited United States, just before they continued their trip towards Central America and the Caribbean. In the present article I show a sorted list of facts under the light of new documental discoveries and within the context of the reception of the events of the Asturias’ revolutionary strike in the New York leftist newspapers and press.Aunque se conoce bien el periplo norteamericano de los Alberti-León durante el año 1935, aún quedan algunos interrogantes por contestar acerca de la labor desarrollada por ambos escritores durante el mes que visitaron los Estados Unidos, antes de continuar su viaje por América Central y el Caribe. En el presente artículo presento una relación ordenada de los hechos de este episodio a la luz de nuevos hallazgos documentales y dentro del contexto de la recepción de los sucesos de la huelga revolucionaria de Asturias en la prensa de izquierdas neoyorquina.

  2. Tratamiento de la compresión del tronco de la arteria coronaria izquierda en pacientes con hipertensión pulmonar Treatment of compression of the left main coronary artery in patients with pulmonary hypertension

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    María L. Talavera

    2011-10-01

    Full Text Available La angina de pecho es un síntoma frecuente en pacientes con hipertensión pulmonar (HP de cualquier etiología. Aunque su fisiopatología no está aclarada, las causas propuestas son: la isquemia subendocárdica por aumento del estrés parietal del ventrículo derecho, la dilatación de la arteria pulmonar por incrementos transitorios de la presión pulmonar y la compresión extrínseca del tronco de la arteria coronaria izquierda (TCI por la arteria pulmonar (AP dilatada. Se presentan tres casos que muestran la relación entre la angina de pecho y la compresión del TCI en pacientes con HP asociada a cardiopatías congénitas, tratados mediante implante de stent coronario.Chest pain is a frequent symptom in patients with pulmonary hypertension of any etiology. Its pathophysiology has not been clearly established, the proposed causes are ischemia due to increased right ventricle wall stress, transient increased pulmonary hypertension resulting in acute pulmonary artery dilatation and external compression of the left main coronary artery (LMCA by a dilated pulmonary artery. We report and discuss here three cases where the association between chest pain and compression of the LMCA by a dilated pulmonary artery could be shown, and they were treated with coronary stenting.

  3. Abordagem supraclavicular da artéria subclávia direita para estabelecimento de circulação extracorpórea nas doenças da aorta

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    FABRI Hélio Antônio

    2002-01-01

    Full Text Available OBJETIVO: Estabelecer a circulação extracorpórea através de canulação da artéria subclávia direita por meio de incisão supraclavicular. MÉTODO: Foram estudados, no período de outubro de 2001 a março de 2002, quatro pacientes com diagnóstico de dissecção aguda de aorta tipo A de Stanford, sendo realizada em todos os casos canulação da artéria subclávia direita por via supraclavicular e realização de perfusão cerebral anterógrada durante o período de parada circulatória total. RESULTADOS: A artéria subclávia direita foi canulada diretamente e não houve nenhuma complicação neurovascular relacionada ao procedimento. A circulação extracorpórea foi mantida com fluxo adequado durante toda a operação. Houve 1 óbito hospitalar, não relacionado ao procedimento. DISCUSSÃO: Um dos passos mais importantes na melhora dos resultados operatórios é a perfusão sistêmica anterógrada, realizada através do sistema arterial e a subclávia para isso permite a perfusão da luz verdadeira. A abordagem supraclavicular nos proporciona um campo operatório adequado e facilidade para a realização da perfusão cerebral anterógrada que também é importante neste arsenal para uma redução da mortalidade operatória. CONCLUSÃO: A incisão supraclavicular nos proporciona um acesso factível com boa exposição da artéria subclávia direita em uma região em que ela apresenta um bom calibre e com poucas estruturas adjacentes que poderiam ser lesadas. Além disso, possibilita a canulação de forma direta e com boa posição da cânula arterial.

  4. 197. Trombosis masiva biauricular intervenida mediante cirugía cardíaca con circulación extracorpórea

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    R. Sánchez Pérez

    2012-04-01

    Conclusión: Destacamos la importancia del diagnóstico precoz y preciso de la trombosis biauricular con embolismo paradójico en aurícula izquierda a través de fosa oval, en el contexto de trombosis venosa profunda, debido a que puede beneficiarse de la cirugía cardíaca como tratamiento inicial.

  5. DEXMEDETOMIDINE IN EMERGENCY HAND SURGERY AS AN ADJUVANT TO ROPIVACAINE-INDUCED SUPRACLAVICULAR BRACHIAL PLEXUS BLOCK: A PROSPECTIVE, DOUBLE-BLINDED AND RANDOMIZED CONTROLLED STUDY

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    Sudipta Kumar

    2015-12-01

    Full Text Available BACKGROUND Accidental industrial hand injury very often requires early intervention. Assuming as full stomach condition, regional anaesthesia is preferred to avoid the risk of aspiration in general anaesthesia. Different additives have been used to prolong the duration of brachial plexus block. We evaluated the effect of adding dexmedetomidine to ropivacaine for supraclavicular brachial plexus blockade. The primary endpoints were the onset and duration of sensory and motor block and duration of analgesia. MATERIALS AND METHODS Seventy six patients aged 20-50 years with ASA grade I, II who were presented with industrial hand injury and required emergency operative interventions were randomly allocated into two groups. Group-RD (n=38 received ropivacaine (30ml 0.5% with dexmedetomidine 1ml (100µg and patients in group-RP (n=38 received ropivacaine (30ml 0.5% with 0.9% normal saline 1ml solution as placebo. Sensory and motor block onset times and durations, time to first analgesic use, total analgesic need, postoperative VAS, hemodynamics and side effects were recorded for each patient. RESULTS Though having comparable demographic profile, the onset of motor and sensory block was significantly fastened by dexmedetomidine (p<0.05. Sensory and motor block duration and time to first analgesic use were significantly prolonged and the total need for rescue analgesics was lower in group RD (P<0.05 than group RD. Postoperative VAS value at 12 hours were significantly lower in group RD (P<0.05. Side effects and hemodynamics were quite comparable among two groups. CONCLUSION It can be concluded that adding dexmedetomidine to brachial plexus block increases the sensory and motor block duration and time to first analgesic use and decreases block onset time and total analgesic use with no side effects

  6. The prognostic impact of supraclavicular lymph node in N3-IIIB stage non-small cell lung cancer patients treated with definitive concurrent chemo-radiotherapy.

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    Oh, Dongryul; Ahn, Yong Chan; Park, Hee Chul; Lim, Do Hoon; Noh, Jae Myoung; Cho, Won Kyung; Pyo, Hongryull

    2017-05-30

    This study aimed to investigate the prognostic impact of supraclavicular lymph node (SCN) metastasis in patients who were treated with definitive chemoradiotherapy for N3-IIIB stage non-small cell lung cancer (NSCLC). The 2- and 5-year overall survival (OS) rates were 57.3% and 35.7% in patients without SCN metastasis and 56.4% and 26.7% in patients with SCN metastasis, respectively. The median OS was 34 months in both groups. There was no significant difference in OS between the two groups (p = 0.679). The 2- and 5-year progression-free survival (PFS) rates were 24.1% and 12.6% in patients without SCN metastasis and 18.0% and 16.0% in patients with SCN metastasis, respectively. Patients without SCN metastasis had slightly longer median PFS (10 months vs. 8 months), but the difference was not statistically significant (p = 0.223). In multivariate analysis, SCN metastasis was not a significant factor for OS (p = 0.391) and PFS (p = 0.149). This retrospective analysis included 204 consecutive patients who were treated with chemoradiotherapy for N3-IIIB stage NSCLC between May 2003 and December 2012. A median RT dose of 66 Gy was administered over 6.5 weeks. Of these, 119 patients (58.3%) had SCN metastasis and 85 (41.7%) had another type of N3 disease: mediastinal N3 nodes in 84 patients (98.8%) and contralateral hilar node in one (1.2%). The patients were divided into two groups according to SCN metastasis. SCN metastasis does not compromise treatment outcomes compared to other mediastinal metastasis in the setting of definitive chemoradiotherapy.

  7. Supraclavicular lymph node incisional biopsies have no influence on the prognosis of advanced non-small cell lung cancer patients: a retrospective study.

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    Dong, Song; Zhao, Ning; Deng, Wei; Sun, Hui-Wen; Niu, Fei-Yu; Yang, Jin-Ji; Zhong, Wen-Zhao; Li, Feng; Yan, Hong-Hong; Xu, Chong-Rui; Zhang, Qiu-Yi; Yang, Xue-Ning; Liao, Ri-Qiang; Nie, Qiang; Wu, Yi-Long

    2017-01-09

    Supraclavicular lymph node (SCLN) biopsies play an important role in diagnosing and staging lung cancer. However, not all patients with SCLN metastasis can have a complete resection. It is still unknown whether SCLN incisional biopsies affect the prognosis of non-small cell lung cancer (NSCLC) patients. Patients who were histologically confirmed to have NSCLC with SCLN metastasis were enrolled in the study from January 2007 to December 2012 at Guangdong Lung Cancer Institute. The primary endpoint was OS, and the secondary endpoints were complications and local recurrence/progression. Two hundred two consecutive patients who had histologically confirmed NSCLC with SCLN metastasis were identified, 163 with excisional and 39 with incisional biopsies. The median OS was not significantly different between the excisional (10.9 months, 95% CI 8.7-13.2) and incisional biopsy groups (10.1 months, 95% CI 6.3-13.9), P = 0.569. Multivariable analysis showed that an Eastern Cooperative Oncology Group (ECOG) performance status (PS) ≥2 (HR = 2.75, 95% CI 1.71-4.38, P < 0.001) indicated a worse prognosis. Having an epidermal growth factor receptor (EGFR) mutation (HR = 0.58, 95% CI 0.40-0.84, P = 0.004) and receiving systemic treatment (HR = 0.36, 95% CI 0.25-0.53, P < 0.001) were associated with a favorable OS. Neither the number (multiple vs. single) nor site (bilateral vs. unilateral) of SCLNs was associated with an unfavorable OS, and SCLN size or fixed SCLNs did not affect OS. SCLN incisional biopsies did not negatively influence the prognosis of NSCLC patients. It was safe and feasible to partly remove a metastatic SCLN as a last resort in advanced NSCLC.

  8. Ultrasonography-Guided Core Biopsy of Supraclavicular Lymph Nodes for Diagnosis of Metastasis and Identification of Epidermal Growth Factor Receptor (EGFR) Mutation in Advanced Lung Cancer.

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    Choe, Jooae; Kim, Mi Young; Baek, Jung Hwan; Choi, Chang-Min; Kim, Hwa Jung

    2015-07-01

    The aim of this study was to evaluate the diagnostic performance of ultrasonography (US)-guided core biopsy of a supraclavicular lymph node (SCN) for detecting metastasis and epidermal growth factor receptor (EGFR) mutations. We included 229 patients who underwent US-guided core biopsy of SCN with lung cancer from January 2011 to December 2013. We evaluated the morphologic characteristics and measured the sizes of SCNs on US and chest computed tomography (CT). The clinical stage, maximum standardized uptake value (SUV max) on 18F-fluorodeoxyglucose positron emission tomography, and the morphology on US and CT in the positive metastasis were compared with those in the negative metastasis. The prevalence of EGFR mutations of the adenocarcinoma and procedure-related complication was investigated. The accuracy of US-guided core biopsy of SCN diagnosing metastasis was 97.8% (224/229). The cutoff values (sensitivity; specificity; area under the receiver operating characteristic curve, 95% confidence interval [CI]) of the short-axis dimension of SCN on CT were 0.85 cm (72.3%; 80.6%; 0.808, 95% CI: 0.740-0.875), on US 0.75 cm (73.5%; 84.8%; 0.843, 95% CI: 0.788-0.897), and that of SUV max 4.05 (79.1%; 81.8%; 0.853, 95% CI: 0.780-0.925). The mutations were positive in 35.8% with adenocarcinoma. There were no procedure-related complications of US-guided SCN core biopsy. US-guided SCN core biopsy is a reliable and safe method for detecting metastasis, histologic subtyping, and identifying the EGFR mutation in the advanced lung cancers. It may be a substitute for more invasive lung biopsy as an initial tissue confirmation in the advanced disease.

  9. Utilidad de la tomografía computada en pacientes con dolor en fosa iliaca derecha: Apendicitis aguda y su diagnóstico diferencial Usefulness of computed tomography in patients with right inferior abdominal quadrant pain: acute appendicitis and its alternative diagnosis

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    Sebastián Atilio Rossini

    2009-03-01

    Full Text Available Propósito: Repasar los hallazgos de tomografía computada (TC de la apendicitis aguda, sus complicaciones y diagnósticos diferenciales. Evaluar la utilidad de la tomografía computada helicoidal (TCH en el diagnóstico de la apendicitis aguda y en el manejo de los pacientes con abdomen agudo de fosa iliaca derecha, tanto en la determinación de un diagnóstico, como de sus complicaciones, que permitan tomar una medida terapéutica. Materiales y métodos: Estudio de cohorte retrospectivo realizado durante 5 meses (mayo a septiembre del 2007, en el que la población de estudio incluyó a pacientes derivados del Servicio de Guardia de nuestra institución para la realización de una TCH por presentar dolor en fosa iliaca derecha como denominador común. Se efectuaron tomografías helicoidales con contraste oral y endovenoso, de no existir contraindicaciones. Los estudios fueron correlacionados con los hallazgos quirúrgicos e histopatológicos y, en aquellos casos de resolución no quirúrgica, por seguimiento clínico. Resultados: Sobre un total de 100 pacientes estudiados, 53 presentaron diagnóstico tomográfico de apendicitis, de las cuales, 22 fueron perforadas; 27 mostraron un diagnóstico alternativo (quistes o folículos anexiales, litiasis ureteral derecha, tiflitis, diverticulitis, colitis inespecífica, salpingitis y quiste anexial complicado; 18 no evidenciaron apendicitis ni alteraciones tomográficas que justificaran la clínica y hubo solo 2 pacientes con resultado indeterminado. El análisis de estos datos demostró una sensibilidad del 100%, especificidad del 95,7%, valor predictivo positivo del 96,2% y valor predictivo negativo del 100% para el diagnóstico tomográfico de apendicitis aguda y una sensibilidad del 100%, especificidad del 81,81%, valor predictivo positivo del 95,12% y un valor predictivo negativo del 100% para el diagnóstico tomográfico de las diferentes etiologías y manejo de los pacientes con abdomen agudo de

  10. A randomized controlled double-blinded prospective study of the efficacy of clonidine added to bupivacaine as compared with bupivacaine alone used in supraclavicular brachial plexus block for upper limb surgeries

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    Shivinder Singh

    2010-01-01

    Full Text Available We compared the effects of clonidine added to bupivacaine with bupivacaine alone on supraclavicular brachial plexus block and observed the side-effects of both the groups. In this prospective, randomized,double-blinded, controlled trial, two groups of 25 patients each were investigated using (i 40 ml of bupivacaine 0.25% plus 0.150 mg of clonidine and (ii 40 ml of bupivacaine 0.25% plus 1 ml of NaCl 0.9, respectively. The onset of motor and sensory block and duration of sensory block were recorded along with monitoring of heart rate, non-invasive blood pressure, oxygen saturation and sedation. It was observed that addition of clonidine to bupivacaine resulted in faster onset of sensory block, longer duration of analgesia (as assessed by visual analogue score, prolongation of the motor block (as assessed by modified Lovett Rating Scale, prolongation of the duration of recovery of sensation and no association with any haemodynamic changes (heart rate and blood pressure, sedation or any other adverse effects. These findings suggest that clonidine added to bupivacaine is an attractive option for improving the quality and duration of supraclavicular brachial plexus block in upper limb surgeries.

  11. Analysis of incidental radiation dose to uninvolved mediastinal/supraclavicular lymph nodes in patients with limited-stage small cell lung cancer treated without elective nodal irradiation.

    Science.gov (United States)

    Ahmed, Irfan; DeMarco, Marylou; Stevens, Craig W; Fulp, William J; Dilling, Thomas J

    2011-01-01

    Classic teaching states that treatment of limited-stage small cell lung cancer (L-SCLC) requires large treatment fields covering the entire mediastinum. However, a trend in modern thoracic radiotherapy is toward more conformal fields, employing positron emission tomography/computed tomography (PET/CT) scans to determine the gross tumor volume (GTV). This analysis evaluates the dosimetric results when using selective nodal irradiation (SNI) to treat a patient with L-SCLC, quantitatively comparing the results to standard Intergroup treatment fields. Sixteen consecutive patients with L-SCLC and central mediastinal disease who also underwent pretherapy PET/CT scans were studied in this analysis. For each patient, we created SNI treatment volumes, based on the PET/CT-based criteria for malignancy. We also created 2 ENI plans, the first without heterogeneity corrections, as per the Intergroup 0096 study (ENI(off)) and the second with heterogeneity corrections while maintaining constant the number of MUs delivered between these latter 2 plans (ENI(on)). Nodal stations were contoured using published guidelines, then placed into 4 "bins" (treated nodes, 1 echelon away, >1 echelon away within the mediastinum, contralateral hilar/supraclavicular). These were aggregated across the patients in the study. Dose to these nodal bins and to tumor/normal structures were compared among these plans using pairwise t-tests. The ENI(on) plans demonstrated a statistically significant degradation in dose coverage compared with the ENI(off) plans. ENI and SNI both created a dose gradient to the lymph nodes across the mediastinum. Overall, the gradient was larger for the SNI plans, although the maximum dose to the "1 echelon away" nodes was not statistically different. Coverage of the GTV and planning target volume (PTV) were improved with SNI, while simultaneously reducing esophageal and spinal cord dose though at the expense of modestly reduced dose to anatomically distant lymph nodes

  12. Analysis of Incidental Radiation Dose to Uninvolved Mediastinal/Supraclavicular Lymph Nodes in Patients with Limited-Stage Small Cell Lung Cancer Treated Without Elective Nodal Irradiation

    Energy Technology Data Exchange (ETDEWEB)

    Ahmed, Irfan; DeMarco, Marylou; Stevens, Craig W. [Department of Radiation Oncology, H. Lee Moffitt Cancer Center, Tampa, FL (United States); Fulp, William J. [Biostatistics Core, H. Lee Moffitt Cancer Center, Tampa, FL (United States); Dilling, Thomas J., E-mail: Thomas.Dilling@moffitt.org [Department of Radiation Oncology, H. Lee Moffitt Cancer Center, Tampa, FL (United States)

    2011-01-01

    Classic teaching states that treatment of limited-stage small cell lung cancer (L-SCLC) requires large treatment fields covering the entire mediastinum. However, a trend in modern thoracic radiotherapy is toward more conformal fields, employing positron emission tomography/computed tomography (PET/CT) scans to determine the gross tumor volume (GTV). This analysis evaluates the dosimetric results when using selective nodal irradiation (SNI) to treat a patient with L-SCLC, quantitatively comparing the results to standard Intergroup treatment fields. Sixteen consecutive patients with L-SCLC and central mediastinal disease who also underwent pretherapy PET/CT scans were studied in this analysis. For each patient, we created SNI treatment volumes, based on the PET/CT-based criteria for malignancy. We also created 2 ENI plans, the first without heterogeneity corrections, as per the Intergroup 0096 study (ENI{sub off}) and the second with heterogeneity corrections while maintaining constant the number of MUs delivered between these latter 2 plans (ENI{sub on}). Nodal stations were contoured using published guidelines, then placed into 4 'bins' (treated nodes, 1 echelon away, >1 echelon away within the mediastinum, contralateral hilar/supraclavicular). These were aggregated across the patients in the study. Dose to these nodal bins and to tumor/normal structures were compared among these plans using pairwise t-tests. The ENI{sub on} plans demonstrated a statistically significant degradation in dose coverage compared with the ENI{sub off} plans. ENI and SNI both created a dose gradient to the lymph nodes across the mediastinum. Overall, the gradient was larger for the SNI plans, although the maximum dose to the '1 echelon away' nodes was not statistically different. Coverage of the GTV and planning target volume (PTV) were improved with SNI, while simultaneously reducing esophageal and spinal cord dose though at the expense of modestly reduced dose to

  13. “Marx el teórico, Lenin el práctico”: Construcción del marxismo en jóvenes militantes de izquierda bajo la Unidad Popular * “Marx the theoretical, Lenin the practical”: Construction of Marxism in young left militants under the Popular Unity

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    Alex Zapata

    2012-08-01

    Full Text Available Por medio del estudio de casos concretos de militantes jóvenes populares de izquierda durante el gobierno de la Unidad Popular, se analizará cómo estas personas fueron construyendo o inventando, en sus prácticas socio-políticas cotidianas, la doctrina marxista de los cuales dicen ser seguidores, para detectar entre otras cosas las mediaciones, las ideas concretas y los sentidos, no exentos de contradicciones que estos le atribuyeron a la enunciada fuente ideológica.

  14. Formações venosas superficiais da fossa cubital: aspectos de interesse para a prática da Enfermagem Formaciones venosas superficiales de la fosa cubital: aspectos de interés para la práctica de Enfermería Superficial venous formation of the cubital fossa: aspects of interest for nursing practice

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    Nilton Alves

    2012-12-01

    Full Text Available O objetivo deste estudo é contribuir para o conhecimento que auxilie o profissional de enfermagem na identificação dos tipos mais comuns de formações venosas da região da fossa cubital e, ainda, enfocar a importância de estar sempre atento aos casos pouco comuns como o aqui relatado. Através de uma revisão bibliográfica, constatamos que as formações venosas dessa região podem ser classificadas em 5 tipos mais comuns, sendo o tipo II o mais frequente. Constatamos ainda, que a VICo é o local de punção mais indicado, seguido pela VIB. Descrevemos também uma variação anatômica, onde observamos ausência de comunicação entre VC e VB no nível da fossa cubital e VIA drenando na VB, estando presente a VCA.El objetivo de esta investigación es contribuir al conocimiento que auxilie al profesional de enfermería en la identificación de los tipos más comunes de formaciones venosas de la fosa cubital, además de advertir sobre la importancia de fijar la atención a los casos poco comunes, como lo aquí reportado. A través de la revisión bibliográfica, clasificamos las formaciones venosas de esta región en cinco tipos más comunes, siendo lo más frecuente el Tipo II. La utilización de la VICo se recomienda como el mejor sitio de punción, seguido por la VIB. Además, describimos una variación anatómica, donde se observó la ausencia de comunicación entre VC y VB a nivel de fosa cubital y VIA drenando en VB, con presencia de la VCA.The aim of this study is to contribute to the knowledge to assists the nursing staff to identify the most common types of venous formations of the cubital fossa region, and also focus on the importance of always being alert to unusual cases as that reported here. Through a literature review, we found that the venous formations of this region can be classified into five common types, bring the Type II the was most frequent. We also found that MCV is considered the best puncture site, followed by MBV

  15. Diplopía y ptosis palpebral izquierda como primera manifestación de metástasis hipofisarias de adenocarcinoma pulmonar Diplopia and left palpebral ptosis as a first manifestation of hypophysary metastases of pulmonary adenocarcinoma

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    S. Junquera

    2012-04-01

    Full Text Available Paciente sin antecedentes patológicos de interés que debuta con diplopía y ptosis palpebral izquierda como primera manifestación de metástasis hipofisarias de un cáncer de origen pulmonar ampliamente diseminado y no conocido previamente. El diagnóstico se hizo con pruebas de imagen específicas del área hipofisaria en donde se apreció una neoformación en silla turca, que invadía el seno cavernoso izquierdo con erosión del dorso selar, junto con la presencia de nódulos pulmonares y múltiples adenopatías, además del estudio histológico de las lesiones. Se detectó un hipogonadismo hipogonadotropo como única alteración hormonal debido a la infiltración de la hipófisis anterior por las metástasis óseas en la base del cráneo. El paciente, a pesar de recibir varias sesiones de radioterapia, sufrió un deterioro neurológico progresivo falleciendo a las pocas semanas.A patient, without significant previous medical history, who started with diplopia and left palpebral ptosis as the first manifestation of hypophysary metastases of a widely disseminated and previously undetected cancer of pulmonary origin. Together with a histological study of the lesions, the diagnosis was made with specific image tests of the hypophysary area, which detected a neoformation in the sella turca that was invading the left cavernous sinus with erosion of the verso of the sellar, together with the presence of pulmonary nodules and numerous adenopathies. An hypogonadotropic hypogonadism was detected as the only hormonal alteration due to the infiltration of the anterior hypophysis due to the osseous metastases at the base of the cranium. The patient, in spite of receiving several weeks of radiotherapy, suffered a progressive neurological deterioration and died after a few weeks.

  16. EFFICACY OF ADDING FENTANYL TO LIGNOCAINE – ADRENALINE COMBINATION IN SUPRACLAVICULAR BRACHIAL PLEXUS BLOCK FOR UPPER LIMB ORTHOPEDIC SURGERIES A MULTI - CENTER STUDY

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    Anish M

    2015-06-01

    Full Text Available BACKGROUND: Brachial plexus block is a suitable alternative to general anesthesia for surgeries of upper limb and it can be performed even in patients who are not adequately fit for general anesthesia. The significance of brachial plexus block has increased in recent years due to renewed interest in day care surgery. Lignocaine hydrochloride has been used extensively for brachial plexus block and it has the disadvantage of having short duration of action. Opioids when added to anesthetic mixtures may improve and prolo ng the action of local anesthetics during peripheral nerve blocks. Such postoperative pain control can reduce both narcotic requirements and narcotic induced side effects. Studies have shown the efficacy of opioids as analgesic adjuvants in prolonging the duration of brachial plexus block. With this background in mind, this study was conducted to compare the onset and duration of sensory and motor block produced by a mixture of lignocaine and adrenaline with that produced by a mixture of fentanyl, lignocain e and adrenaline. Aims: To assess the effectiveness of addition of fentanyl to a mixture of lignocaine and adrenaline in prolonging the duration of analgesia and motor block for upper limb orthopedic surgeries. MATERIALS AND METHODS: This multi - center rand omized control study was conducted in two tertiary care centers in 80 patients underwent elective upper limb orthopedic surgeries and they were allocated into two groups of 40 each group L and group F. the classical approach of supraclavicular brachial ple xus block. Drug used were 30 ml of lignocaine 1.5%+adrenaline 5mcg/ml + 0.5ml normal saline in group L and 30ml of lignocaine 1.5% + adrenaline 5mcg/ml + fentanyl 50 mcg in group F. Adequacy of block was assessed by the pin prick test and temperature test. Motor power was assessed by the modified Lowett scale. Sedation was monitored using the modified Ramsay scale. An assessment was made for onset of analgesia, onset of

  17. Left paraduodenal hernias; Hernias paraduodenales izquierdas

    Energy Technology Data Exchange (ETDEWEB)

    Lopez-Negrete, L.; Garcia-Lozano, J.; Sanchez, J. L.; Tejeiro, A.; Sala, J. [Hospital Valle del Nalon. Riano-Sama. Asturias (Spain)

    2002-07-01

    We report two cases of left paraduodenal internal hernias located in the fossa of Landzert that were diagnosed by CT. Internal hernias are an infrequent cause of acute abdomen, due to the intestinal sub occlusion they produce. Left paraduodenal hernias are responsible for about 50% of internal hernias. CT makes it possible to demonstrate the group of herniated loops between the stomach, fourth segment of the duodenum, descending colon, and tail of the pancreas. The identification of the loops in an atypical position together with displaced blood vessels (mesenteric vessels) and colon gives concerns on them a typical radiological semiology that makes them easily identifiable. (Author) 9 refs.

  18. Resultados inmediatos y a los 5 años de la cirugía de pacientes portadores de lesión del tronco de la coronaria izquierda

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    Rodolfo A. Ahuad Guerrero

    2008-01-01

    Full Text Available AntecedentesLa cirugía de revascularización miocárdica se considera hasta el momento el mejor tratamiento para los pacientes portadores de enfermedad del tronco de la coronaria izquierda (TCI; pese a ello existen pocos datos locales que comuniquen los resultados de esta cirugía.ObjetivosDescribir los resultados inmediatos y a los 5 años de una serie de cirugías coronarias en pacientes con lesiones del TCI.Material y métodosEn el período 2003-2007 se estudiaron 174 cirugías coronarias del TCI realizadas en forma consecutiva en tres servicios quirúrgicos asociados. Se analizaron los resultados quirúrgicos a los 30 días y en el seguimiento hasta 5 años, en los que se tuvieron en cuenta la mortalidad de causa cardiovascular y por otras causas, los eventos cardiovasculares mayores, la necesidad de nueva revascularización y la supervivencia libre de síntomas. Las curvas se compararon con la supervivencia esperada para el mismo grupo de edad y sexo.ResultadosEl 90,8% de los pacientes tuvieron lesiones múltiples. La mortalidad a los 30 días fue del 4,0%, similar a la esperada según el EuroSCORE (6,4%, OR = 0,62, IC 95% 0,21-1,78; p = 0,333, y los eventos cardiovasculares mayores incluyeron 2,9% de infarto y 1,7% de accidente cerebrovascular (ACV. El seguimiento fue de 506 pacientes-años (12 a 60 meses e involucró al 91% de los pacientes. Al considerar la mortalidad cardiovascular, la supervivencia a los 5 años fue del 83,7%, similar a la esperada en la población general. La supervivencia en el mismo plazo descendió al 77,6% cuando se computaron todas las causas de muerte (p = 0,436. La supervivencia a los 5 años libre de angina y de nueva revascularización fue del 72,2% y del 88,1%, respectivamente.ConclusionesEn este estudio observacional de pacientes operados con lesión del TCI se demostró una mortalidad quirúrgica algo inferior a la calculada con el EuroSCORE y una tasa de ACV e infarto de entre el 1,7% y el 2,9%. El

  19. Producción y calidad sanitaria de la lechuga fertilizada con efluente de fosa séptica biodigestora Produção e qualidade sanitária de alface adubada com efluente de fossa séptica biodigestora

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    Miréia Aparecida Bezerra Pereira

    2012-04-01

    Full Text Available

    Se evaluó la producción y los aspectos sanitarios de la lechuga fertilizada con aguas residuales de efluente humano derivada de fosa séptica biodigestora en Assentamento Rural Vale Verde, Gurupi, Estado de Tocantins, Brasil. Fueron realizadas evaluaciones morfofisiológicas y microbiológicas en plantas y microbiológicas en muestras de agua del suelo, de la lechuga y del efluente de la fosa séptica biodigestora. Por el número de hojas, altura de planta y peso fresco se observó que las plantas que recibieron la dosis de 60 L de efluente tuvieron valores más altos que los demás. Hubo un aumento del área foliar de las plantas con el aumento de la dosis de efluente. Las plantas que recibieron 60 L de efluentes fueron las que produjeron más clorofila total, y las que recibieron 20 L presentaran valores cerca de éstos. El rendimiento de la producción fue significativamente mayor en las plantas que recibieron 20, 40 y 60 L de efluente, y menor para los demás (0 y 80 L. En este estudio, no hubo contaminación por coliformes fecales a 45 º C en las muestras 1, 3, 4, 5 y 7. De las plantas de las parcelas fertilizadas con efluente del tanque séptico, sólo una muestra presentó contaminación, sin embargo, el valor se ha considerado como adecuado por estar dentro de los límites de 95% de la prueba. Se trata de una alternativa sostenible que contribuye a maximizar los recursos disponibles dentro de la agricultura familiar, sin comprometer el nivel de calidad sanitaria de consumo humano de la lechuga en las condiciones estudiadas y con incremento de la productividad.

    Avaliou-se a produção e os aspectos sanitários de alface adubada com efluente humano de fossa séptica biodigestora no Assentamento Rural Vale Verde, Gurupi-TO. Foram realizadas avaliações morfofisiológicas e análises microbiológicas de amostras de água do solo, alface e do efluente de fossa séptica biodigestora. Para número de

  20. Estratigrafía del sector central de la fosa deLoncopué: eldepocentro cuaternario del Huecú - sector occidental de la Cuenca Neuquina Stratigraphy of thecentral sector of the Loncopué Trough: The Quaternary depocenter of the Huecú (Western sector of the Neuquénbasin

    Directory of Open Access Journals (Sweden)

    Emilio A. Rojas Vera

    2009-10-01

    Full Text Available El depocentro del Huecú seencuentra en el sector central de la fosa de Loncopué en la región occidentalde Neuquén. El relleno de la cuenca es de carácter volcánico, volcaniclástico,fluvial y lacustre, desde por lo menos los 1,60 Ma comprendiendo sedimentos ylavas postglaciarias hasta históricas. Durante gran parte de su evolución haconstituido una pequeña depresión cerrada (cuenca transtensional dentro de lafosa de Loncopué que es una de las pocas cuencas de retroarco extensionalcuaternaria de los Andes Centrales y Patagónicos. Desde sus inicios secaracterizó por estar limitada hacia el norte por un gran sistema deestravolcanes amalgamados en la cordillera de Mandolegüe de edad generalpostpliocena que segmenta transversalmente a la fosa de Loncopué. La cuenca fuerellenada por productos volcánicos generados en forma foránea a los mecanismosde la misma, a partir de derrames fisurales del sector norte de la caldera delAgrio adyacente, agrupados dentro la denominación Basalto Escorial de 1,60 a 0,80 Ma. A continuación se emplazaron en la zona grandes aparatos volcánicos de retroarco,particularmente el cerro Trolón al noroeste. Estos sistemas de edad pleistocenase encuentran parcialmente desmantelados por la acción glaciaria que afectótardíamente a la zona. Hacia finales de los tiempos preglaciarios sedesarrollaron dos amplias unidades volcánicas asociadas a mecanismos fisuralesy centrales, de tipo principalmente monogénico, agrupadas en el BasaltoRankül-Lom y en el Basalto Tres Hermanos, las cuales cubrieron gran parte de lacuenca reconstituyendo en algunos casos los aparatos volcánicos desmantelados.Finalmente una serie de erupiones postglaciarias ocurrieron en la zona,particularmente ubicadas en las cotas topográficas inferiores, las cualesfueron agrupadas en Basalto Cerro Artillería y la "Colada del Agrio".Las erupciones más antiguas de este conjunto se asocian a la obstrucción de loscauces fluviales que drenan la

  1. A meta-analysis of the prognosis in patients with breast cancer with ipsilateral supraclavicular lymph node metastasis versus patients with stage Ⅲb/c or Ⅳ breast cancer

    Institute of Scientific and Technical Information of China (English)

    Xu-Hong Liu; Lei Zhang; Bo Chen

    2015-01-01

    Objective:To systematically evaluate the prognosis in patients with breast cancer with ipsilateral supraclavicular lymph node metastasis (SLNM) versus patients with stage Ⅲb/c or Ⅳ breast cancer,so as to provide evidence for clinical practice and research.Methods:Computer retrieval from PubMed,Cochrane Libratory,CNKI (China National Knowledge Infrastructure),CBM and Wanfang Database with the assistance of other retrieval tools.All the studies evaluating the prognosis in patients with breast cancer with ipsilateral supraclavicular lymph node metastasis versus patients with stage Ⅲb/c or Ⅳ breast cancer were collected.Quality assessment was performed for the included data based on the quality assessment criteria appropriate for this study.Meta-analysis was performed using RevMan 5.3 software.Results:A total of four references (1277 patients) were included.Assessment of influences on prognosis:As compared to the stage Ⅲb/c group,the 5-year survival rate was slightly lower in the SLNM group (relative risk (RR) 0.79; 95% confidence interval (CI) 0.59-1.06; Z =1.55,P =0.12),but there was no statistical significance; in contrast,the 5-year survival rate was significantly increased in the SLNM group as compared to the stage Ⅳ group (RR =2.70; 95%CI:1.36-5.37; Z =2.84,P =0.005).As compared to the stage Ⅲb/c group,the 5-year disease-free survival rate was lower in the SLNM group (RR =0.65; 95%CI:0.40-1.05; Z =1.75,P =0.08); however,there was no statistical significance.Conclusions:In patients with advanced breast cancer receiving combined therapy,the prognosis in patients with breast cancer with ipsilateral SLNM was significantly better than in those with stage Ⅳ breast cancer,and slightly worse than those with stage Ⅲb/c breast cancer.However,with the scarcity and poor quality of these observational studies,the long-term prognosis remains to be further verified in large-sample,high-quality studies.

  2. Sobre el dominio territorial como requisito del elemento político en la definición de los crímenes de lesa humanidad. Un análisis enfocado en la calificación jurídica de los actos de la izquierda armada en Argentina

    Directory of Open Access Journals (Sweden)

    Juan Francisco Iosa

    2014-03-01

    Full Text Available Ofrezco primero una caracterización  de la teoría de los dos demonios. Esta teoría, tras gozar del rol de discurso de Estado luego de la recuperación democrática en Argentina, ha sido explícitamente rechazada en la segunda generación de juicios: aquí se consideró que sólo los militares (no las organizaciones de izquierda cometieron crímenes contra la humanidad. Mi interés está centrado en evaluar las razones que sustentan esa distinción. Con vistas a ese fin, segundo, presento la figura de los crímenes contra la humanidad tal como está fijada en el Estatuto de Roma y distingo cuatro concepciones relativas a cómo debe delinearse su  elemento político. Tercero, reconstruyo la interpretación que la Corte y los tribunales argentinos hacen de los requisitos necesarios para que un delito califique como crimen contra la humanidad. Hago foco en  el elemento político y específicamente en las condiciones que una organización debe satisfacer para ser capaz de cometer dichos crímenes. Cuarto, comparo las decisiones argentinas con las tomadas por las cortes internacionales. Quinto, ofrezco una reconstrucción de los requisitos que a mi entender deben ser tenidos en cuenta (según la concepción normativa que considero correcta en la definición legal de los crímenes contra la humanidad. Con esta herramienta conceptual en mano evalúo las decisiones jurisprudenciales mencionadas más arriba. Por último, presento la que considero como la calificación jurídica adecuada de los delitos cometidos por la izquierda armada en los setenta. 

  3. Evolución tectónica de la fosa de Loncopué: Estructura del depocentro cuaternario del Huecú y su relación con la sedimentación y el volcanismo Tectonic evolution of the Loncopué trough: Structure of the Quaternary Huecú depocenter and its relation to the sedimentation and volcanism

    Directory of Open Access Journals (Sweden)

    Emilio A. Rojas Vera

    2009-04-01

    Full Text Available El depocentro del Huecú constituye un depocentro alojado en el sector central del retroarco en la fosa de Loncopué. Su relleno de carácter volcánico, volcaniclástico, fluvial y lacustre, muestra una estrecha relación con la actividad tectónica que le diera origen. Los diferentes pulsos de efusión mayormente de composición basáltica reflejan la recurrencia de la actividad tectónica asociada a fallamiento extensional y al desarrollo de fisuras tensionales. A partir de métodos potenciales se ha podido verificar que el basamento de las secuencias terciarias participa de la deformación extensional que afectó a la zona durante los últimos 5 Ma. Asimismo rasgos neotectónicos en secuencias volcánicas cuaternarias sugieren la persistencia de los mecanismos de subsidencia en esta cuenca. Estas fallas se encuentran directamente relacionadas con la segmentación inferida del basamento a partir de la gravimetría y magnetometría. La inundación histórica de la zona a partir del endicamiento del río Agrio durante un pulso de eruptividad fisural de la cuenca, demuestra la alta probabilidad de que erupciones en el área del retroarco se repitan en el futuro. El reconocimiento de las áreas anegadas correspondientes a las últimas inundaciones del depocentro del Huecú permite estimar el alcance de estos procesos localizados en el retroarco de Neuquén asociados a tectónica activa y sismicidad.The Huecú basin is located at the central part of the large Loncopué retroarc trough. Its volcanic, volcaniclastic, lacustrine and fluvial filling is directly related to neotectonic activity in the area. The basaltic eruptions are reflecting different pulses associated with the development of extensional faults and tensional fractures. Geophysical potential methods have identified basement involvement in the extensional deformation that affected the Tertiary sequences of the area during the last 5 Mys. Neotectonic features in Quaternary volcanic

  4. El alto de Copahue - Pino Hachado y la fosa de Loncopué: un comportamiento tectónico episódico, Andes neuquinos (37º - 39ºS The Copahue-Pino Hachado high and the Loncopuè trough: An episodic tectonic behaviour, Neuquén Andes (37º- 39ºS

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    E. García Morabito

    2005-12-01

    Full Text Available Los Andes de la parte central de Neuquén (38º-39ºS, enmarcados en los Andes Centrales Australes (35º-39ºS, han poseído una cronología de levantamiento similar al resto de los Andes Patagónicos Septentrionales (39º-46ºS construyéndose a través de sucesivas fases de alzamiento en el Cretácico medio, Eoceno medio y Mioceno superior. Sin embargo, se han diferenciado con respecto al resto de los Andes Patagónicos, ubicados hacia el sur, en lo relativo a las distintas fases de relajamiento extensional que han sufrido, tanto en el Oligoceno superior como en el Plio-Cuaternario. Existen evidencias que sugieren un comportamiento episódico de la faja plegada y corrida neuquina dado por regímenes tectónicos compresivos seguidos por estadios de extensión generalizados al menos desde el Cretácico medio. El estudio de dos unidades morfoestructurales desarrolladas entre los 37º y los 39ºS ejemplifican este comportamiento peculiar, el alto de Copahue - Pino Hachado ubicado en la zona limítrofe argentino-chilena y su extensión hacia el norte en territorio chileno, en la laguna de la Laja, y la fosa de Loncopué en el retroarco. El estudio de la estructura miocena a cuaternaria y la descripción detallada de la estratigráfía de este sector cordillerano han aportado un nuevo cuadro de evolución para este sector de los Andes.The Andes located in the central Neuquén (38º-39ºS, which belong to the southern Central Andes (35º-39ºS, have recorded a similar chronology of uplift than the neighbor northern Patagonian Andes (39º-46ºS. Both areas have been formed trough successive phases of contraction in the Late Cretaceous, Middle Eocene and Late Miocene respectively. However, the Neuquén Andes have experienced two discrete phases of orogenic relaxation, during the Late Oligocene and Pliocene-Quaternary, which make then distinctive respect to the area located to the south. Field studies have shown new evidences of an episodic behavior of

  5. Epidermal growth factor enemas for induction of remission in left-sided ulcerative colitis Enemas de factor de crecimiento epidérmico para inducir la remisión de la colitis ulcerosa izquierda

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    Hugo Nodarse-Cuní

    2013-03-01

    enema para tratamiento de la manifestación izquierda leve o moderada de la enfermedad. Este antecedente sirvió de base para evaluar la eficacia y perfil de seguridad de una solución viscosa del producto. Métodos: fueron aleatorizados 31 pacientes hacia tres grupos de tratamiento diario durante 14 días. Doce recibieron enemas de 10 mg de factor de crecimiento epidérmico en 100 mL de solución viscosa, mientras nueve fueron tratados con enemas placebo conteniendo solamente solución viscosa. Ambos grupos recibieron además 1,2 g diarios de mesalacina oral. El tercer grupo incluyó 10 pacientes con mesalacina en enemas de 3g / 100 mL. La variable principal de eficacia fue la respuesta clínica al finalizar las dos semanas de tratamiento, definida como la disminución de, al menos tres puntos, el índice basal de actividad de la enfermedad acompañada de mejoría endoscópica o histológica. Resultados: se alcanzó remisión de la enfermedad en todos los pacientes que recibieron factor de crecimiento epidérmico y en seis de los grupos mesalacina enema y placebo. Todas las comparaciones entre grupos mostraron superioridad estadísticamente significativa para el factor de crecimiento epidérmico, único producto que logró la reducción significativa del índice de actividad de la enfermedad y de la presencia e intensidad de los síntomas digestivos en los pacientes luego del tratamiento. Ningún evento adverso fue reportado. Conclusiones: estos resultados son consistentes con las anteriores evidencias moleculares y clínicas que señalan al factor de crecimiento epidérmico capaz de reducir la actividad e inducir la remisión de la colitis ulcerosa. Debe ser realizado un nuevo estudio en un número mayor de pacientes para confirmar la eficacia de los enemas de factor de crecimiento epidérmico.

  6. The left and the democratic stability in Latin America: the ideology of the Bolivarian Revolution and its impact on the political processes in Venezuela and Latin America Izquierda y estabilidad de la democracia en América latina: la ideología de la revolución bolivariana y su repercusión sobre el proceso político en Venezuela y América latina

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    José Enrique MOLINA V.

    2010-10-01

    Full Text Available One of the main areas of work in Comparative Politics and Political Theory has been the determination of the variables associated with the stability/instability of political systems in general, and democracy in particular. This paper focuses on one of these variables. One with newly acquired importance after the recent electoral successes by the left, but that nevertheless has not been in the spotlight of scholarly analysis: ideological polarization. Particularly, ideological polarization brought about by the attempt to pursue by the government a leftist political project. The main focus is on the ideological project pursued by the Venezuelan Bolivarian Government and its association with the political instability of 2002 and 2003. The paper considers this topic taken into account mainstream theoretical approaches on political stability, and the experience of previous Latin American leftist governments. The paper reaches the conclusion that in Latin America the attempt to implement a socialist program by a democratically elected government, if it is done without meaningful social and political negotiation, and with authoritarian overtones, is likely to lead to intense political instability and to the ultimate failure of the proposed social change. Los factores vinculados a la estabilidad o inestabilidad de los sistemas políticos y la democracia han sido una preocupación central de la política comparada y la teoría política. Este trabajo se centra en analizar un factor que adquiere nueva importancia dado el resurgimiento de la izquierda en América Latina, pero que no ha estado en el centro del debate académico sobre la estabilidad democrática: la polarización ideológica producida por el adelanto de un proyecto político de izquierda desde el gobierno. Su análisis se enmarca en los enfoques teóricos sobre la estabilidad de la democracia y los sistemas políticos. Dentro del contexto de los gobiernos de izquierda en América Latina, se

  7. Neurothekeoma celular: Presentación de un caso

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    Mirian Zaldívar Ochoa

    2002-12-01

    Full Text Available Se presenta un caso de neurothekeoma calular en una mujer de 38 años, cuyo asiento de la lesión tumoral es en el vestíbulo de la fosa nasal izquierda, el cual se resecó completamente. Se describe el caso por ser un tumor de reciente caracterización, raro, tanto en nuestro medio como en la literatura médica internacional revisada

  8. Diagnóstico fractal de disfunción cardéaca severa: Dinámica fractal de la ramificación coronaria izquierda Fractal diagnosis of severe cardiac dysfunction: Fractal dynamic of the left coronary branching

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    Javier O Rodréguez

    2012-10-01

    Full Text Available INTRODUCCIÓN Y OBJETIVOS: la geometría fractal evalúa la irregularidad de los objetos naturales, permitiendo caracterizar de forma imparcial la totalidad de la ramificación coronaria izquierda a diferencia de la metodología actual que evalúa únicamente partes de ésta. Con base en esta medida se generalizó una nueva metodología diagnóstica para detectar cualquier tipo de disfunción cardiaca severa. MÉTODOS: estudio de concordancia diagnóstica en el que se utilizó el método de box counting para medir dimensiones fractales de imágenes consecutivas entre sístole y diástole de la ramificación coronaria izquierda en proyección oblicua derecha anterior de angiografías de ocho pacientes con enfermedad arterial oclusiva leve. Así mismo, se evaluaron sus cambios por medio de los conceptos de variabilidad y diferencia neta y se compararon estos resultados con pacientes sin enfermedad arterial oclusiva, con enfermedad arterial oclusiva moderada y severa evaluados previamente de igual forma, para obtener una metodología matemática que evalúa el impacto de cualquier patología en la dinámica cardiaca. RESULTADOS: los casos que presentan diferencias netas de cero corresponden a pacientes con disfunciones cardiacas severas, independientemente del grado o ausencia de enfermedad arterial oclusiva diagnosticada. CONCLUSIONES: se generalizó una nueva metodología diagnóstica de aplicación clínica que detecta disfunciones cardiacas severas sub-diagnosticadas con las metodologías actuales, mediante la caracterización de la dinámica total de la ramificación coronaria izquierda.INTRODUCTION AND OBJETIVES: fractal geometry evaluates the irregularity of natural objects, allowing impartially characterize the entire left coronary branching unlike the current methodology which evaluates only parts of it. Based on this measure, a new diagnostic method was generalized to detect any type of severe cardiac dysfunction. METHODS: Concordance

  9. Dispersión del QRS como índice de disincronía en el bloqueo de rama izquierda y de sincronía tras la terapia de resincronización cardíaca, una variable de respuesta exitosa / QRS dispersion as an index of dyssynchrony in left bundle branch block and of

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    Elibet Chávez González

    2015-08-01

    Full Text Available Introducción: En pacientes con insuficiencia cardíaca, el bloqueo de rama izquierda del haz de His constituye un importante marcador de mal pronóstico, en ellos la tera-pia de resincronización puede mejorar la función del ventrículo izquierdo. Objetivo: Describir variables electrocardiográficas asociadas a una mejor respuesta de la resincronización cardíaca. Método: Se estudiaron 19 pacientes, 7 mujeres y 12 hombres con bloqueo de rama izquierda y fracción de eyección ≤ 35 %. Se realizó electrocardiograma antes y des-pués de la terapia de resincronización, medición del QRS en las doce derivaciones y cálculo de su dispersión, se midieron voltajes máximos del QRS, y se realizaron eco-cardiografías antes y después del procedimiento. Resultados: La fracción de eyección se incrementó desde 29,8±4,7 hasta 41,2±10,7 % (p=0.000. La correlación lineal entre fracción de eyección y dispersión del QRS a los seis meses de seguimiento fue significativa (r=0.34 y p=0.02; las mujeres presentaron mayor dispersión del QRS (48,0±24,0 vs. 37,14±13,8 ms; p=0.04. Los voltajes del QRS fueron predominantemente negativos en aVR (-0,52±0,58 vs. 0,28±0,42 mvolt; p=0.032 y positivos en V5 (0,71±1,12 vs. -0,15±1,20 mvolt; p=0.023 para los responde-dores en relación con los no respondedores. Conclusiones: La dispersión del QRS incrementada en el electrocardiograma con blo-queo de rama izquierda y la disminución de la dispersión del QRS posresincronización demostraron correlaciones significativas con la fracción de eyección; además, el es-trechamiento del QRS tras la resincronización fue significativo para los respondedo-res. Los voltajes predominantemente positivos en aVR y negativos en V5, pudieran predecir cuáles pacientes no responderán adecuadamente a la terapia de resincroni-zación cardíaca.

  10. Efficacy and feasibility of docetaxel, cisplatin, and 5-fluorouracil induction chemotherapy for locally advanced head and neck squamous cell carcinoma classified as clinical nodal stage N2c, N3, or N2b with supraclavicular lymph node metastases.

    Science.gov (United States)

    Izawa, Naoki; Onozawa, Yusuke; Hikosaka, Tomomi; Hamauchi, Satoshi; Tsushima, Takahiro; Todaka, Akiko; Machida, Nozomu; Haraguchi, Yutaka; Ogawa, Hirofumi; Nishimura, Tetsuo; Nakagawa, Masahiro; Fuke, Tomohito; Iida, Yoshiyuki; Kamijo, Tomoyuki; Onitsuka, Tetsuro; Boku, Narikazu; Yasui, Hirofumi; Yokota, Tomoya

    2015-06-01

    We evaluated the efficacy and feasibility of docetaxel, cisplatin, and 5-fluorouracil (TPF) induction chemotherapy followed by concurrent chemoradiotherapy (CRT) for locally advanced head and neck squamous cell carcinoma (HNSCC) with a high risk of distant metastases compared with CRT alone. We retrospectively analyzed 29 HNSCC patients with clinical nodal stage N2c, N3, or N2b disease and supraclavicular lymph node metastases receiving CRT alone (CRT group; n = 16) or TPF induction chemotherapy followed by CRT (TPF group; n = 13) between April 2008 and May 2012. The median follow-up periods were 14.5 (range 5.0-65.0) and 25.0 (range 14.0-32.0) months for CRT and TPF groups, respectively. A greater proportion of patient characteristics in the CRT group had advanced T and N stages. The overall response rate to induction TPF was 50.0%; grade 3-4 toxicities included neutropenia, febrile neutropenia, anorexia, and hyponatremia. Complete response rates after CRT completion were 55.5% in the TPF and 42.9% in the CRT group; median overall survival was not reached in the TPF group and was 14.0 months in the CRT group (p = 0.037). Multivariate analysis revealed that induction TPF and T stage were independent prognostic factors [hazard ratio (HR) = 0.196; 95% confidence interval (CI) 0.043-0.898; p = 0.036, HR = 9.966; 95% CI 2.270-43.75; p = 0.002, respectively). TPF followed by CRT is tolerated and may be an option for the treatment of locally advanced stage N2c, N3, or N2b HNSCC.

  11. Social utopia and technological utopia in the Argentinean lefts wingsthinking in order to change agrarian capitalism, 1890-1945 Utopía social y utopía tecnológica en el pensamiento de las izquierdas argentinas para la transformación del capitalismo agrario, 1890-1945

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    Osvaldo Fabián Graciano

    2010-01-01

    Full Text Available The objectives of this work are to rebuild the Communist and Socialist thinking and the political proposals used, between 1890 and 1945, to set a new model of economics and society within the agrarian sector in the Pampas Region, and which, on its basis, include elements of social and technological utopias. Along the first half of the twentieth century, the left wings developed several projects aimed to transform the agrarian economics and society in Argentina and thus, tried to influence the modifications of social and economics rural relations dominant in the country, and in particular in the Pampas Region. Those proposals started to throw the imaginary of a rural world different to the current upon the speech and the political thinking of the left wings. In many of them shaped as a social utopia and in others shaped as a technological utopia, for its realization.Este trabajo tiene como objetivos reconstruir el pensamiento socialista y comunista y las propuestas políticas con las que buscaron entre 1890 y 1945, concretar un nuevo modelo de sociedad y economía en el agro pampeano y que en sus fundamentos inscribían elementos de las utopías sociales y las tecnológicas. A lo largo de la primera mitad del siglo XX las izquierdas formularon diversos proyectos para la transformación de la economía y la sociedad agrarias argentina, intentando con ellos incidir en la modificación de las relaciones económicas y sociales rurales dominantes en el país y en particular en su región pampeana. Esas propuestas fueron proyectando en el discurso y en el pensamiento político de izquierdas el imaginario de un mundo rural alternativo al vigente, tomando en muchas de ellas la forma de la utopía social y en otras la de la utopía de tipo tecnológico para su realización.

  12. Evaluation and diagnosis of the cathodic protection of ducts in the left margin of the Tonala River of the Superintendencia General de Ductos Minatitlan; Evaluacion y diagnostico de la proteccion catodica en la margen izquierda del Rio Tonala de la Superintendencia General de Ductos Minatitlan

    Energy Technology Data Exchange (ETDEWEB)

    Gonzalez N, Miguel A; Malo T, Jose M; Munoz Ledo C, Ramon; Uruchurtu C, Jorge; Castrejon G, Rafael [Instituto de Investigaciones Electricas, Cuernavaca, Morelos (Mexico); Sanchez G, Luis; Algarra M, Raul; Abreu L, Emilio [Gerencia de Mantenimiento, Pemex (Mexico)

    2003-07-01

    The present study contains the measurements obtained as a part of the evaluation of the protection system of ducts located in the left margin of the Tonal River, made by the Gerencia de Materiales y Procesos Quimicos of the Instituto de Investigaciones Electricas (IIE) during the last trimester of year 2001. Also, the measurements of potential in conditions of instantaneous ignition and extinguished in measuring posts of the duct in Rights of Way (DDV) Tonala-Nudo Teapa 23 are studied, in order to determine the real protection level reached by the cathodic protection system, the possible unprotected zones and the possible corrective measures that lead to a safe operation of the ducts. [Spanish] El presente estudio contiene las mediciones obtenidas como parte de la evaluacion del sistema de proteccion de los ductos ubicados en la margen izquierda del rio Tonala, realizadas por la Gerencia de Materiales y Procesos Quimicos del Instituto de Investigaciones Electricas (IIE) durante el ultimo trimestre del ano 2001. Asimismo, se tratan las mediciones de potencial en condiciones de encendido y apagado instantaneo en postes de medicion del ducto en los Derechos De Via (DDV) Tonala-Nudo Teapa 23, con el proposito de determinar el nivel real de proteccion alcanzado por el sistema de proteccion catodica, las posibles zonas desprotegidas y las posibles medidas correctivas que conduzcan a una operacion segura de los ductos.

  13. Patterns of left ventricular geometry and the transition to congestive heart failure with preserved versus depressed ejection fraction (Patrones de geometría ventricular izquierda y la transición a la insuficiencia cardíaca congestiva con fracción de eyección conservada versus deprimida

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    José H. Donis Hernández

    2014-12-01

    Full Text Available Abstract (english Analysis of cross-sectional and follow up clinical studies, of hypertensive patients with the different left ventricular geometric patterns, provide plausible explanations for the transition from hypertensive heart disease to the two distinct phenotypes of systolic and diastolic congestive heart failure. According to the LIFE study treated-uncomplicated patients, with normal ventricular geometry (12%, concentric remodeling (11 % and concentric hypertrophy (34 %, may evolve to the eccentric hypertrophy pattern. Patients with the eccentric hypertrophy pattern have selective sympathetic activation and progressive enlargement of the left ventricular cavity with thinning of its walls. This pattern goes on to a stage of systolic dysfunction with diminished ejection fraction and enhanced degradation of the collagen matrix. On the other hand, patients with the concentric hypertrophy pattern have predominant activation of the renin-angiotensin-aldosterone system and progressive shrinking of the left ventricular cavity with thickening of its walls. This pattern usually precedes the stage of diastolic heart failure with preserved ejection fraction, impairment of relaxation and increased deposition of collagen in the myocardial interstitium. Thus, ventricular remodeling preceding diastolic heart failure is opposite to that of hypertensive patients who go on to develop systolic heart failure. Resumen (español El análisis de los estudios transversales y longitudinales, de pacientes hipertensos con diferentes patrones de geometría ventricular izquierda, permite postular posibles mecanismos fisiopatológicos para explicar la transición de la cardiopatía hipertensiva hacia los dos fenotipos conocidos de insuficiencia cardiaca. De acuerdo con el estudio LIFE, los pacientes hipertensos no complicados, con patrones de geometría ventricular normal (12 %, remodelado concéntrico (11 % e hipertrofia concéntrica (34 %, pueden evolucionar hacia

  14. Is the Deep Inspiration Breath-Hold Technique Superior to the Free Breathing Technique in Cardiac and Lung Sparing while Treating both Left-Sided Post-Mastectomy Chest Wall and Supraclavicular Regions

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    Anupama Darapu

    2017-01-01

    Full Text Available Aims: To evaluate the efficacy of the deep inspirational breath-hold (DIBH technique and its dosimetric advantages over the free breathing (FB technique in cardiac (heart and left anterior descending artery [LAD] and ipsilateral lung sparing in left-sided post-mastectomy field-in-field conformal radiotherapy. DIBH is highly reproducible, and this study aims to find out its dosimetric benefits over FB. Materials and Methods: Nineteen left-sided mastectomy patients were immobilized using breast boards with both arms positioned above the head. All patients had 2 sets of planning CT images (one in FB and another in DIBH with a Biograph TruePoint HD CT scanner in the same setup. DIBH was performed by tracking the respiratory cycles using a Varian Real-Time Position Management system. The target (chest wall and supraclavicular region, organs at risk (OARs; ipsilateral lung, contralateral lung, heart, LAD, and contralateral breast, and other organs of interests were delineated as per the RTOG (Radiation Therapy Oncology Group contouring guidelines. The single-isocenter conformal fields in the field treatment plans were generated with the Eclipse Treatment Planning System (Varian Medical Systems for both FB and DIBH images, and the doses to the target and OARs were compared. The standard fractionation regimen of 50 Gy in 25 fractions over a period of 5 weeks was used for all patients in this study. Results and Discussion: The target coverage parameters (V95, V105, V107, and Dmean were found to be 97.8 ± 0.9, 6.1 ± 3.4, 0.2 ± 0.3, and 101.9 ± 0.5% in the FB plans and 98.1 ± 0.8, 6.1 ± 3.2, 0.2 ± 0.3, and 101.9 ± 0.4% in the DIBH plans, respectively. The plan quality indices (conformity index and homogeneity index also showed 1.3 ± 0.2 and 0.1 for the FB plans and 1.2 ± 0.3 and 0.1 for the DIBH plans, respectively. There was a significant reduction in dose to the heart in the DIBH plans compared to the FB plans, with p values of nearly 0 for the

  15. Ultrasound-guided supraclavicular brachial plexus anaesthesia ...

    African Journals Online (AJOL)

    affect the characteristics of blood flow across the fistula.1 RCAVF is the preferred route for ... shoulder and neck were examined to detect any sign of previous trauma, muscle ... 48 hours after surgery, at 2 weeks and at 6 weeks postoperatively.

  16. Disfunción ventricular izquierda subclínica en diabéticos tipo I con 10 o más años de evolución de la diabetes Disfunción ventricular izquierda subclínica en diabéticos tipo I con 10 o más años de evolución de la diabetes Subclinical left ventricular dysfunction in type 1 diabetics with 10 or more years of diabetes progression

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    Omar Singh Linares

    2001-08-01

    Full Text Available Se realizó un estudio transversal en 32 diabéticos tipo 1 con 10 o más años de evolución, con edades entre 17 y 40 años, para conocer la frecuencia de disfunción ventricular izquierda (DVI subclínica y sus factores asociados. Se excluyeron los pacientes que presentaban valvulopatía, cardiopatía isquémica, hipertensión arterial y otras enfermedades que provocan miocardiopatía. A todos se les realizó una historia clínica completa y se les indicó: glucemia en ayunas, hemoglobina glucosilada (HbA1, colesterol total, triglicéridos totales, lipoproteína de alta densidad (HDL-colesterol, excreción urinaria de albúmina (EUA, velocidad de conducción nerviosa motora y sensitiva en los miembros inferiores, electrocardiograma y ecocardiograma a modo M, bidimensional y con Doppler pulsado. Para el diagnóstico ecocardiográfico de DVI se adoptaron los criterios propuestos por la Sociedad Americana de Ecocardiografía. Se comprobó DVI en el 34,3 %. Se observaron alteraciones estructurales cardíacas en el 18,75 %. Se presentó neuropatía periférica en 8/11 pacientes con DVI (72,7 %. Los niveles de EUA fueron significativamente mayores en los afectados de DVI (233,4 ± 176 mg/L. El engrosamiento de septum interventricular y de la pared posterior fue significativamente mayor en pacientes con DVI. Se concluyó que la DVI es una complicación frecuente en el diabético tipo 1, lo que obliga a su búsqueda sistemática en este grupo de pacientesA cross-sectional study of 32 type 1 diabetics aged 17-40 years, with 10 or more years of diabetes profession was conducted to find out the frequency of subclinical left ventricular dysfunction (LVD and its associated factors. Those patients presenting with valvulopathy, ischemic heart disease, blood hypertension and other diseases leading to myocardiopathy, were excluded. Their complete medical histories were made and they were indicated the following: glycemia in fasting conditions, glycosylated

  17. Ecocardiografia transesofágica e diagnóstico intraoperatório de veia cava superior esquerda persistente Ecocardiografía transesofágica y diagnóstico intraoperatorio de vena cava superior izquierda persistente Transesophageal echocardiography and intraoperative diagnosis of persistent left superior vena cava

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    Alexander Alves da Silva

    2009-12-01

    Full Text Available JUSTIFICATIVA E OBJETIVOS: A persistência da veia cava superior esquerda ocorre isoladamente em 0,5% da população normal, porém nos pacientes com cardiopatia congênita chega a estar presente em 3% a 10% dos casos. O objetivo deste relato foi apresentar um caso de diagnóstico intraoperatório com o auxílio da ecocardiografia transesofágica e ressaltar a importância da sua utilização rotineira em intervenções cirúrgicas para correção de cardiopatia congênita. RELATO DO CASO: Paciente do sexo masculino, 16 anos, ASA II, com diagnóstico prévio de comunicação interatrial (CIA tipo seio venoso superior com drenagem anômala parcial de veias pulmonares em programação para correção cirúrgica da cardiopatia. Após indução da anestesia geral foi realizado ecocardiograma transesofágico (ETE. O exame inicial mostrou dilatação das câmaras cardíacas direitas, CIA tipo seio venoso superior de 17 milímetros, drenagem anômala da veia pulmonar superior direita desembocando na veia cava superior (VCS direita e dilatação do seio coronário, o que aventou a possibilidade da persistência da veia cava superior esquerda. Para a confirmação da suspeita foram injetados no acesso venoso do braço esquerdo 10 mL de solução fisiológica a 0,9% (faz o papel de "contraste" no exame ecocardiográfico e imediatamente após foram visualizadas as microbolhas passando pelo seio coronário, teste positivo para o diagnóstico de VCS superior esquerda persistente. CONCLUSÕES: A ecocardiografia transesofágica rotineira no intraoperatório de pacientes com cardiopatia congênita tem fundamental importância como método auxiliar não só ao cirurgião, muitas vezes influenciando diretamente na técnica cirúrgica empregada, como também para o anestesiologista, que pode extrair do exame uma série de informações úteis no manuseio hemodinâmico do paciente.JUSTIFICATIVA Y OBJETIVOS: La persistencia de la vena cava superior izquierda ocurre

  18. Variabilidad de la dimensión fractal de la ramificación coronaria izquierda en ausencia y presencia de enfermedad arterial oclusiva moderada y severa Variability in fractal dimension of left coronary artery ramification during absence and presence of moderate and severe occlusive arterial disease

    Directory of Open Access Journals (Sweden)

    Javier Rodríguez

    Full Text Available La teoría fractal permite la caracterización objetiva de objetos irregulares. La ramificación coronaria izquierda es un objeto irregular que en la actualidad se evalúa por medio de la arteriografía, donde se determina la enfermedad arterial oclusiva a partir de la comparación de medidas entre segmentos arteriales, sin evaluar el impacto de la lesión en la ramificación coronaria total. La irregularidad de la totalidad de la ramificación coronaria puede evaluarse con dimensiones fractales. De manera fractal se caracterizaron imágenes consecutivas entre sístole y diástole de nueve pacientes con enfermedad arterial oclusiva moderada y se confrontaron con las medidas de siete pacientes con enfermedad arterial oclusiva severa y siete sin enfermedad arterial oclusiva mediante comparaciones de la variabilidad y la diferencia neta. Los pacientes con lesión moderada y sin enfermedad arterial oclusiva, presentan un comportamiento matemático que se caracteriza por mayor variabilidad, mientras que los pacientes con enfermedad arterial oclusiva severa presentan diferencias netas generalmente iguales a 0.The fractal theory allows the objective characterization of irregular objects. The left coronary artery ramification is an irregular object actually evaluated by means of arteriography, in which the occlusive arterial disease is evaluated through the comparison of measures between arterial segments, without evaluating the impact of the lesion in the whole coronary ramification. The irregularity of the whole coronary ramification can be evaluated through fractal dimensions. Consecutive images between systole and diastole of nine patients with moderate occlusive arterial disease were characterized in a fractal way and were confronted with the measures of seven patients with severe occlusive arterial disease and with seven without occlusive arterial disease by comparing the variability and the net difference. Patients with moderate lesion and

  19. La extrema izquierda armada colombiana representada en los relatos de ficción de la novela y el cuento, décadas de 1970 y 1990 The Colombian Armed Left-wing Represented in Fictional Narratives of the Novel and the Tale, Decades 1970 and 1990

    Directory of Open Access Journals (Sweden)

    Dairo Correa Gutiérrez

    2010-01-01

    Full Text Available A partir de un ejercicio de lectura comparativa de diez y siete obras literarias colombianas publicadas en las décadas de 1970 y 1980, entre novelas y cuentos, se busca debatir sobre la manera en que fue representada ficcionalmente la extrema izquierda armada en el país. El interés en explorar la narrativa deviene de la creciente importancia de su función testimonial para el análisis de fenómenos sociopolíticos. La literatura, en tanto discurso dotado de múltiples significados, fue durante el periodo estudiado, un arte politizado y un vehículo para la denuncia de asimetrías sociales, capaz de recoger tipos sociales densamente considerados que ilustran la interacción de grupos humanos y el poder político. El artículo pretende aportar a los estudios en torno a las relaciones literatura-política, los cuales en Colombia hoy están ligados a la construcción de la idea de nación, las guerras civiles del siglo XIX, la Violencia de los años 50 del siglo XX y recientemente al narcotráfico.Based on a comparative reading exercise of seventeen Colombian literary works published in the 1970s and 1980s, including novels and short stories, the paper seeks to discuss how was fictionally represented the armed extreme left-wing in the country. The interest in exploring the narrative stems from the growing importance of its testimonial role for the analysis of socio-political phenomena. The Literature, as speech endowed with multiple meanings, was during the period studied a politicized art and a vehicle for the exposure of several social inequalities, capable to gather densely considered social types that illustrate the interaction of human groups and political power. The article seeks to contribute to studies on Literature-Politics relations, which in Colombia today are linked to the construction of the idea of Nation, the Civil Wars of the nineteenth century, the violence of the 50s of the twentieth century and, recently, drug trafficking.

  20. TECNOLOGÍA LÍTICA EN LA MARGEN IZQUIERDA DEL PARANÁ MEDIO: LOS MATERIALES RECUPERADOS EN JURISDICCIÓN GOYA (CORRIENTES, ARGENTINA / Lithic technology along the left margin of the Paraná river: the assemblages from Goya (Corrientes, Argentina

    Directory of Open Access Journals (Sweden)

    Carolina V. Píccoli

    2014-12-01

    Full Text Available En el marco de las investigaciones arqueológicas iniciadas en el año 2007 en la margen izquierda del curso medio del río Paraná, en el sector de su llanura aluvial comprendido en la jurisdicción Goya (Corrientes, Argentina, se identificaron distintas concentraciones arqueológicas en las que el material lítico constituye uno de los ítems menos representados. En este trabajo se presenta el análisis tecnológico de la totalidad del conjunto lítico hasta ahora recuperado en las distintas instancias de trabajo de campo realizadas en el sector mencionado. Se efectuó la caracterización macroscópica del mismo para identificar los diversos estadios de la cadena de producción lítica. Asimismo, se evalúan los resultados en relación con la disponibilidad de las materias primas. El análisis realizado permite sostener que en los sitios no se llevaron a cabo las primeras etapas de la confección de artefactos líticos. Asimismo, para tales fines se utilizó principalmente una de las dos únicas materias primas procedentes de la región del Paraná Medio, factibles de ser utilizadas (areniscas. Palabras clave: material lítico; análisis tecnológico; río Paraná; Holoceno tardío.    Abstract As a result of the archaeological research began in 2007 on the left bank of Middle Paraná River, Goya (Corrientes, Argentina, lithic material was recovered in low frequency. This paper presents the technological analysis of the lithic assemblage recovered. The analysis was based on the macroscopic characteristics to identify different stages of stone tool production. It also includes geological references to provide a context for understanding lithic raw material availability in the area. The analysis reflects that initial stages of production occurred off-site. Also, the preferential use of one specific local raw material was observed (sandstone. Keywords: lithic material, technological analysis, Paraná River, Late Holocene

  1. Lesão da artéria ilíaca esquerda durante laminectomia lombar: relato de caso Lesión de la arteria ilíaca izquierda durante laminectomia lombar: relato de caso Left iliac artery injury during lumbar laminectomy: case report

    Directory of Open Access Journals (Sweden)

    Wanderley Rodrigues Moreira

    2003-08-01

    Full Text Available JUSTIFICATIVA E OBJETIVOS: Lesão da artéria ilíaca é uma ocorrência rara em laminectomias, porém, muito grave. O objetivo deste relato é apresentar um caso de lesão da artéria ilíaca esquerda, em paciente submetido a laminectomia lombar sob raquianestesia, que se manifestou clinicamente no pós-operatório imediato, sete horas após o início da cirurgia. RELATO DO CASO: Paciente do sexo masculino, estado físico ASA I, 31 anos, 68 kg, foi submetido à laminectomia lombar em decúbito ventral sob raquianestesia em L2-L3, com bupivacaína hiperbárica a 0,5% (20 mg e fentanil 25 µg. A cirurgia transcorreu normalmente e sete horas após o seu início, já no pós-operatório, o paciente apresentou hipotensão arterial, taquicardia, agitação e dor abdominal difusa. A tomografia abdominal mostrou aspecto compatível com hematoma retroperitoneal e a laparotomia exploradora revelou lesão da artéria ilíaca comum esquerda. Após a laparotomia, o paciente evoluiu bem. CONCLUSÕES: Na dependência do posicionamento e do estado físico, técnicas de anestesia geral se impõem. O caso chama atenção para o fato de que qualquer técnica anestésica que tenha sido realizada, o sangramento no campo operatório pode não ser real, na vigência de uma lesão vascular, porque este sangramento pode ser tardio. No presente caso, a manifestação clínica ocorreu sete horas após o início da cirurgia, quando o paciente já estava recuperado da anestesia. No entanto, o fenômeno (hipotensão arterial poderia ter ocorrido no per-operatório.JUSTIFICATIVA Y OBJETIVOS: Lesión de la arteria ilíaca es una ocurrencia rara en laminectomias, no obstante, muy grave. El objetivo de este relato es presentar un caso de lesión de la arteria ilíaca izquierda, en paciente sometido a laminectomia lombar sobre raquianestesia, que se manifestó clínicamente en el pós-operatorio inmediato, siete horas después del inicio de la cirugía. RELATO DEL CASO: Paciente

  2. Disfunción ventricular izquierda subclínica en diabéticos tipo 1 con menos de 10 años de evolución de la diabetes Subclinical left ventricular dysfunction in type 1 diabetics with less than 10 years of evolution of diabetes

    Directory of Open Access Journals (Sweden)

    Manuel Licea Puig

    2001-04-01

    Full Text Available Se realizó un estudio transversal en 32 diabéticos tipo 1 con menos de 10 años de evolución de la enfermedad, edades entre 17 y 40 años, para conocer la frecuencia de disfunción ventricular izquierda (DVI subclínica y factores asociados a la misma. Se excluyeron los pacientes que presentaron valvulopatías, cardiopatía isquémica, hipertensión arterial y otras enfermedades que provocan miocardiopatías. Se les realizó una historia clínica completa y se les indicó: glucemia en ayunas, HbA1, colesterol total, triglicéridos totales, HDL-colesterol, excreción urinaria de albúmina (EUA, velocidad de conducción motora y sensitiva de los miembros inferiores, electrocardiograma y ecocardiograma modo M, bidimensional y con Doppler pulsado. Se adoptaron los criterios propuestos por la Sociedad Americana de Ecocardiografía para el diagnóstico ecocardiográfico de DVI. Se comprobó DVI en el 25 %. Las alteraciones estructurales cardíacas se observaron en el 6,2 %. La neuropatía periférica se presentó en 6 de 8 pacientes con DVI. Los niveles de EUA fueron significativamente mayores en los afectados de DVI (219,5 ± 170,2 mg/L vs. 66,9 ± 86,9 mg/L. En conclusión, se afirmó que la DVI es de observación relativamente frecuente en los diabéticos con menos de 10 años de evolución y los niveles de EUA pudieran constituir un marcador de riesgo para el desarrollo de esta complicación.A cross-sectional study in 32 type l diabetics aged 17-40 with less than 10 years of evolution of the disease was conducted to know the frequency of subclinical left ventricular dysfunction (LVD and its associated factors. Patients with valvulopathies, ischemic heart disease, arterial hypertension and other diseases causing myocardiopathies, were excluded. Complete medical histories were obtained and fasting glycemia, HbAl, total cholesterol, total triglycerides, HDL-cholesterol, urinary excretion of albumin (USA, velocity of motor and sensitive conduction

  3. Situs inversus totalis

    OpenAIRE

    Navarro, Veronica; Oshiro, Harumi; Peña, Bruce; Moquillaza Pineda, Fernando

    2014-01-01

    Situs inversus totalis (SIT) es una enfermedad rara, en la cual existe transposición de los órganos torácicos y abdominales. Se presenta el caso de una paciente de 65 años de edad, que acude a emergencias por dolor epigástrico de 20 horas de evolución que luego de unas horas migra a fosa iliaca izquierda asociado a hiporexia. En primera instancia, se sospecha del diagnóstico de diverticulitis, luego de los exámenes imagenológicos respectivos es descartada por encontrarse hallazgos co...

  4. Evaluación radiográfica de aumentos de rebordes alveolares con injertos aloplásticos de hidroxiapatita no reabsorbible : seguimiento a nueve meses

    OpenAIRE

    Gil Cárdenas, Félix Antonio

    2008-01-01

    Introducción: el objetivo fue determinar radiográficamente el porcentaje de estabilidad de la altura del reborde alveolar del maxilar superior e inferior en pacientes sometidos a cirugía preprotésica de aumento de reborde con implante de HA no reabsorbible. Métodos: el estudio se realizó en quince pacientes, en quienes se determinaron mediciones reproducibles. Para el maxilar superior: (A) desde espina nasal anterior; (B derecha-izquierda) desde el borde más inferior de las fosas nasales; (C ...

  5. Terapia de resgate com amiodarona em crianças com grave disfunção ventricular esquerda causada por veneno de escorpião Terapia de rescate con amiodarona en niños con severa disfunción ventricular izquierda ocasionada por veneno de escorpión Antiadrenergic rescue therapy with amiodarone in children with severe left ventricular dysfunction secondary to scorpion envenomation

    Directory of Open Access Journals (Sweden)

    Justo J. Santiago

    2010-01-01

    Full Text Available FUNDAMENTO: As crianças picadas por escorpião, pressintam ativação maciça do sistema nervoso simpática com vários graus de disfunção sistólica ventricular esquerda. OBJETIVO: Testar um protocolo de resgate em crianças com grave disfunção ventricular esquerda causada por picada de escorpião. Métodos: Quatro crianças após serem picadas por escorpião foram submetidas a: Encubação endotraqueal e suporte respiratório, eletrocardiograma, radiografia de tórax, ecocardiograma e determinação sérica da norepinefrina e troponina I. As análises foram repetidas após 12, 24 e 48 horas. As seguintes medicações intravenosas foram administradas: dobutamina 4-6 μg/kg/min; amiodarona 3 mg/kg durante duas horas, com dose de manutenção de 5 mg/kg/dia; e furosemida 0,5 mg/kg. Amiodarona, dobutamina e furosemida foram administradas durante as primeiras 48 horas. Bloqueadores beta-adrenérgicos e inibidores da enzima conversora da angiotensina foram administrados até 48 após a internação, uma vez que o estado clínico havia melhorado e a fração de ejeção ventricular esquerda encontrava-se acima de 0,35%. RESULTADOS: Na admissão, a dosagem da norepinefrina foi 1.727,50± 794,96 pg/ml, a de troponina I 24,53 ± 14,09 ng/ml e a fração de ejeção do ventrículo esquerdo foi 0,20 ± 0,056. Após 12 horas, os níveis séricos de norepinefrina e de troponina I diminuíram para a metade dos valores iniciais e a fração de ejeção aumentou para 0,32 ± 0,059. Durante as 24 e 48 horas subseqüentes, a fração de ejeção elevou-se para 0,46 ± 0,045 (pFUNDAMENTO: Los niños con picaduras de escorpión sufren activación masiva del sistema nervioso simpático con varios grados de disfunción sistólica ventricular izquierda. OBJETIVO: Probar un protocolo de rescate en niños con disfunción ventricular severa izquierda ocasionada por picadura de escorpión. MÉTODOS: Cuatro niños tras un escorpión picarlas se sometieron a: incubaci

  6. 扩张的颈肩峰区锁骨上皮瓣修复面颈部软组织缺损%Pre-expanded cervico-acromial flap based on the supraclavicular artery for resurfacing soft tissue defects of head and neck

    Institute of Scientific and Technical Information of China (English)

    杨喆; 刘伟; 李养群; 王乃利; 唐勇; 赵穆欣; 马宁; 王维新

    2015-01-01

    Objective To investigate the therapeutic effect of pre-expanded cervico-acromial flap based on the supraclavicular artery for resurfacing soft tissue defects of head and neck. Methods In this series,from Jan 2008 to Jan 2014,24 patients with ages between 5 and 42 years suffering from facial and cervical scar or nevis or port-wine stain were treated.In the first stage,the tissue expander (600ml to 800ml in volume) was implanted on the deep fascia layer of the cervicoacromial region;600 to 800ml saline were injected during a 10 to 16 weeks period.In the second stage after expansion, sufficient skin and tissue was obtained to resurface the defects of head and neck. Results All 24 flaps healed primarily with good functional and cosmetic results.The maximum size of the flap was 23cm × 16cm,whereas the minimum size was 20cm × 8cm.After an average follow-up time of 12 months, significant improvement in function with good esthetic outcomes were achieved,and the donor sites scar seemed acceptable.There were no significant complications. Conclusion The pre-expandedcervico-acromialfasciocutaneous flap based on the supraclavicularartery can provide a large amount of thin tissue with both good color and texture,and without the need for microsurgery, and avoid the disadvantages of donor-site morbidity.This flap is reliable and safe for resurfacing large skindefects of the head and neck.%目的:探讨扩张的颈肩峰区锁骨上皮瓣修复面颈部较大面积软组织缺损的临床治疗效果。方法:2008年1月至2014年1月对24例面颈部软组织缺损患者,年龄5~42岁,采用以锁骨上动脉为蒂的预扩张的颈肩峰区筋膜皮瓣修复。一期在颈肩峰区域深筋膜浅层埋置1~2枚扩张器(600~800ml),定期注水,二期切除面颈部瘢痕或色素病变,以扩张皮瓣带蒂转移修复组织缺损,供区多可直接缝合。结果:本组24例患者扩张皮瓣切取面积为20cm×8cm~23cm×16cm,皮瓣均成活

  7. Brachial plexus injury: the London experience with supraclavicular traction lesions.

    Science.gov (United States)

    Birch, Rolfe

    2009-01-01

    In this article, the author details the experiences of his hospital and other London hospitals in treating brachial plexus injury. As noted, important advances have been made in methods of diagnosis and repair. Myelography was replaced by CT scan and later by MRI. Among the topics the author explores are diagnosis (including pain, the presence or absence of the Tinel sign, and the irradiation of pins and needles) and the principles of repair. The author emphasizes that it is imperative that ruptured nerves be repaired as soon as possible, with the closed traction lesion coming, in urgency, close behind reattachment of the amputated hand or repair of a great artery and a trunk nerve in the combined lesion. Finally, the article concludes that the surgeon must be actively engaged in the whole process of rehabilitation and treatment of pain. This is part of a Point-Counterpoint discussion with Dr. David G. Kline's presentation of "A Personal Experience."

  8. Thermoradiotherapy using ultrasound hyperthermia system for supraclavicular lymph node metastasis

    Energy Technology Data Exchange (ETDEWEB)

    Kuroki, Masaomi; Ono, Seiji; Shiba, Toru; Nishii, Ryuiti; Tamura, Shozo [Miyazaki Medical Coll., Kiyotake (Japan); Hirose, Tetsuo; Kawamura, Shinji

    1998-06-01

    Metastatic lymphnodes located in the subclavian region were treated with thermoradiotherapy using an ultrasound hyperthermia system. The mean size of tumor was 37 mm diameters (range 30-55 mm). Two cases were histologically diagnosed adenocarcinoma and one case was squamous cell carcinoma. The radiation dose was 40-64 Gy. The hyperthermia was performed once or twice a week, total number of session was 4-6. The ultrasound frequency of applicator was 1.0 MHz or 1.5 MHz. The temperature of tumor center was measured by thermo-couples. In three out of 4 cases the tumor temperature raised over 42.5degC within about 6 minutes but temperature of skin surface were under 37.0degC. Three cases had complete response and one case had partial response. Side effects were occurred in two cases, those were pain of clavicle and weakness of affected side arm and blister. The thermoradiotherapy using ultrasound hyperthermia system was considered to be useful modality for subclavian lymphnode metastasis. (author)

  9. Supraclavicular lymph node tuberculosis presenting with immune thrombocytopenic purpura

    Institute of Scientific and Technical Information of China (English)

    LU Hua; WANG Yong-ren; JI Ou; XU Wei; ZHANG Jian-fu; FAN Qin-he; LI Jian-yong

    2007-01-01

    @@ Tuberculosis (TB) differs from many other infectious maladies in having particular social and geographic distributions. The disease was under control in developed nations and being brought under control in developing countries, as in China.

  10. hoarseness and Horner's after supraclavicular brachial plexus block

    African Journals Online (AJOL)

    injury was suspected and a tourniquet was applied over the proximal part of the upper ... air SpO2 98%. Airway, spine and systemic examination revealed ... A nerve stimulator (Stimuplex DIG RC®; B. Braun Medical Inc,. Bethlehem, PA, USA) ...

  11. Democracia profética. De la izquierda cristiana a la izquierda social en las páginas de la revista Alternativa Latinoamericana (1985-1990

    Directory of Open Access Journals (Sweden)

    Guillermo Alejandro Barón Del Pópolo

    2016-03-01

    Full Text Available Una de las categorías histórico sociales fundamentales que ordena el discurso del movimiento cristiano ecuménico argentino en los 80 es la oposición democracia substancial y democratismo abstracto. Con esta categorización el movimiento ecuménico logró instalar la discusión hacia adentro de un espacio democrático mayor, determinado por la oposición al autoritarismo. Esta dicotomía no es sino la expresión de una oposición categorial más abarcativa, aquella planteada entre profetismo y mesianismo que para nosotros caracteriza a los movimientos sociales de inspiración cristiana en el nuevo escenario que se abre en América Latina luego del periodo signado por las dictaduras de seguridad nacional.

  12. La cuestión democrática en la izquierda latinoamericana: del dilema izquierda-derecha al dilema democracia-autoritarismo

    OpenAIRE

    Zapata,Francisco

    2010-01-01

    O texto analisa as razões de se importar gás natural boliviano. O emprego do carburante importado foi admitido como uma das formas para neutralizar a crise de energia elétrica que o Brasil vem atravessando desde os anos 1990, cujo ápice se deu com o "apagão" de 2001. Além disso, o uso da matéria-prima traduz a ausência de políticas públicas coerentes para o setor energético. O Brasil aceitou, em grande parte, programas sugeridos pelas agências financeiras internacionais, que negavam o papel e...

  13. Compresiones neurovasculares de la fosa craneal posterior en la neuralgia del trigémino. Estudio anatomoclínico

    OpenAIRE

    Ruiz Juretschke, Fernando

    2016-01-01

    La neuralgia del trigémino (NT) es un síndrome doloroso facial caracterizado por un dolor neuropático paroxístico irradiado al territorio sensitivo del nervio trigémino. A lo largo de las últimas décadas la creciente evidencia experimental y clínica ha contribuido a establecer la teoría de una compresión neurovascular (CNV) del nervio trigémino como causa fundamental de este trastorno. Esta teoría apoya el tratamiento quirúrgico de la NT mediante una descompresión microvascular (DMV). Actualm...

  14. Las fronteras de la memoria. La masacre de las Fosas Ardeatinas. Historia, mito, rituales y símbolos

    OpenAIRE

    Alessandro Portelli

    2002-01-01

    Les voy a hablar sobre la interacción que se establece entre lo que consideramos un hecho y lo que ocurre en la memoria, incluyendo acontecimientos imaginarios y falsos recuerdos. Lo haré a través de un caso específico -el asesinato de 335 personas, rehenes o, simplemente, personas tomadas al azar en la calle por las fuerzas de ocupación alemanas, en Roma en 1944, como represalia por un ataque partisano. En ese acto occurrido el día anterior, al que los registros británicos llaman consecuente...

  15. Fibrilación auricular en una paciente con megaorejuela auricular izquierda

    Directory of Open Access Journals (Sweden)

    Alejandro Villamil

    2007-01-01

    Full Text Available La FA constituye una de las arritmias sostenidas más frecuentes que motivan la consulta. El sustrato comprende diferentes mecanismos, entre los que se encuentra el agrandamiento auricular izquierdo. Presentamos el caso de una mujer de 33 años con antecedentes depalpitaciones, que ingresó en la guardia por FA de alta respuesta ventricular. En la radiografía de tórax se observó una deformación del borde izquierdo de la silueta cardíaca. Posteriormente,el ecocardiograma transesofágico y la resonancia magnética nuclear evidenciaron una megaorejuela aneurismática debida, probablemente, a un defecto pericárdico. La conducta fue anticoagulación oral y tratamiento con atenolol, con evolución favorable.

  16. Uruguay 2006: éxitos y dilemas del gobierno de izquierda

    Directory of Open Access Journals (Sweden)

    Daniel Chasquetti

    2007-01-01

    Full Text Available El artículo repasa el año político uruguayo a partir de la evaluación de los éxitos del gobierno en materia de crecimiento de la economía, mejoras en el terreno social y avances en los derechos humanos. También se examinan el papel del conflicto entre Uruguay y Argentina, el debate sobre la inserción internacional del país, la elección interna del partido de gobierno y el trabajo del Poder Ejecutivo y Legislativo. El artículo concluye con una reflexión sobre los desafíos de la democracia uruguayaThe article reviews the Uruguayan political year, taken into account the government successes in areas as the growth of the economy, the social indicators, and the advances in the human rights. The article also analyses the conflict between Uruguay and Argentina, the debate on the Uruguayan international insertion, the election of authorities of the government party, and the performance of the Executive and Legislative branches. The article concludes with a reflection on the challenges of the Uruguayan democracy

  17. Las izquierdas en América Latina: cómo caracterizar el caso argentino

    Directory of Open Access Journals (Sweden)

    Graciela Ducatenzeiler

    2010-12-01

    Full Text Available The aim of this paper is to provide an overview of the differences between the many "left" in Latin America and interpret the Argentine case, discussing the usefulness of the concept to describe this political phenomenon. We'll see how far the Kirchner government meets the objectives of the new left and if there is consistency between public policies and their results. Our argument is that the progressive rhetoric of these governments is not accompanied by appropriate public policies or by institutional reforms leading to the establishment of a more democratic and more egalitarian society.

  18. Terapia VAC® en traumatismo grave de pierna izquierda VAC® therapy in severe left leg injury

    Directory of Open Access Journals (Sweden)

    F.J. De Juan Pérez

    2010-09-01

    Full Text Available Las fracturas abiertas de los miembros inferiores debidas a traumatismos de alta energía, suponen un reto terapéutico debido a la gravedad de las heridas, la afectación importante de varios tipos de tejidos y a la complejidad de los procedimientos quirúrgicos necesarios para su tratamiento que pueden llegar hasta complicadas técnicas microquirúrgicas mediante colgajos libres, quedarse en un colgajo muscular o compuesto, pediculado, o bien mantener una actitud más conservadora. Esto último es posible desde la aparición en los años 90 de una nueva técnica, la Terapia Vacuum Assisted Closure (Terapia VAC®, que se basa en la aplicación de vacío o presión negativa sobre la herida. Este recurso terapéutico permite una pauta más conservadora de tratamiento de estas fracturas tan complejas, reduciendo los riesgos, la morbilidad y minimizando las complicaciones. Presentamos un caso de fractura del miembro inferior izquierdo, abierta, compleja, con policontusión y aplastamiento, que creemos muy demostrativo del excelente resultado clínico que se puede obtener mediante el empleo de la terapia con presión negativa con el Sistema VAC®.The open fractures of the lower limb caused by high energy trauma, poses a major surgical challenge. These wounds have a significative complexity, with multiple lesions involving bone, muscle, nerves, vessels, skin and subcutaneous tissues. There are a wide spectrum of reconstructive options for the treatment, most of them requiring complex microsurgical transfers of autologous tissue. The Vacuum Assisted Therapy (VAC® has become a most useful tool for the plastic surgeon since the last century´s 90 decade. Based in the application of negative pressure to the wound bed, promotes healing by granulation tissue formation, keeping the wound clean and avoiding bacterial colonization. Used as a primary method or in combination with others, VAC® therapy allows more conservative options in the treatment of these wounds, lowering the incidence of complications and avoiding the need of demanding and high cost surgical interventions. We describe the application of the VAC® therapy in a clinical case with complex lower limb open fracture and crush injury, showing its efficacy.

  19. Terapia VAC® en traumatismo grave de pierna izquierda VAC® therapy in severe left leg injury

    OpenAIRE

    F.J. De Juan Pérez

    2010-01-01

    Las fracturas abiertas de los miembros inferiores debidas a traumatismos de alta energía, suponen un reto terapéutico debido a la gravedad de las heridas, la afectación importante de varios tipos de tejidos y a la complejidad de los procedimientos quirúrgicos necesarios para su tratamiento que pueden llegar hasta complicadas técnicas microquirúrgicas mediante colgajos libres, quedarse en un colgajo muscular o compuesto, pediculado, o bien mantener una actitud más conservadora. Esto último es ...

  20. Frente conjetural: escritores brasileños de izquierda y el Estado Novo

    Directory of Open Access Journals (Sweden)

    Moreira, Luiza F.

    2010-08-01

    Full Text Available In the official newspaper of the Estado Novo, a dictatorship led by Getúlio Vargas in Brazil from 1937 to 1945, a group of intellectuals organized a cultural section, «Pensamento da América», devoted to publishing translations of writers from across the Americas. Drawing on archival research, this article reconstructs the trajectory of this cultural section, from muted anti-fascism and Latin Americanism, in 1941, to playing a supporting role for Vargas’s wartime foreign policy, from 1942 on. It is concerned, above all, with exploring the contexts that both opened the way and set the limits for the activities of the intellectuals responsible for «Pensamento da América».

    En el diario oficial del Estado Novo, la dictadura liderada por Getúlio Vargas en Brasil entre 1937 y 1945, un grupo de intelectuales organizaron una sección cultural, «Pensamento da América», dedicada a publicar traducciones de escritores de toda América. Basado en trabajo de archivo, este artículo reconstruye la trayectoria de esta sección cultural, desde un antifascismo y latinoamericanismo más bien en sordina durante 1941, hasta su papel de apoyo a la política exterior de Vargas durante la guerra, de 1942 en adelante. El artículo se ocupa, sobre todo, de explorar los contextos que abrieron el camino y establecieron los límites para las actividades de los intelectuales responsables de «Pensamento da América».

  1. Agnosia integrativa causada por una epilepsia focal occipital izquierda: estudio de caso

    Directory of Open Access Journals (Sweden)

    Óscar Mauricio Aguilar Mejía

    2011-01-01

    Full Text Available La agnosia integrativa es un tipo de agnosia visual asociada a lesiones occipitales bilaterales que se caracteriza por la incapacidad para identificar estímulos en fondos complejos, especialmente, cuando se trata de formas superpuestas o entrelazadas. Existen dificultades para codificar y agrupar el todo a partir de las partes del estímulo. Se presenta un caso de una paciente de 14 años, con una agnosia integrativa como consecuencia de una epilepsia focal sintomática refractaria, con un foco epileptogénico occipital izquierdo. Se plantean las características clínicas de la paciente y se hace un análisis de sus procesos de reconocimiento visual discutidos a partir de los diferentes modelos teóricos que tratan de explicar la percepción visual.

  2. 乌拉圭的左派政党%Los partidos de izquierda de Uruguay

    Institute of Scientific and Technical Information of China (English)

    贺双荣

    2004-01-01

    乌拉圭左派政党的发展令人关注。一是自20世纪70年代以来左派政党的力量不断壮大;二是左派政党进步联盟一广泛阵线候选人塔瓦雷·巴斯克斯可能在2004年10月的总统选举中获胜,从而打破乌拉圭自独立以来两大传统政党长期轮流执政的政治格局;三是如果巴斯克斯当选,未来的进步联盟一广泛阵线政府将会与巴西和阿根廷的左派政府加强合作,从而对南美地区的政治及地区一体化合作产生重要影响。

  3. Fibrilación auricular en una paciente con megaorejuela auricular izquierda

    OpenAIRE

    Alejandro Villamil; Patricia Avellana; Claudio Hadid; Horacio Di Nunzio; Daniela Coria; Darío Di Toro; Noemí Prieto

    2007-01-01

    La FA constituye una de las arritmias sostenidas más frecuentes que motivan la consulta. El sustrato comprende diferentes mecanismos, entre los que se encuentra el agrandamiento auricular izquierdo. Presentamos el caso de una mujer de 33 años con antecedentes depalpitaciones, que ingresó en la guardia por FA de alta respuesta ventricular. En la radiografía de tórax se observó una deformación del borde izquierdo de la silueta cardíaca. Posteriormente,el ecocardiograma transesofágico y la reson...

  4. Asistencia ventricular izquierda para terapia de destino: primera experiencia en septuagenarios

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    Sebastian V. Rojas

    2016-10-01

    Conclusiones: Nuestros resultados iniciales demuestran que el implante mínimamente invasivo de DAVI puede ser realizado de manera eficaz, segura y con buenos resultados en pacientes septuagenarios terapia de destino. Los bajos niveles de eventos adversos durante el seguimiento por 2 años demuestran que la terapia de destino puede ser realizada incluso en pacientes septuagenarios.

  5. Los días terrenales y el escándalo de las izquierdas

    Directory of Open Access Journals (Sweden)

    Marco Campos

    2009-10-01

    mexicano, dando señales sobre las diferencias que el autor tuvo con la orientación del partido en la década del 50 y, sobre todo, las relaciones, también críticas, con el escritor chileno Pablo Neruda, comunista ortodoxo por entonces.

  6. Terapia VAC® en traumatismo grave de pierna izquierda VAC® therapy in severe left leg injury

    Directory of Open Access Journals (Sweden)

    F.J. De Juan Pérez

    2011-12-01

    Full Text Available Las fracturas abiertas de los miembros inferiores debidas a traumatismos de alta energía, suponen un reto terapéutico debido a la gravedad de las heridas, la afectación importante de varios tipos de tejidos y a la complejidad de los procedimientos quirúrgicos necesarios para su tratamiento que pueden llegar hasta complicadas técnicas microquirúrgicas mediante colgajos libres, quedarse en un colgajo muscular o compuesto, pediculado, o bien mantener una actitud más conservadora. Esto último es posible desde la aparición en los años 90 de una nueva técnica, la Terapia Vacuum Assisted Closure (Terapia VAC®, que se basa en la aplicación de vacío o presión negativa sobre la herida. Este recurso terapéutico permite una pauta más conservadora de tratamiento de estas fracturas tan complejas, reduciendo los riesgos, la morbilidad y minimizando las complicaciones. Presentamos un caso de fractura del miembro inferior izquierdo, abierta, compleja, con policontusión y aplastamiento, que creemos muy demostrativo del excelente resultado clínico que se puede obtener mediante el empleo de la terapia con presión negativa con el Sistema VAC®.The open fractures of the lower limb caused by high energy trauma, poses a major surgical challenge. These wounds have a significative complexity, with multiple lesions involving bone, muscle, nerves, vessels, skin and subcutaneous tissues. There are a wide spectrum of reconstructive options for the treatment, most of them requiring complex microsurgical transfers of autologous tissue. The Vacuum Assisted Therapy (VAC® has become a most useful tool for the plastic surgeon since the last century´s 90 decade. Based in the application of negative pressure to the wound bed, promotes healing by granulation tissue formation, keeping the wound clean and avoiding bacterial colonization. Used as a primary method or in combination with others, VAC® therapy allows more conservative options in the treatment of these wounds, lowering the incidence of complications and avoiding the need of demanding and high cost surgical interventions. We describe the application of the VAC® therapy in a clinical case with complex lower limb open fracture and crush injury, showing its efficacy.

  7. Agnosia integrativa causada por una epilepsia focal occipital izquierda: estudio de caso

    OpenAIRE

    Óscar Mauricio Aguilar Mejía; Beatriz Ramírez Bermejo; Luis Manuel Silva Martín

    2011-01-01

    La agnosia integrativa es un tipo de agnosia visual asociada a lesiones occipitales bilaterales que se caracteriza por la incapacidad para identificar estímulos en fondos complejos, especialmente, cuando se trata de formas superpuestas o entrelazadas. Existen dificultades para codificar y agrupar el todo a partir de las partes del estímulo. Se presenta un caso de una paciente de 14 años, con una agnosia integrativa como consecuencia de una epilepsia focal sintomática refractaria, con un foco ...

  8. CIERRE PERCUTÁNEO DE LA OREJUELA IZQUIERDA EN PACIENTES CON FIBRILACIÓN AURICULAR

    Directory of Open Access Journals (Sweden)

    Fernandez G

    2014-01-01

    Full Text Available Atrial fibrillation is the most common sustained arrhythmia in the adult population and stroke is its most feared and devastating complication. Anticoagulation has proved to effectively reduce this event. The main risk of this therapy is major bleeding. Furthermore, patients who have greater risk of haemorrhages are also those with contraindications for anticoagulation. It is well-known that about 90% of thrombi are located in the left atrial appendage (LAA. Recently, percutaneous-implanted devices have been developed aiming the occlusion of LAA, thereby isolating it from the systemic circulation and preventing thrombi embolism. The characteristics of the different devices will be presented. We will briefly explain the implantation technique and the evidence currently available for its use in general population and in those patients who have contraindication for anticoagulation.

  9. Estesioneuroblastoma, una tumoración poco frecuente. A propósito de un caso

    Directory of Open Access Journals (Sweden)

    Ángel A Rodríguez U

    2014-09-01

    Full Text Available El estesioneuroblastoma es un tumor que se origina del neuroepitelio olfatorio y su incidencia es del 3% de los tumores nasales. Los síntomas son inespecíficos, pero las dos manifestaciones más frecuentes son la obstrucción nasal unilateral y la epistaxis. El diagnóstico definitivo de los pacientes es mediante el estudio histológico, el cual es difícil porque se confunde a menudo con otras neoplasias de células pequeñas y redondas de la cavidad nasal y la inmunohistoquímica de las muestras de la biopsia. Los enfoques terapéuticos actuales incluyen la combinación de técnicas endoscópicas con craneotomía anterior, seguidos de radioterapia adyuvante; y la quimioterapia en estadios avanzados. Se presenta un caso de masculino de 40 años de edad, quien consulta por epistaxis con predominio en la fosa nasal izquierda, en la rinoscopia anterior izquierda se evidencia una lesión ocupante de espacio, de aspecto blanco-grisáceo, no sangrante, de consistencia dura, con secreción serohemática escasa, la biopsia reporta una neoplasia maligna de células redondas pequeñas compatible con un neuroblastoma olfatorio (estesioneuroblastoma. Su diagnóstico definitivo se realiza con inmunohistoquímica. Se practica una maxilectomía total izquierda con la colocación de material de osteosíntesis. Debido a la baja incidencia de estas tumoraciones, es menester dar a conocer los casos existentes, para que luego sean estudiados por las nuevas generaciones de médicos, con el fin de no pasar por alto una patología poco usual.

  10. Estudio comparativo de la eficacia del bloqueo supraclavicular en la artroscopia de hombro Comparative study of the efficacy of the supraclavicular block for arthroscopic shoulder surgery

    Directory of Open Access Journals (Sweden)

    C. Morales Muñoz

    2010-12-01

    Full Text Available Introducción: Nuestro objetivo es valorar la eficacia de dos técnicas anestésicas en el tratamiento del dolor postoperatorio, así como su influencia en la estancia hospitalaria, tras la cirugía artroscópica de hombro. Material y métodos: Estudio retrospectivo basado en la recogida de datos de las historias de anestesiología y de nuestra unidad de dolor agudo (UDA, durante un período de 6 meses, seleccionando los casos de artroscopias de hombro realizadas y distribuyendo los pacientes en 2 grupos en función de la técnica anestésica empleada. En el grupo I se incluyó a pacientes con anestesia locorregional (bloque interescalénico e interesternocleidomastoideo combinado con anestesia general. En el grupo II se incluyeron los casos de anestesia general con analgesia por vía intravenosa con bolos de fentanilo. Las variables registradas fueron: dolor posoperatorio, tanto en reposo como en movimiento, en las primeras 24h, utilizando una escala verbal simple (EVS, la presencia de efectos secundarios, la necesidad de rescate analgésico y el tiempo quirúrgico empleado. En los casos en que los pacientes fueron dados de alta en las primeras 24h, se realizó una consulta telefónica para valoración de dichas variables. El análisis estadístico se realizó mediante prueba de la t de Student (para variables numéricas y prueba de la χ² (para analizar las relaciones entre variables cualitativas, considerando el estudio estadísticamente significativo si se obtuvo una p0,05. En el grupo de la anestesia combinada el tiempo medio de estancia fue de 36h, frente a las 60h de media en el grupo de anestesia general (pObjectives: Our aim is to evaluate the efficacy of two anesthetic techniques for the treatment of the postoperative pain, as well as their influence on hospital stay, after surgery arthroscopic of shoulder. Materials and methods: Retrospective study based on the collection of data from anesthesia histories and from of our postoperative acute pain unit, during a 6-months period. Cases of shoulder arthroscopies carried out during this period were selected and the patients were distributed in 2 groups depending on the anesthetic technique used: group I consisted of patients treated with locoregional anesthesia (interscalene and inter-sternocleidomastoid block combined with general anesthesia. Group II was general anesthesia cases with intravenous analgesia. The recorded variables were the following: postoperative pain, both at rest and during exercise in the first 24h, using a simple verbal scale (SVS; the presence of side effects, need of analgesic rescue and duration of hospital stay. In the cases where the patients were discharged from hospital in the first 24h, a telephone consultation was carried out for the evaluation of the abovementioned variables. Statistical analysis: Student-t and Chi-square tests. A P.05. In the group of combined anesthesia the average duration of hospital stay was 36h, compared to the 60h average duration in the group of General Anesthesia. (P<.05. Discussion: The blockade of the brachial plexus over the clavicle combined with general anesthesia has shown greater efficacy in the control of perioperative pain, both at rest and during exercise than the general anesthesia with intravenous analgesia. In addition, the incidence of undesirable effects, the need of rescue and the duration of hospital stay were lower in the group of patients with the combined technique, without significant effects on the duration of operating room occupation.

  11. Desarrollo educativo de vocaciones científicas y artísticas: percepciones sobre la lateralidad izquierda

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    Antonio Xavier Vergara López

    2016-01-01

    Full Text Available La política educativa en el Ecuador estuvo impactada con el compromiso que adquirió el Estado para cambiar la baja calidad educativa, la poca pertinencia del currículo y el acceso limitado de la educación por la falta de equidad. El plan decenal 2006-2015 intentó cimentar estos objetivos estratégicos en los siguientes marcos cognitivos: curricular, talento humano, financiero y de gestión, marco legal, marco de rendición de cuentas. En la matriz productiva postulada en el Plan Nacional del Buen Vivir se plantea como meta el fomento del talento humano en Ciencia y Tecnología para la producción de conocimiento en áreas prioritarias a nivel país

  12. Origen anómalo de la arteria pulmonar derecha y estenosis de vena pulmonar superior izquierda

    OpenAIRE

    Patiño Bahena,Emilia; Calderón-Colmenero,Juan; Ramírez,Samuel; García Montes,José Antonio; Meave, Aloha; Erdmenger,Julio; Zabal,Carlos; Buendía,Alfonso

    2006-01-01

    Se presenta una niña de 9 meses con historia de cianosis desde el período neonatal, la valoración cardiológica integral que incluyó angiocardiografía y angiorresonancia magnética estableció los siguientes diagnósticos: Origen anómalo de la rama derecha de la arteria pulmonar naciendo de la aorta ascendente, estenosis de vena pulmonar superior derecha, persistencia del conducto arterioso e hipertensión arterial pulmonar a nivel sistémico. Se llevó a cirugía correctiva de todos los defectos de ...

  13. El encuentro de la izquierda cubana con la Revolución Rusa: el Partido Comunista y la Comintern

    Directory of Open Access Journals (Sweden)

    Víctor Jeifets

    2017-04-01

    Full Text Available This article analyzes the background and evolution of the affiliation of the Cuban left with the Comintern (Communist International, from their first contacts with the Bolshevik Revolution until the end of the 1920s. The authors recover a little-known history in historiography to show that, despite a series of disagreements between Moscow and Cuban communism, Comintern influence was by no means considered unfavorable to interests for Cuba’s communist movement. In fact, it helped to strengthen the left in that nation.

  14. 262. Seudoaneurisma Sacular Aórtico y Origen Anómalo de Carótida Izquierda

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    N. Arce

    2012-04-01

    Conclusión: aunque poco frecuentes, las anomalías en el origen de los troncos supraaórticos implican un mayor riesgo de complicaciones neurológicas para el uso de endoprótesis en procedimientos híbridos. El abordaje convencional, mediante esternotomía media con extensión cervical de la incisión, hipotermia profunda y parada circulatoria permite, en estos casos, una más adecuada preservación de la perfusión cerebral aunque no evita totalmente el daño neurológico.

  15. Luchas hegemónicas y cambios político: el avance de la izquierda suramericana en perspectiva comparada.

    Directory of Open Access Journals (Sweden)

    Jorge Lazo Cividanes.

    2007-12-01

    Full Text Available The object of this article is to analyse the recent phenomenon of the left’s advance in South America. Besides considering institutional and structural factors which contribute to the comprehension of the left’s diverse expressions in the south of the continent, the analysis revolves around ideological and discursive aspects that give unity to the phenomenon. Starting from the hypothesis that the advance of the left in the region is linked to a process of hegemonic fights in societies with structural crisis, this article offers evidence that enlightens possible causal and explanatory factors of such a phenomenon from the perspective of discursive theory.

  16. ESTUDIO SOBRE PRODUCCION DE ORACIONES CON RAMIFICACION A LA IZQUIERDA Y A LA DERECHA EN ESPAÑOL

    OpenAIRE

    2012-01-01

    INTRODUCCIÓN La vejez es un estado de involución y no de enfermedad. Durante la involución senil, los órganos constitutivos del ser vivo se modifican y van sufriendo una regresión o atrofia en su estructura y sus funciones van experimentando una disminución. Estas modificaciones se manifiestan tanto en el plano físico como en el plano cognitivo. Según Juncos-Rabadán et al. (2006), el envejecimiento cognitivo es un proceso normal que tiene lugar a lo largo de los años y que produce un...

  17. La inteligencia de izquierdas en las constituyentes republicanas y su intento de transición ideológica

    Directory of Open Access Journals (Sweden)

    María Dolores GÓMEZ MOLLEDA

    2010-02-01

    Full Text Available Debo aclarar el primer momento que utilizo el término inteligencia en lugar del de intelectuales de modo necesario y no superfluo, ya que en ello reside precisamente el carácter de revisión que pretendo dar al tema. El término intelectuales ha sido empleado de modo exclusivamente reduccionista unas veces, de manera demasiado amplia otras. Inteligencia es un concepto sociológico no referido exclusivamente a una alta élite intelectual, aunque tampoco a una minoría de fronteras indeterminadas cualitativamente hablando. Se incluyen en este concepto aquellos individuos con titulación académica o de oficio intelectual con unas determinadas connotaciones sociales, culturales y políticas -las precisaremos en seguida- que como grupo social se definen por su papel ideológico y ético-político.

  18. 220. Asistencia univentricular izquierda Berlin heart como puente al trasplante en pacientes con hipertensión pulmonar grave

    Directory of Open Access Journals (Sweden)

    P. Martínez Cabeza

    2010-01-01

    Conclusiones: En nuestra limitada experiencia, este tipo de estrategia permite: a reducir significativamente la presión pulmonar; b realizar el trasplante cardíaco, y c hacerlo con garantías de éxito.

  19. ¿Cooptación, cooperación o competencia? Microfinanzas y nuevas izquierdas en Bolivia, Ecuador y Nicaragua

    Directory of Open Access Journals (Sweden)

    Florent Bédécarrats

    2013-05-01

    Full Text Available La última década ha estado marcada por el resurgimiento de movimientos políticos izquierdistas en Latinoamérica. Sin embargo, la magnitud del alzamiento de estas “nuevas izquierdas” oculta a menudo la relación ambivalente entre estos movimientos y la sociedad, así como su lucha por encontrar alternativas al modelo de desarrollo prevaleciente. A lo largo del continente, el sector de las microfinanzas ha llenado el vacío dejado por los fallos de los bancos públicos, desarrollándose bajo una forma crecientemente comercial. Análisis de Nicaragua, Ecuador y Bolivia revelan que los nuevos gobiernos comparten su desconfianza hacia las IMF (instituciones de microfinanzas. Sin embargo, en la ausencia de alternativas viables para la provisión de servicios financieros, los gobiernos y las microfinanzas se ven obligados a coexistir. El medio en el cual lo hacen varía grandemente, dependiendo de políticas locales y factores institucionales. No obstante, algunas tendencias comunes pueden ser discernidas.

  20. Imagen y represión del "rojo separatista" : algunos ejemplos de la izquierda catalana en 1939

    Directory of Open Access Journals (Sweden)

    Francesc Vilanova Vila-Abadal

    1998-01-01

    Full Text Available La represión y la violencia políticas desatadas por los militares sublevados y sus cómplices civiles, a partir de verano de 1936, no solamente fue un aspecto ya previsto y programado de la insurreción, sino que también se extendió por todo el territorio español y fue adaptado según las características de las diferentes regiones en donde se aplicó. En el caso de Cataluña, la represión franquista, además de aplicarse en sus líneas generales, añadió el plus del «separatismo», la persecución del catalanismo político y cultural en todas sus variantes posibles. De aquí que hiciera fortuna la expresión «rojo-separatista», tanto a nivel propagandístico como de acusación política y criminal, que permitía ensanchar la represión e incluir a un amplio número de víctimas: conservadores, republicanos, comunistas, católicos y librepensadores. A partir del análisis de diferentes expedientes de responsabilidades políticas, puede seguirse la aplicación de la acusación de «rojo-separatista» y la construcción de una imagen muy concreta de los vencidos.The political repression and violence launched by the rebel militaries and their civil accomplices, from the summer of 1936, was an aspect already foreseen and scheduled of the insurrection. Furthermore, this repression and violence was spread in the whole Spanish territory and adapted to the features of the features of the different regions where it was brought. In the case of Catatonía, the Francoist repression, besides of being applied in its general Unes, added a plus of «separatism», the persecution of the political and cultural catalanísm in any of its possible variants. From here it comes the expression «red-separatist» that become popular, both at the propaganda level, and to include in it a larga number of victims: conservatives, republicans, communist, Catholics and freethinkers. The applícation of the charge of «red-separatist» could be foUowed from the analysis of different files of political responsibilities, which set up a very specific image of the ones defeated.

  1. El aparato cultural del imperio. C. Wright Mills, la Revolución Cubana y la Nueva Izquierda

    Directory of Open Access Journals (Sweden)

    Rafael Rojas

    2014-07-01

    Full Text Available Este ensayo intenta reconstruir el debate que suscitó el libro Listen, Yankee (1960, del sociólogo norteamericano C. Wright Mills, en la opinión pública de Estados Unidos. Elprofesor de la Universidad de Columbia fue uno de los primeros intelectuales en viajar a la isla, luego del triunfo de la Revolución Cubana, y en interesarse en esa experienciade cambio social. La solidaridad de Wright Mills no era, sin embargo, acrítica con ciertos elementos autoritarios que observaba en el socialismo cubano y estaba fundamentalmente dirigida a defender una política comprensiva y respetuosa hacia el nacionalismo revolucionario del Caribe desde Estados Unidos. Esa política y esa crítica, defendidas por Wright Mills en el contexto de la Guerra Fría, formaron parte del repertorio de valores yprácticas que él mismo identifico con el concepto de “Nueva Izquierda”.

  2. Bolivia, Perú y Ecuador: outsiders, izquierda e indígenas en la disputa electoral

    OpenAIRE

    Rodríguez Ostria, Gustavo

    2007-01-01

    1. IntroducciónBolivia, Ecuador y Perú, comparten pasado, presente y futuro. Las tres naciones andinas meridionales reconocen una historia común ligada a las luchas independentistas. Pertenecen a la Comunidad Andina de Naciones (CAN), poseen riqueza y diversidad multicultural, importantes reservas hidrocarburíferas  y han enfrentado en la última década una profunda crisis y colapso de su sistema político. Un electorado volátil y partidos débiles han permitido la emergencia de outsiders con de...

  3. Combined endovascular and surgical treatment of melanoma of the nasal cavity: a case report; Melanoma de fosas nasales. Tratamiento combinado endovascular y quirurgico. A proposito de un caso

    Energy Technology Data Exchange (ETDEWEB)

    Romero, A.; Delgado, F.; Ramos, M.; Bravo, F. [Hospital Universitario Reina Sofia. Cordoba (Spain)

    2000-07-01

    Melanoma of the nasal cavity is a rare tumor with a worse prognosis than cutaneous melanoma. It usually presents as nasal obstruction and/or epistaxis. The observation of a pigmented mass in the nasal cavity is highly suggestive of this lesion. Computed tomography shows a mass with nonspecific features. In magnetic resonance studies, it has a characteristics signal consisting of hyperintensity of T1-weighted images and hypointensity on T2-weighted images, depending on the amount of melanin. The treatment of choice is surgical resection. We present a case of melanoma of the nasal cavity in which endovascular embolization of the tumor was performed prior to surgical treatment. (Author) 11 refs.

  4. Estudio "in vivo" sobre diferentes métodos para el diagnóstico de caries de fosas y fisuras

    OpenAIRE

    Melo Almiñana, María Pilar

    2014-01-01

    En las ciencias médicas se va imponiendo el paradigma de que un diagnóstico precoz de las enfermedades lleva asociado un tratamiento más eficaz de las mismas. La Odontología no escapa a esa idea. No existe unanimidad en la literatura a la hora de afirmar cuál de los métodos o sistemas diagnósticos es el ideal para diagnosticar lesiones incipientes de caries. El estudio cuenta con la aprobación del Comité de Ética de Investigacaión en Humanos de la Universitat de València. La muestra const...

  5. Teratoma of the posterior fossa CT and MR aspects A case. Teratoma de fosa posterior: Aspectos en TC y RM. A proposito de un caso

    Energy Technology Data Exchange (ETDEWEB)

    Pina, J.I.; Feijoo, R.; Lasierra, R.; Medrano, J.; Benito, J.L. de (Hospital Clinico Universitario Zaragoza. (Spain))

    1994-01-01

    The CT and MR findings are reported for a patient diagnosed as having teratoma of the posterior fossa with onset in the form of intracranial hypertension. The objective of this article is to report the detection of the lesion, as well as its origin in the closure defect of the cranial cavity with the formation of a cutaneous fistula, and review the recent literature.

  6. Gravimetric model of the Gastre trough, province of Chubut, Argentina; Modelo gravimetrico en la fosa de Gastre, provincia de Chubut, Argentina

    Energy Technology Data Exchange (ETDEWEB)

    Lince Klinger, F.; Nacif, S.; Martinez, M. P.; Gimenez, M. E.; Ruiz, F.; Alvarez, O.

    2011-07-01

    A gravimetric study of the Gastre trough in the Province of Chubut, to the southwest of the Canadon Asfalto basin, has allowed us to determine the geometry of its crystalline basement. Using filtering techniques we were able to map residual Bouguer anomalies, which show the heterogeneities situated within the upper crust, some of which are linked to recognised geological structures. The gravimetric minima in the residual Bouguer anomaly map are associated with graben-type basins, flanked by positive gravity values associated with alignments identified on the surface and with the overall topographic relief of the Gastre trough. After suitable treatment of the density values of the outcrops and seismic data we were able to construct a 2D density model, perpendicular to the trough, which indicated a depth of 3600 m. The importance of this study lies in the fact that it has been possible to arrive at a gravimetric characterization of the Gastre trough in the Canadon Asfalto basin sector, a potentially hydrocarbon-bearing area hitherto lacking in reliable data concerning its subsoil. (Author)

  7. Types and severity of operated supraclavicular brachial plexus injuries caused by traffic accidents.

    Science.gov (United States)

    Kaiser, Radek; Waldauf, Petr; Haninec, Pavel

    2012-07-01

    Brachial plexus injuries occur in up to 5% of polytrauma cases involving motorcycle accidents and in approximately 4% of severe winter sports injuries. One of the criteria for a successful operative therapy is the type of lesion. Upper plexus palsy has the best prognosis, whereas lower plexus palsy is surgically untreatable. The aim of this study was to evaluate a group of patients with brachial plexus injury caused by traffic accidents, categorize the injuries according to type of accident, and look for correlations between type of palsy (injury) and specific accidents. A total of 441 brachial plexus reconstruction patients from our department were evaluated retrospectively(1993 to 2011). Sex, age, neurological status, and the type and cause of injury were recorded for each case. Patients with BPI caused by a traffic accident were assessed in detail. Traffic accidents were the cause of brachial plexus injury in most cases (80.7%). The most common type of injury was avulsion of upper root(s) (45.7%) followed by rupture (28.2%), complete avulsion (16.9%) and avulsion of lower root(s) (9.2%). Of the patients, 73.9% had an upper,22.7% had a complete and only 3.4% had a lower brachial plexus palsy. The main cause was motorcycle accidents(63.2%) followed by car accidents (23.5%), bicycle accidents(10.7%) and pedestrian collisions (3.1%) (paccidents had a higher percentage of lower avulsion (22.7%) and a lower percentage of upper avulsion (29.3%), whereas cyclists had a higher percentage of upper avulsion (68.6%) based on the data from the entire group of patients (paccidents (9.3%,paccidents),significantly more upper and fewer lower palsies were present. In the bicycle accident group, upper palsy was the most common (89%). Study results indicate that the most common injury was an upper plexus palsy. It was characteristic of bicycle accidents, and significantly more common in car and motorcycle accidents. The results also indicate that it is important to consider the potential of a brachial plexus injury after serious traffic accidents and to examine both upper extremities in detail even if some motor function is preserved.

  8. Suppurative supraclavicular bacille calmette-guerine lymphadenitis - A case report, awareness and management options

    Directory of Open Access Journals (Sweden)

    U S Udgaonkar

    2015-01-01

    Full Text Available Diagnosis of Bacille calmette-guerine (BCG adenitis is clinical. Conventional laboratory tests do not differentiate BCG adenitis from tuberculous adenitis. We report a case of a 3-month-old healthy baby presenting with suppurative BCG adenitis. FNAC revealed AFB on ZN-Staining, later confirmed to be Mycobacterium bovis by multiplex PCR. The treatment of suppurative BCG adenitis is needle aspiration. Anti-tubercular treatment is unwarranted.

  9. Suppurative supraclavicular bacille calmette-guerine lymphadenitis - A case report, awareness and management options

    OpenAIRE

    U S Udgaonkar; Patil, S S; Rekha, V.B.; Shah, S.

    2015-01-01

    Diagnosis of Bacille calmette-guerine (BCG) adenitis is clinical. Conventional laboratory tests do not differentiate BCG adenitis from tuberculous adenitis. We report a case of a 3-month-old healthy baby presenting with suppurative BCG adenitis. FNAC revealed AFB on ZN-Staining, later confirmed to be Mycobacterium bovis by multiplex PCR. The treatment of suppurative BCG adenitis is needle aspiration. Anti-tubercular treatment is unwarranted.

  10. Significance of prophylactic radiotherapy over the parasternal and supraclavicular regions against n0 breast cancer

    Energy Technology Data Exchange (ETDEWEB)

    Miura, D.; Suzuki, Noriyuki; Nakazawa, Hideki; Okazaki, Atsushi [Toranomon Hospital, Tokyo (Japan)

    2000-08-01

    The analysis of the prognosis of breast cancer at the Department of Endocrine Surgery, Toranomon Hospital revealed significant differences in relation to the location of the tumor (medial and lateral) as well as the axillary involvement. Accordingly, we conducted radiotherapy (RT) over the PS and SC regions in some of the patients we could an agreement of RT with tumor located medially, and examined the benefits and disadvantages of RT. We experienced a total of 128 patients of n0 breast cancer with medical tumor undergoing modified radical mastectomy between 1989 and 1997. Forty patients were in RT+ group, and 88 were in RT- group. The nine-year overall and disease-free survival rates were 97.5%, 86.0% in RT+ group, and 91.6%, 86.9% in RT- group, respectively, exhibiting statistically no significant differences. While improvement in the survival rate was not achieved by PS and SC irradiation against n0 breast cancer, the result of our study suggest that the irradiation may be effective for local control. (author)

  11. Male Occult Breast Cancer First Manifesting as a Supraclavicular Lymph Node Metastasis: A Case Report

    National Research Council Canada - National Science Library

    Maoyuan Zhao; Qiuyang Jing; Yuyi Wang; Feng Luo

    2017-01-01

    ... and a lack of public awareness. We report a 64 year old male patient presenting with palpable masses in his left cervical region, in whom imaging was unremarkable, except for slightly enlarged axillary lymph nodes without increased...

  12. Apendagitis epiploica primaria: Clínica y evolución de 73 casos

    Directory of Open Access Journals (Sweden)

    Graciela M Vázquez

    2014-12-01

    Full Text Available La apendagitis epiploica primaria es una enfermedad relativamente infrecuente dentro de los diagnósticos diferenciales del abdomen agudo. Describimos las características clínicas y evolución de una serie de 73 casos de apendagitis epiploica primaria. Se realizó una búsqueda de imágenes ecográficas y tomográficas con diagnóstico de apendagitis en el sistema de información hospitalario electrónico del Hospital Alemán entre abril del 2007 y julio del 2013 y posteriormente se revisaron sus historias clínicas. Se incluyeron 73 casos; la edad promedio fue de 45 años (± 16, 54 (74% eran varones. El motivo de consulta fue dolor abdominal: en fosa ilíaca izquierda en 65 (el 89% de los casos; en fosa ilíaca derecha en seis (8% y en otras localizaciones en dos (3%. Se les realizó ecografía abdominal a 44 (60%, tomografía computarizada a 21 (29%, y ambos estudios a 8 (11%. En el 49% de los casos se solicitó interconsulta con el servicio de cirugía. Recibieron tratamiento con antibióticos 15 (21% pacientes, de los cuales el 73% fue indicado por un médico clínico. Recibieron tratamiento ambulatorio con antiinflamatorios no esteroides 67 (92%; dos requirieron cirugía laparoscópica, dos internación y dos opiáceos. La apendagitis epiploica es infrecuente dentro de los diagnósticos diferenciales de abdomen agudo, pero es una entidad que no debe ser desconocida por los médicos para prevenir intervenciones innecesarias y el uso excesivo de antibióticos.

  13. Papiloma invertido: Presentación de un caso INVERTED PAPILLOMA: A CASE REPORT

    Directory of Open Access Journals (Sweden)

    Luis Hernández Pedroso

    2005-04-01

    Full Text Available Se presenta el caso clínico de una paciente que acude al Servicio de Cirugía Maxilofacial del Hospital "Dr. Miguel Enríquez" con aumento de volumen en hemimaxilar izquierdo que aparece después de exodoncia de 26 y 27 realizada 2 meses antes, con el objetivo de mostrar un caso poco frecuente, su diagóostico y conducción. La paciente revela rinolalia e hipoacusia, al examen físico se encontró tumefacción que borra el fondo del surco vestibular de premolares y molares del lado izquierdo, de consistencia dura, con un área central de aspecto granular. Al examen rinoscópico se aprecia masa tumoral hipocoloreada que ocupa la fosa nasal izquierda y desvía el tabique nasal hacia el lado contrario. Estudios imageneológicos ratifican la presencia de un tumor en la fosa nasal izquierda. Se realizó biopsia incisional que confirma el diagnóstico histopatológico de papiloma invertido. Este caso, poco frecuente, tuvo una solución satisfactoria mediante la reseccion quirúrgica.The clinical case of a patient that visits the Service of Maxillofacial surgery of "Miguel Enríquez" Hospital with an increase of volume in the left hemimaxilla that appear after exodontia of 26 and 27 2 months before, is presented aimed at showing an uncommon case, its diagnosis and conduction. The patient reveals rhinolalia and hypoacusia. On the physical examination, it was found tumefaction that erases the bottom of the vestibular sulcus of premolars and molars of the left side, of hard consistency, and with a central area of granular aspect. On the rhinoscopic examination, it is observed a hypocolored tumoral mass that occupies the left nasal fossa and deviate the nasal septum to the opposite side. Imaging studies ratify the presence of a tumor on the left nasal fossa. The incisional biopsy performed confirms the histopathological diagnosis of inverted papilloma. This uncommon case had a satisfactory solution by surgical resection.

  14. Hemangioma cavernoso del mesosigmoide: informe de un caso y revisión de la bibliografía

    Directory of Open Access Journals (Sweden)

    Ibraín Rodríguez Rodríguez

    Full Text Available Se informa un caso de hemangioma cavernoso del mesosigmoide, su presentación clínica, diagnóstico y tratamiento, y se ofrece una revisión de la literatura asequible sobre el tema, para lo cual se realizó una búsqueda en las bases de datos de Medigraphic, Cochrane, Medline y PubMed. El paciente es un hombre de 72 años de edad, que se presentó con dolor abdominal, estreñimiento, pérdida de peso y masa tumoral en la fosa ilíaca izquierda. A pesar de las investigaciones imaginológicas y endoscópica, no se pudo hacer el diagnóstico preoperatorio. Se trató por laparotomía y resección del tumor, y el diagnóstico se confirmó por estudio histopatológico. El hemangioma cavernoso del mesosigmoide es un tumor raro, difícil de diagnosticar preoperatoriamente, a pesar de las avanzadas técnicas imaginológicas. La escisión quirúrgica y el examen histológico pueden ser los únicos medios para el diagnóstico.

  15. A classical brown adipose tissue mRNA signature partly overlaps with brite in the supraclavicular region of adult humans

    DEFF Research Database (Denmark)

    Jespersen, Naja Zenius; Larsen, Therese Juhlin; Peijs, Lone

    2013-01-01

    . A similar mRNA expression profile was observed when comparing isolated human adipocytes from BAT and white adipose tissue (WAT) depots, differentiated in vitro. In conclusion, our data suggest that human BAT might consist of both classical brown and recruitable brite adipocytes, an observation important...

  16. Soft tissue abscess and lymphadenitis due to Mycobacterium avium Complex as an expression of immune reconstitution inflammatory syndrome after a second scheme of highly active antiretroviral therapy Linfadenitis y absceso subcutáneo por Complejo Mycobacterium avium como manifestación de síndrome inflamatorio de reconstitución inmune luego de un segundo esquema de terapia antirretroviral de gran actividad

    Directory of Open Access Journals (Sweden)

    Marcelo Corti

    2007-08-01

    Full Text Available Immune reconstitution inflammatory syndrome (IRIS is an atypical and unexpected reaction related to highly active antiretroviral therapy (HAART in human immunodeficiency virus (HIV infected patients. IRIS includes an atypical response to an opportunistic pathogen (generally Mycobacterium tuberculosis, Mycobacterium avium complex, cytomegalovirus and herpes varicella-zoster, in patients responding to HAART with a reduction of plasma viral load and evidence of immune restoration based on increase of CD4+ T-cell count. We reported a case of a patient with AIDS which, after a first failure of HAART, developed a subcutaneous abscess and supraclavicular lymphadenitis as an expression of IRIS due to Mycobacterium avium complex after starting a second scheme of HAART.El síndrome inflamatorio de reconstitución inmune (SIRI es una reacción atípica e inesperada relacionada con el tratamiento antirretroviral de gran actividad (TARGA en pacientes infectados por el virus de la inmunodeficiencia humana (VIH. El SIRI representa una respuesta inflamatoria frente a un patógeno oportunista (generalmente Mycobacterium tuberculosis, Complejo Mycobacterium avium, citomegalovirus y herpes varicela-zóster en pacientes que responden a la TARGA con una marcada reducción de la carga viral en plasma y evidencia de una recuperación inmunológica expresada por el incremento de los niveles de linfocitos T CD4+. Presentamos el caso de un paciente con síndrome de inmunodeficiencia adquirida que desarrolló un absceso subcutáneo en muslo derecho y una adenitis supraclavicular izquierda como manifestación de SIRI por Complejo Mycobacterium avium luego del inicio de un segundo esquema de TARGA.

  17. Bloqueio do plexo braquial por via supraclavicular: estudo clínico comparativo entre bupivacaína e levobupivacaína Bloqueo del plexo braquial por vía supraclavicular: estudio clínico comparativo entre bupivacaína y levobupivacaína Supraclavicular brachial plexus block: a comparative clinical study between bupivacaine and levobupivacaine

    Directory of Open Access Journals (Sweden)

    José Ricardo Pinotti Pedro

    2009-12-01

    Full Text Available JUSTIFICATIVA E OBJETIVOS: O bloqueio de plexo braquial é técnica anestésica utilizada para procedimentos em membros superiores. O plexo braquial é território potencial para absorção de anestésicos locais. Estudos dos estereoisômeros da bupivacaína vêm demonstrando menor potencial de toxicidade da fração levógira (levobupivacaína sobre o sistema cardiovascular. Porém, é discutida a eficácia anestésica (bloqueio sensitivo e motor da levobupivacaína em anestesia do neuroeixo. Este estudo visa demonstrar a eficácia anestésica da levobupivacaína, comparandoa com a bupivacaína racêmica em bloqueio de plexo braquial, via perivascular subclávia. MÉTODO: Cinquenta pacientes adultos de ambos os sexos, ASA I e II, foram submetidos à anestesia de plexo braquial via perivascular subclávia para procedimentos ortopédicos de membros superiores, com auxílio de neuroestimulador. Foram divididos de modo aleatório em dois grupos: G BUPI - bupivacaína racêmica e G LEVO - levobupivacaína, num volume de 30 mL a 0,5%. O bloqueio sensitivo foi avaliado pelo método de "picada de agulha" nos metâmeros de C5 a C8; e o bloqueio motor, nos intervalos em minutos 1, 2, 5, 10, 15, 20, 25, 30 ou até instalação do bloqueio em movimentos dos dedos, mão, antebraço e braço. RESULTADOS: Não houve diferença estatística entre os dois grupos quanto à latência, incidência de falhas e grau do bloqueio motor, bem como incidência de falhas do bloqueio sensitivo, mas verificou-se diferença estatística da latência do bloqueio sensitivo em todos os metâmeros analisados. Não houve efeitos adversos inerentes à aplicação do anestésico local. CONCLUSÕES: A levobupivacaína demonstrou eficácia anestésica em bloqueio de plexo braquial, equiparável à solução racêmica usualmente empregada.JUSTIFICATIVA Y OBJETIVOS: El bloqueo de plexo braquial es la técnica anestésica utilizada para procedimientos en miembros superiores. El plexo braquial es el territorio potencial para la absorción de anestésicos locales. Estudios de los estereoisómeros de la bupivacaína han venido demostrando un menor potencial de toxicidad de la fracción levógira (levobupivacaína, sobre el sistema cardiovascular. Sin embargo, se discute la eficacia anestésica (bloqueo sensitivo y motor, de la levobupivacaína en anestesia del neuro eje. Este estudio pretende demostrar la eficacia anestésica de la levobupivacaína, comparándola con la bupivacaína racémica en bloqueo de plexo braquial por la vía perivascular subclavia. MÉTODO: Cincuenta pacientes adultos de ambos sexos, ASA I y II, fueron sometidos a la anestesia de plexo braquial vía perivascular subclavia para procedimientos ortopédicos de miembros superiores con la ayuda de un neuroestimulador. Se dividieron de modo aleatorio, en dos grupos: G BUPI - bupivacaína racémica, G LEVO - levobupivacaína, en un volumen de 30 mL a 0,5%. El bloqueo sensitivo fue evaluado por el método de "picada de aguja" en los metámeros de C5 a C8; y el bloqueo motor, en los intervalos en minutos: 1, 2, 5, 10, 15, 20, 25, 30, o hasta la instalación del bloqueo en los movimientos de los dedos, la mano el antebrazo y el brazo. RESULTADOS: No hubo ninguna diferencia estadística entre los dos grupos en cuanto a la latencia, incidencia de fallas, grado del bloqueo motor e incidencia de fallas y grado del bloqueo motor e incidencia de fallas del bloqueo sensitivo, pero sí que se verificó la diferencia estadística de la latencia del bloqueo sensitivo en todos los metámeros analizados. No hubo efectos adversos inherentes a la aplicación del anestésico local. CONCLUSIONES: La levobupivacaína demostró una eficacia anestésica en el bloqueo de plexo braquial, igualable a la solución racémica usualmente utilizada.BACKGROUND AND OBJECTIVES: Brachial plexus block is used in surgical procedures of the upper limbs. The brachial plexus is a potential territory for absorption of local anesthetics. Studies on bupivacaine isomers have shown reduced cardiovascular toxicity of its levorotatory form (levobupivacaine. However, the anesthetic efficacy (sensorial and motor blockades of levobupivacaine in neuroaxis blocks has been debated. The objective of this study was to demonstrate the anesthetic efficacy of levobupivacaine in brachial plexus block, using the perivascular subclavian approach, by comparing it to racemic bupivacaine. METHODS: Fifty adult patients of both genders, ASA I and II, underwent subclavian perivascular brachial plexus block, with the aid of a peripheral neurostimulator, for orthopedic surgeries of the upper limbs. Patients were randomly divided into two groups: G BUPI - racemic bupivacaine, and G LEVO - levobupivacaine, and they received 30 mL of the 0.5% solution. Sensorial blockade was evaluated by pinprick stimulation from C5 to C8 metameres; and the motor blockade was assessed 1, 2, 5, 10, 15, 20, 25, and 30 minutes after the administration of the local anesthetic or until blockade of fingers, hand, forearm, and arm movements was observed. RESULTS: Statistical differences in latency, failure rate, and degree of the motor blockade, and failure of the sensorial blockade between both groups were not observed, but the latency of the sensorial blockade in all metameres analyzed showed statistically significant differences. Adverse events inherent to the administration of local anesthetics were not observed. CONCLUSIONS: The anesthetic efficacy of levobupivacaine in brachial plexus block was similar to that of the racemic solution commonly used.

  18. Valor clínico de la utilización del strain rate sistólico en el estudio de distintas formas de hipertrofia ventricular izquierda

    Directory of Open Access Journals (Sweden)

    Norberto Marani

    2007-01-01

    Full Text Available IntroducciónLa hipertrofia del ventrículo izquierdo (HVI incluye diferentes etiologías, estados evolutivos y pronóstico. El strain rate sistólico (SRS o estudio de la deformación miocárdica permite analizar la función sistólica regional al evaluar la velocidad de acortamiento miocárdico en función del tiempo, con independencia del movimiento traslativo del corazón o del tironeamiento de estructuras vecinas.ObjetivoDeterminar la utilidad del strain rate sistólico para diferenciar formas de hipertrofia del ventrículo izquierdo.Material y métodosLa población del estudio estuvo conformada por cuatro grupos: Grupo 1: (G1, n = 10: voluntarios sanos sedentarios; grupo 2 (G2, n = 21: atletas de alto rendimiento con aumento del índice de masa del ventrículo izquierdo (IMVI > 125 g/m2; grupo 3 (G3, n = 15: pacientes hipertensos según VII JNC con IMVI > 125 g/m2 y grupo 4 (G4, n = 12: pacientes con miocardiopatía hipertrófica (MCH, septum > 15 mm y/o relación septum/pared posterior > 1,5:1, sin causa que lo justifique.ResultadosEn los grupos con IMVI incrementado no hubo diferencia en la fracción de acortamiento mesoparietal (p = 0,3 o el IMVI (p = 0,6.SRS 01 seg (G1 0,75 1/s, (G2 0,87 1/s, (G3 0,57 1/s, (G4 0,29 1/s (p < 0,001.SRS 02 seg (G1 0,67 1/s, (G2 0,52 1/s, (G3 0,49 1/s (G4 0,18 1/s (p < 0,001.SRS 03 seg (G1 0,57 1/s, (G2 0,38 1/s, (G3 0,25 1/s (G4 0,11 1/s (p < 0,002.EL SRS permitió diferenciar MCH en deportistas durante toda la sístole.ConclusiónEl acortamiento sistólico regional determinado por SRS está disminuido en la MCH. La utilización de esta técnica permite diferenciar formas de hipertrofia patológica de la hipertrofia fisiológica.

  19. El cartel político, social y cultural de la izquierda chilena en el Gobierno de la Unidad Popular: 1970-1973

    OpenAIRE

    Vico Sánchez, Mauricio Esteban

    2016-01-01

    El objeto del trabajo de investigación que aquí se presenta ha sido la localización, rescate, datación, catalogación y documentación del conjunto de carteles o afiches que se editaron en Chile durante el período comprendido entre el lanzamiento de la campaña electoral de Salvador Allende para las elecciones presidenciales de 1970, hasta el golpe de Estado protagonizado por el general Augusto Pinochet que le puso término, acabando así con el Gobierno de la Unidad Popular, y con la vida del Pre...

  20. 拉美左翼思想动向%Las tendencias ideológicas de las izquierdas de América Latina

    Institute of Scientific and Technical Information of China (English)

    刘承军

    2004-01-01

    如果从思想的角度来谈拉美的左翼,其范围要宽泛得多。这个意义上的左翼应该包括主张社会公正、维护人类平等的政党、非政府组织、民众运动、仍然坚持武装斗争道路的政治军事组织,以及知识分子、宗教人士、领袖人物等。冷战后,东西方阵营不复存在,传统的意识形态本身也受到很大冲击,在今天观察左翼思潮,必须考虑到这一历史背景的变迁。脱离具体内容的人道主义、人权

  1. 237. Malformación hamartomatosa de la aurícula izquierda como causa infrecuente de ataque isquémico transitorio de repetición

    Directory of Open Access Journals (Sweden)

    O. Leal

    2012-04-01

    Conclusiones: Ante la presencia de AIT, en primer lugar debemos considerar el origen cardioembólico, excluidos éstos, la patología tumoral aunque infrecuente debe tenerse en cuenta, y su tratamiento generalmente es quirúrgico.

  2. Una historia del sindicato de la madera: organización gremial e influencia de la izquierda en las luchas obreras, Buenos Aires, 1917-1943

    Directory of Open Access Journals (Sweden)

    Hernán Camarero

    2015-01-01

    Full Text Available El objetivo de este trabajo es analizar un área económica escasamente abordada por los estudios que posicionaron su mirada en el mundo del trabajo en la Argentina durante las décadas de 1920 a 1940. Nos referimos al importante sector de la industria de la madera de la Ciudad de Buenos Aires y alrededores. La investigación tiene tres ejes: en primer lugar, describir brevemente las particularidades de la rama en aquellos años, así como de las modalidades de su disposición geográfica; en segundo lugar, nos enfocamos en la organización gremial, para describir la presencia de los sindicatos únicos por rama industrial, sus características internas y la dinámica de los conflictos en los que se vieron envueltos trabajadores, empresarios y Estado; por último, no perdemos de vista el papel de la intervención de las diferentes tendencias ideológicas del movimiento obrero (anarquistas, socialistas, sindicalistas y comunistas, procurando mensurar la influencia de cada una de ellas y conceptualizando sus estrategias políticas y organizativas.

  3. El Sexo y la Revolución: la liberación lésbico-gay y la izquierda partidaria en Brasil

    Directory of Open Access Journals (Sweden)

    Rafael de la Dehesa.

    2007-12-01

    Full Text Available This article draws on field theory to explain why leftist parties in Brazil first broached debates on homosexual liberation in the late 1970s and early 1980s. The concept of a cultural field allows one to bring together both an institutional and a cultural analysis of changing debates in the left, casting light on processes of contestation often obscured in the institutionalist party literature. Electoral institutional changes and the emergence of a new generation of cadres, particularly from the student movement, fundamentally changed who and what were representable in the field. The emergence of a youth counterculture also expanded the discursive repertoire available to activists and their party allies, supported by debates in Marxist circles occurring internationally. This conjuncture of forces ultimately allowed party militants to contest meanings historically attached to the body, sexuality, the political, and everyday life.

  4. Origen anómalo de la arteria coronaria izquierda en la arteria coronaria derecha y curso ínter-arterial

    Directory of Open Access Journals (Sweden)

    Nilson López, MD

    2010-11-01

    Full Text Available El origen del tronco coronario principal izquierdo a partir de la arteria coronaria derecha o del seno de Valsava opuesto, es una anomalía extremadamente rara con un riesgo potencial de mortalidad. En este informe se describe el caso de una paciente con esta anomalía, inicialmente detectada por coronariografía y posteriormente confirmada mediante resonancia magnética cardiaca.

  5. Butler, Judith. Violencia de Estado, guerra, resistencia. Por una nueva política de la izquierda. Madrid: Katz Editores, 2011

    Directory of Open Access Journals (Sweden)

    Juan Antonio Fernández Manzano

    2015-07-01

    Full Text Available This book is the transcript of a conference that Judith Butler (Ohio, 1956 gave in Barcelona in April 2010 together with an in-depth interview. Both texts, addressed to an educated reader, not necessarily specialized in political philosophy revolve around the role the left can play in the defense of the most vulnerable in view of the present forms of oppression, exclusion and violence.

  6. 119. Reparación quirúrgica de la salida anómala del tronco de la coronaria izquierda desde el seno coronario derecho

    Directory of Open Access Journals (Sweden)

    E. Bernabeu

    2012-04-01

    Conclusiones: el origen anómalo de las coronarias es una alteración congénita rara asociada a muerte súbita. Cuando existe un trayecto intramural, el unroofing es la técnica más empleada. La TCMD es útil para la planificación preoperatoria, permitiendo individualizar la reconstrucción quirúrgica, y para evaluar en el postoperatorio el resultado anatómico.

  7. Vigencia del continuo ideológico izquierda/derecha durante las elecciones presidenciales de 2011 en Lima - Perú

    Directory of Open Access Journals (Sweden)

    Jan Marc Rottenbacher de Rojas

    2012-12-01

    Full Text Available Validity of the ideological left/right continuum during 2011 Presidential Elections in Lima-PeruThis study analyzes the relationship between political ideology, voting behavior and emotional responses after Peruvian presidential elections in 2011. Scales of intolerance for ambiguity, need for closure, right-wing authoritarianism (RWA and the right-wing political orientation were used to assess right-wing political conservatism. A structural equation model proposes that intolerance of ambiguity and need for closure exert a direct effect on RWA. Also, RWA influences directly the right-wing political orientation, which exerts a direct influence on negative emotional responses and an inverse effect on positive emotional responses after O. Humala’s victory. Final discussion focuses on the contemporary relevance of left/right ideological continuum.

  8. Vólvulo gástrico intratorácico secundario a hernia diafragmática izquierda crónica postraumática

    Directory of Open Access Journals (Sweden)

    Giovanni Ospino- Saumett

    2005-04-01

    Full Text Available En el 5% de los pacientes con trauma toracoabdominal severo ocurre la ruptura diafragmática, y en el 45 a 60% de estos se presenta la hernia de las vísceras abdominales al tórax. El órgano más frecuentemente herniado es el estómago². El vólvulo gástrico intratorácico total es poco común en la hernia diafragmática traumática; allí sufre una torsión órganoaxial que lo predispone a estrangulación y necrosis. Puede presentarse como una emergencia quirúrgica, aunque los crónicos, manifiestan síntomas inespecíficos que podrían ser tratados electivamente 5. Las hernias diafragmáticas traumáticas siempre son un desafío diagnóstico para el cirujano. En general son causadas por trauma abdominal cerrado y con menos frecuencia, por trauma torácico cerrado. La ruptura se localiza, en el 90% de los casos, en el lado izquierdo; probablemente debido al efecto amortiguador del hígado en el lado derecho. La ruptura diafragmática en el trauma agudo no es diagnosticada en el 40% de los casos; pues su curso asintomático produce síntomas menores inespecíficos que aparecen horas o días después del trauma. Si esta ruptura no es reconocida, entonces ocurre un periodo de latencia que puede oscilar entre horas y muchos años, hasta que ocurre un prolapso significativo de un órgano abdominal hacia la cavidad torácica, causando ese desplazamiento una variedad de síntomas. Después del diagnóstico de hernia diafragmática traumática, hay indicación urgente y absoluta de terapia quirúrgica1,6. Se presenta el caso de un paciente masculino de 24 años de edad, con antecedente de trauma toracoabdominal, con vólvulo gástrico intratorácico, y que fue manejado exitosamenteDiaphragmatic rupture occurs in 5% of severe thoracoabdominal trauma and the herniation of abdominal visceral to the thorax happens in 45 to 60% of the cases. The stomach is the organ more frequently herniated². Complete intrathoracic gastric volvulus is uncommon in traumatic diaphragmatic hernia, in which the stomach undergoes organoaxial torsion predisposing to strangulation and necrosis. It may appear as a surgical emergency, though chronic patients with non specifics symptoms can be treated electively5. Traumatic diaphragmatic herniae are a diagnostic challenge to the surgeon. They are usually caused by blunt abdominal trauma, and less often by blunt thoracic trauma. They are located on the left side in 90% of all cases, probably secondary to the "buffer" effect of the liver on the right side. A rupture of the diaphragm is not diagnosed during the acute posttraumatic period in up to 40% of the cases, because it can remain asymptomatic or it may give nonspecific symptoms, that can appear hours or days after trauma. If the rupture stays unrecognized, a latency period ranging from hours to many years occurs until a significant thoracic prolapse of abdominal organs develops, causing a variety of symptoms. Once diagnosed a traumatic diaphragmatic hernia is an absolute and urgent indications for surgical therapy1,6. We present the case of a 24 year old male with the history of toracoabdominal trauma, who had an intrathoracic gastric volvulus. He was handle surgically and did fine

  9. Vólvulo gástrico intratorácico secundario a hernia diafragmática izquierda crónica postraumática

    Directory of Open Access Journals (Sweden)

    Giovanni Ospino- Saumett

    2005-04-01

    Full Text Available En el 5% de los pacientes con trauma toracoabdominal severo ocurre la ruptura diafragmática, y en el 45 a 60% de estos se presenta la hernia de las vísceras abdominales al tórax. El órgano más frecuentemente herniado es el estómago². El vólvulo gástrico intratorácico total es poco común en la hernia diafragmática traumática; allí sufre una torsión órganoaxial que lo predispone a estrangulación y necrosis. Puede presentarse como una emergencia quirúrgica, aunque los crónicos, manifiestan síntomas inespecíficos que podrían ser tratados electivamente 5. Las hernias diafragmáticas traumáticas siempre son un desafío diagnóstico para el cirujano. En general son causadas por trauma abdominal cerrado y con menos frecuencia, por trauma torácico cerrado. La ruptura se localiza, en el 90% de los casos, en el lado izquierdo; probablemente debido al efecto amortiguador del hígado en el lado derecho. La ruptura diafragmática en el trauma agudo no es diagnosticada en el 40% de los casos; pues su curso asintomático produce síntomas menores inespecíficos que aparecen horas o días después del trauma. Si esta ruptura no es reconocida, entonces ocurre un periodo de latencia que puede oscilar entre horas y muchos años, hasta que ocurre un prolapso significativo de un órgano abdominal hacia la cavidad torácica, causando ese desplazamiento una variedad de síntomas. Después del diagnóstico de hernia diafragmática traumática, hay indicación urgente y absoluta de terapia quirúrgica1,6. Se presenta el caso de un paciente masculino de 24 años de edad, con antecedente de trauma toracoabdominal, con vólvulo gástrico intratorácico, y que fue manejado exitosamente

  10. Retos de las Izquierdas en México y América Latina%墨西哥和拉美左派面临的挑战

    Institute of Scientific and Technical Information of China (English)

    埃尔维拉·孔切伊洛; 林华

    2007-01-01

    首先,我忠心地感谢中国社会科学院拉丁美洲研究所邀请我参加这一重要的国际学术论坛。能够与参加这次论坛的各位共同分享我对墨西哥和拉美左派的一些思考,是我莫大的荣幸。

  11. América Latina: El fin del ‘Consenso de Washington’, el estado de la democracia y el debate sobre las dos izquierdas

    Directory of Open Access Journals (Sweden)

    Alex E. Fernández Jilberto

    2007-04-01

    Full Text Available – La democracia en América Latina. Hacia una Democracia de Ciudadanas y Ciudadanos. El Debate Conceptual sobre la Democracia. Programa de las Naciones Unidas para el Desarrollo (PNUD, Buenos Aires: Aguilar, Altea, Tauros y Alfaguara, 2004. – La democracia en América Latina. Hacia una Democracia de Ciudadanas y Ciudadanos. Contribuciones para el Debate. Programa de la Naciones Unidas para el Desarrollo (PNUD, Buenos Aires: Aguilar, Altea, Tauros y Alfaguara, 2004. – Nueva Sociedad 205, ‘América Latina en tiempos de Chávez’, (varios autores, septiembre/octubre 2006, Caracas. – From Pinochet to the ‘Third Way’. Neoliberalism and Social Transformation in Chile, by Marcus Taylor. Pluto Press, London, 2006. – On Argentina and the Southern Cone. Neoliberalism and National Imaginations, by Alejandro Grimson and Gabriel Kessler. Routledge, London, 2005.

  12. Hipertrofia Ventricular Izquierda y Variabilidad Circadiana de la Presión Arterial en una Cohorte de pacientes diagnosticados de Hipertensión Arterial

    OpenAIRE

    Cinza Sanjurjo, Sergio

    2012-01-01

    Objetivo. El objetivo principal fue conocer el valor pronóstico de la HVI en función de la variabilidad circadiana de la PA (VCPA). Como objetivo secundario se analizó la asociación existente entre HVI, lesión renal subclínica y PA ambulatoria, así como su valor pronóstico.

  13. Revisión de los Sciuridae del Aragoniense y del Rambliense en la fosa de Calatayud-Montalbán = Revision of Aragonian and Ramblian Sciuridae in the Calatayud-Montalban Trench

    NARCIS (Netherlands)

    Cuenca Bescós, G.

    1988-01-01

    The Sciuridae are the family of rodents that comprises all extant and fossil squirrels. In the Ramblian and especially in the Aragonian of the Tertiary basin of Calatayud-Montalbán (Aragón, Spain) the remains of Sciuridae are relatively abundant. A major problem solved in this paper is the distincti

  14. Corrección de mordida cruzada posterior vestibular en dentición primaria. Reporte de dos casos clínico

    Directory of Open Access Journals (Sweden)

    Jerusalén E. Mata T.

    2016-07-01

    Full Text Available La mordida cruzada posterior vestibular cruzada bucal o mordida en tijera ocurre cuando las cúspides linguales de los molares superiores ocluyen vestibularmente a las fosas centrales de los molares inferiores o cuando las caras palatinas de los dientes superiores están en contacto con las caras vestibulares de los dientes inferiores. Pueden ser funcionales, causadas por inclinación de los molares inferiores hacia lingual o por asimetrías mandibulares. El tratamiento temprano es recomendado para normalizar las relaciones transversales y promover un correcto desarrollo de la oclusión. Se presentan dos casos de mordida cruzada posterior vestibular unilateral en dentición primaria y mixta temprana. Caso 1: paciente masculino de 5 años de edad, presentó lesiones extensas de caries, normoclusión, mordida cruzada posterior vestibular unilateral derecha y fue tratado mediante aparato fijo tipo Bi-Helix con bandas cementadas a los segundos molares primarios. Caso 2: paciente masculino de 5 años de edad, presentó lesiones extensas de caries, normoclusión y mordida cruzada posterior vestibular unilateral Izquierda. Fueron colocadas pistas directas de resina. En ambos casos se logró una relación trasversal satisfactoria, corrigiendo la mordida cruzada vestibular. Conclusión: La mordida cruzada posterior vestibular puede presentarse debido a desviación mandibular por interferencias oclusales y a inclinaciones inapropiadas de los molares primarios. Cuando esta es la etiología, el tratamiento es exitoso al utilizar pistas directas de resina, eliminación de contactos prematuros y expansor inferior tipo Bi-Helix.

  15. [Cross-reactivity in allergic fungal sinusitis. Case report].

    Science.gov (United States)

    González-Díaz, Sandra Nora; Arias-Cruz, Alfredo; Rivero-Arias, Dulce María; Partida-Ortega, Alma Belén; Elizondo-Villarreal, Bárbara; Ibarra-Chávez, Jesús Arturo; Ramos-Valencia, Lissette; Monge-Ortega, Olga Patricia; Macouzet-Sánchez, Carlos; Salinas-Díaz, María Rocío

    2016-01-01

    Antecedentes: La presencia de mucina alérgica en la rinosinusitis alérgica fúngica (RAF) es una manifestación que la identifica como un proceso de hipersensibilidad. En la RAF existe un fenómeno de reactividad cruzada entre proteínas unidas a IgE que tienen al menos dos epítopes compartidos. Caso clínico: Varón de 13 años de edad con síntomas obstructivos nasales de tres años de evolución. Por exploración física y tomografía se identificó masa obstructiva en los senos paranasales. En la cirugía endoscópica, en la fosa nasal izquierda se identificó pólipo con aspecto macroscópico de mucina alérgica; el pólipo fue resecado. El examen histopatológico final mediante tinciones con ácido peryódico de Schiff y metenamina plata de Grocott indicó Aspergillus. Dos semanas después de la cirugía, las pruebas percutáneas mostraron sensibilización a Alternaria alternata, Helminthosporium sativum y Deramatophagoides farianae, con negatividad a Aspergillus fumigatus. Conclusiones: La ausencia de títulos significativos de anticuerpos IgE específicos para Aspergillus fumigatus constituyó la evidencia de que la respuesta de hipersensibilidad fue desencadenada por un patógeno distinto del aislado en el estudio histopatológico, que aunada a las pruebas positivas para otros hongos puede explicarse por el fenómeno de reactividad cruzada en un probable fenómeno de hipersensibilidad.

  16. [A case of advanced colon cancer with metastases to both supraclavicular and para-aortic lymph nodes effectively treated by radiation and S-1 therapy].

    Science.gov (United States)

    Sasaki, Yoshiyuki; Kunieda, Katsuyuki; Imai, Tateharu; Sakuratani, Takuji; Tajima, Jeshi Yu; Kanematsu, Masako; Yamada, Atsuko; Matsuhashi, Nobuyasu; Tanaka, Chihiro; Nishina, Takuo; Nagao, Narutoshi; Kawai, Masahiko; Furuichi, Nobuaki; Yanagawa, Shigeo

    2010-12-01

    We report the case of a 60-year-old woman with multiple lymph node metastases after ascending colon cancer who received radiation therapy and then chemotherapy with S-1. She was diagnosed with lymph node metastasis of the para aorta and left upper clavicle 10 months after surgery. We performed radiation therapy for the left upper clavicle (64 Gy)and para aorta (40 Gy). Consequently, we administered S-1(100mg/day)orally. After three months, the upper clavicle lymph nodes had disappeared and the para-aortic lymph nodes reduced. All metastatic lesions disappeared after 10 months. She survived for 32 months after the radiation therapy.

  17. Low-Volume Brachial Plexus Block Providing Surgical Anesthesia for Distal Arm Surgery Comparing Supraclavicular, Infraclavicular, and Axillary Approach. A Randomized Observer Blind Trial

    DEFF Research Database (Denmark)

    Vazin, Mojgan; Jensen, Kenneth; Hjort, Mathias

    2016-01-01

    Background. Distal arm surgery is widely performed under regional anesthesia with brachial plexus block. The preponderance of evidence for the efficacy relies upon injection of local anesthetic in excess of 30 mL. We aimed to compare three different ultrasound-guided brachial plexus block techniq...

  18. Anatomía y geometría ventricular izquierda en la Estenosis subaórtica congénita en perros de raza boxer Anatomy And Geometry In The Congenital Subaortic Stenosis In Boxer Dogs

    Directory of Open Access Journals (Sweden)

    R.J Barrios

    2008-06-01

    Full Text Available Los autores estudiaron la anatomía y geometría del ventrículo izquierdo en 45 perros bóxer afectados por estenosis subaórtica congénita por medio de la evaluación de los diámetros sistólico y diastólico del ventrículo izquierdo, de los espesores sistólico y diastólico de la pared libre del ventrículo izquierdo y del septum interventricular y del espesor parietal relativo. Todos los pacientes incluidos en el presente estudio presentaban como indicio de la existencia de la enfermedad un soplo, grado 1/6 o 2/6, sistólico con epicentro en el foco aórtico. Las medidas de los diámetros sistólico y diastólico y de los espesores sistólico y diastólico de la pared libre del ventrículo izquierdo y del septum interventricular fueron normales para el correspondiente rango de peso corporal. El valor promedio del espesor parietal relativo obtenido en el presente estudio fue de 0,439 ± 0,06, valor considerado normal en perros. Ambos aspectos indican que en los pacientes estudiados el padecimiento de la estenosis subaórtica congénita no provocó adaptaciones anatómicas ni geométricas del ventrículo izquierdo.The authors studied the anatomy and geometry of the left ventricle in 45 boxer dogs suffering congenital subaortic stenosis through of measurement of left ventricular systolic and diastolic diameters, the left ventricular systolic and diastolic thickness of the free wall and interventricular septum and the evaluation of the Relative Wall Thickness. All patients included in this study presented, as indication of the presence of the disease, a systolic murmur, degree 1/6 or 2/6, with maximal intensity in the aortic focus. The measures for the left ventricular diameters, septum and free wall were normal for the corresponding body weight. The mean value of the Relative Wall Thickness obtained in the present study was 0,439 ± 0,06 value considered normal in dogs. This fact indicates that in these patients the presence of the congenital subaortic stenosis did not caused anatomical or geometric adaptation of the left ventricle.

  19. 拉美左派的现状与发展趋势%La situación actual y las tendencias de las izquierdas en América Latina

    Institute of Scientific and Technical Information of China (English)

    刘纪新

    2004-01-01

    4年前,正在为争取执政地位而奋斗的巴西劳工党领袖、现任总统卢拉关于6~8年内拉美大多数国家将由左派政党执政的预言,曾引起国际政治学界的广泛关注。4年后的今天,这个预言已得到部分印证一些左派政党上台执政,一些左派代表进入议会或担任省市要职,拉美的政治版图发生了重大变化;不少国家的左派组织虽然没有直接进入政治领导地位,但积极参政,在本国社会政治生活中扮演着重要角色。拉美左派正在走出

  20. La situación actual y las tendencias de los partidos de izquierda de Brasil%巴西左派政党的现状与发展趋势

    Institute of Scientific and Technical Information of China (English)

    吴志华

    2004-01-01

    2003年1月1日,卢拉总统领导的巴西劳工党政府开始执政,这在巴西左派政党发展史上具有里程碑意义。它不仅反映了巴西左派政党在20多年的政治民主化进程中不断发展和壮大,从一个“在野党”转变为“执政党”,掌握了国家政权,而且也反映了左派政党所倡导的改革和社会理念已成为巴西当今社会的主流思潮,对未来巴西社会的发展有着深远的影响。

  1. Efectos de la reperfusión tardía en el infarto sobre la morbimortalidad y la función ventricular izquierda: metaanálisis de estudios aleatorizados

    Directory of Open Access Journals (Sweden)

    Javier A. Mariani

    2008-01-01

    Full Text Available ObjetivosEvaluar mediante un metaanálisis los efectos de la reperfusión tardía en el IAM (hipótesis de la arteria abierta sobre la morbimortalidad y la fracción de eyección (Fey.Material y métodosSe incluyeron estudios aleatorizados controlados (EAC que compararan angioplastia (ATC con tratamiento médico (TM en pacientes con infarto agudo de miocardio (IAM que permanecieran con la arteria ocluida > 12 horas, con un seguimiento > 3 meses. Se realizaron búsquedas electrónicas y en listas de referencias.ResultadosOcho EAC, que sumaron 2.972 pacientes, cumplieron los criterios de inclusión; los estudios incluyeron entre 30 y 2.166 pacientes (media: 77. El intervalo entre el IAM y la ATC fue de 25 horas a 26,3 días (media: 8,3 días.En forma global se detectó una tendencia a la reducción del riesgo de muerte [RR 0,73 (IC 95% 0,46-1,16] y al incremento del riesgo de IAM [RR 1,15 (IC 95% 0,76-1,72]. Hubo una tendencia a la reducción en las internaciones por IC con la ATC con un RR de 0,56 (0,26-1,21 y una reducción significativa de procedimientos de revascularización con un RR de 0,82 (0,70-0,97. La Fey en el seguimiento fue 2,39 puntos mayor en el grupo ATC (-0,06-4,84.Sin embargo, la evaluación de los datos según la calidad de los estudios demuestra que el beneficio sobre la mortalidad se concentra en los EAC de menor calidad [0,50 (0,25-0,99], mientras que no existe tal beneficio en los EAC de mayor calidad [0,89 (0,53-1,51].No hubo heterogeneidad significativa, excepto en los efectos sobre la fracción de eyección (p de heterogeneidad = 0,03; el nivel de inconsistencia general fue moderado. Existen evidencias de sesgo de publicación.ConclusionesSobre la base de estos resultados, el metaanálisis indica que efectuar una angioplastia tardía en vasos ocluidos en el infarto no aporta beneficios sobre la morbimortalidad. Los resultados entusiastas de los primeros ensayos de pequeñas dimensiones pueden ser atribuidos a sesgos de publicación y a déficits en el diseño. Se registra un discreto incremento en la Fey con la intervención que no se tradujo en beneficios clínicos en esta población de bajo riesgo, aunque sería interesante su estudio en pacientes con compromiso significativo de la función ventricular

  2. Can we reduce the risk of disease heart in treatments of left breast? bated breath; Podemos reducir el riesgo de enfermedad cardiaca en tratamientos de mama izquierda? respiracion contenida

    Energy Technology Data Exchange (ETDEWEB)

    Fuentemilla Urio, N.; Lozares Cordero, S.; Otal Palacin, A.; Olasolo Alonso, J.; Pellejero Pellejero, S.; Martin Albina, M. L.; Maneru Camara, F.; Miquelez Alonso, S.; Rubio Arroniz, T.; Soto Prados, P.

    2013-07-01

    In studies related to breast cancer and mortality, there has been an increase in the mortality of patients with survival greater than 10 years treated with radiotherapy. Subsequent studies it appears that the main cause is heart disease. Therefore, that the heart started to consider organ of risk in the treatment of breast cancer with radiation therapy (adjuvant). Reducing the doses both heart and coronary arteries leads to a reduction in the risk of heart disease. Currently are introducing new techniques, to reduce the dose in heart and in the left anterior descending coronary artery such as new positions or techniques of Breath bated breath hold... (Author)

  3. Arteritis with left carotid artery thrombosis produced by Salmonella enteritides. Study with CT, MR and angiography with digital subtraction. Arteritis con trombosis carotidea izquierda por Salmonella enteritidis. Estudio con TC, RM y angiografia con sustraccion digital

    Energy Technology Data Exchange (ETDEWEB)

    Iribarren Marin, M.A.; Fernandez Cruz, J.; Serrano Gotarredona, P.; Reyes Dominguez, M.J. (Hospital Universitario Virgen del Rocio, Sevilla (Spain))

    1994-01-01

    We present a case of suppurative arteritis of left common carotid artery produced by Salmonella enteritides in a 66-year-old man. We show the findings obtained by CT, MR and selective arteriography of the supra-aortic branches. We review this uncommon disorder. (Author)

  4. Relación entre marcadores de riesgo cardiovascular y de estrés oxidativo con la presencia de hipertrofia ventricular izquierda y función diastólica en niños obesos.

    OpenAIRE

    Porcar Almela, Manuel

    2015-01-01

    La obesidad se caracteriza por un estado inflamatorio de bajo grado que produce alteraciones metabólicas y hemodinámicas a nivel sistémico. El conjunto de alteraciones cardiacas producidas por la obesidad, es lo que se conoce como “cardiomiopatía de la obesidad”. En adultos los mecanismos de la remodelación cardiaca en el contexto de la obesidad son complejos y dada la prevalencia de los trastornos comórbidos y las variables de confusión concomitantes con la obesidad es dificultoso caracteriz...

  5. Diseño de la defensa ribereña para el balneario turístico Cocalmayo, ubicado en la margen izquierda del Río Urubamba

    OpenAIRE

    Zevallos Loaiza, Marcia

    2015-01-01

    La tesis tiene como objetivo realizar el cálculo y elaborar el diseño del sistema de protección ribereña aplicado al tramo del río Urubamba, ubicado entre la quebrada Cocalmayo - quebrada Huillcar. Estas obras protegerían adecuadamente el balneario de aguas termales de Cocalmayo, trayendo consigo mayor acogida de turistas y, por consiguiente, el incremento de movimiento económico en el distrito de Santa Teresa y poblaciones aledañas. El estudio contempla la descripción del comportamiento y la...

  6. Oscar Terán: Nuestros años sesentas. La formación de la nueva izquierda intelectual argentina, 1956-1966 : Buenos Aires, Siglo XXI, 2013, 288 págs.

    OpenAIRE

    Pis Diez, Nayla

    2015-01-01

    Mediando 2013 fue reeditado Nuestros años sesentas, un aporte imprescindible para la reconstrucción de la historia reciente argentina. Publicado inicialmente en el año 1991, tiempo histórico marcado por los indultos presidenciales y la “demonización” de aquellos años, el trabajo de Oscar Terán propone un estudio sobre las ideas y los debates que marcaron a una generación. En esta reedición, el trabajo original y revisado se acompaña de un Estudio Preliminar de Hugo Vezzetti, y de las transcri...

  7. Aquic Xerofluvent. Aquic Xerofluvents. Fluvisol. Área de estudio: Valle del Guadiamar, tramo intermedio. Localización: Llanura aluvial del río Guadiamar en su margen izquierda.

    OpenAIRE

    Clemente Salas, Luis; Cabrera, Francisco; García, Luis V.; Cara García, Juan S.

    1999-01-01

    3 páginas. Este documento se encuentra en la base de datos citada anteriormente, de Evenor-TEch (Spin-off del CSIC). http://www.evenor-tech.com/banco/seisnet/seisnet.htm., que incluye versiones en tres idiomas más. Se indica el enlace en Digital CSIC al artículo citado: http://hdl.handle.net/10261/47257

  8. Typic Xerofluvent. Typic Xerofluvents. Fluvisol. Área de estudio: Valle del Guadiamar. Tramo intermedio. Localización: Llanura aluvial del río Guadiamar en su margen izquierda

    OpenAIRE

    Clemente Salas, Luis; Cabrera, Francisco; García, Luis V.; Cara García, Juan S.

    1999-01-01

    3 páginas.-- Este documento se encuentra en la base de datos de Evenor-TEch (Spin-off del CSIC).-- http://www.evenor-tech.com/banco/seisnet/seisnet.htm, que incluye versiones en tres idiomas más.-- Indicamos el enlace en Digital CSIC al artículo citado: http://hdl.handle.net/10261/47257

  9. Incidencia poblacional del infarto con elevación del ST o bloqueo de rama izquierda a lo largo de 11 años en una comunidad de la provincia de Buenos Aires

    Directory of Open Access Journals (Sweden)

    Alberto Caccavo

    2007-01-01

    Full Text Available IntroducciónEl infarto agudo de miocardio (IAM es una causa importante de muerte en la población argentina.Actualmente, su tratamiento está dirigido a intentar la reperfusión precoz de la arteria ocluida por un trombo. No conocemos estudios, realizados en nuestro país, que permitan estimar cuántas personas necesitan este tipo de tratamiento en una población determinada.Objetivosa Describir la tasa anual de hospitalizaciones por infarto agudo de miocardio (IAM en un distrito de la provincia de Buenos Aires en el período 1995-2005.b Describir la variación de dicha tasa según edad, sexo y época del año.c Evaluar la mortalidad intrahospitalaria.Población y Material y métodosEl presente es un estudio descriptivo retrospectivo (1995-2005 realizado en el distrito de Coronel Suárez, provincia de Buenos Aires, a partir de las hospitalizaciones de los únicos hospitales que internan pacientes con IAM. Se consideró a todo paciente que presentara un diagnóstico de IAM con supradesnivel del ST, se correlacionó con el censo 2001 del INDEC y se estimó la tasa anual de hospitalización para toda la población, por sexo, grupo etario y estación del año. Para analizar la significación estadística de la diferencia de tasas en hombres y mujeres y entre estaciones se utilizó el intervalo de confianza para la relación entre dos tasas independientes y la prueba de chi cuadrado.ResultadosA lo largo del estudio se identificaron 367 hospitalizaciones por IAM, 275 en hombres y 92 en mujeres. La tasa anual de hospitalización por IAM (cada 10.000 personas para toda la población fue de 9,06 [8,13-9,98], en hombres fue de 13,8 y en mujeres de 4,47 (razón: 3,06 [2,37-3,76]. La tasa anual mostró una tendencia creciente con la edad.ConclusionesEn nuestra población, aproximadamente 9 personas cada 10.000 habitantes requerirían internación por IAM por año. La tasa de hospitalización es mayor en hombres y en > 65 años, sin diferencias estacionales significativas. La mortalidad intrahospitalaria hallada en el estudio fue del 9%.

  10. La política en los miedos de los medios y el refuerzo periodístico de estereotipos sociales: tratamiento electoral de la Izquierda en diarios cordobeses y argentinos (1999-2005

    Directory of Open Access Journals (Sweden)

    Ana Pamela Paz García

    2013-07-01

    Full Text Available Con frecuencia, en la cobertura periodística de procesos políticos algunos estereotipos sociales traman una deliberada ausencia o invisibilización de ciertos dirigentes y partidos, o bien emergen en la exposición discrecional y reiterada de actores o propuestas reforzando lecturas contextuales específicas. Desde los aportes de la crítica ideológica, la sociología y la psicología política al estudio interdisciplinario del discurso, analizo cómo en la interpretación y toma de posicionamiento frente a los acontecimientos que permean cualquier información ofrecida por la prensa, la visión del escenario, los actores, los problemas en juego y ciertos miedos culturales, son factores clave de un enmarcamiento intencionado de la agenda electoral. En términos teóricos establezco una conexión analítica entre conceptos más abstractos como imaginario o representaciones sociales y nociones más operativas como estereotipos e ideología, recuperando el valor de su interrelación desde una perspectiva socio-psico-política sobre las instancias de circulación del discurso mediático en las democracias contemporáneas.

  11. TESTICULAR CANCER AT KENYATTA NATIONAL HOSPITAL ...

    African Journals Online (AJOL)

    hi-tech

    2000-02-02

    Feb 2, 2000 ... detection of relapse in germ cell cancers(15). Other less ... enlarged supraclavicular and cervical lymph nodes, one patient (2.56%) had orbital .... from supraclavicular adenopathy, haemoptysis from lung metastasis, back pain.

  12. A designated centre for people with disabilities operated by COPE Foundation, Cork

    LENUS (Irish Health Repository)

    Hanumanthaiah, Deepak

    2013-09-01

    Ultrasound guided regional anaesthesia is becoming increasingly popular. The supraclavicular block has been transformed by ultrasound guidance into a potentially safe superficial block. We reviewed the techniques of performing supraclavicular block with special focus on ultrasound guidance.

  13. Archview Lodge, Drumany, Letterkenny, Donegal.

    LENUS (Irish Health Repository)

    Hanumanthaiah, Deepak

    2013-09-01

    Ultrasound guided regional anaesthesia is becoming increasingly popular. The supraclavicular block has been transformed by ultrasound guidance into a potentially safe superficial block. We reviewed the techniques of performing supraclavicular block with special focus on ultrasound guidance.

  14. Evaluación de escalas diagnósticas en pacientes con dolor abdominal sugestivo de apendicitis

    Directory of Open Access Journals (Sweden)

    Álvaro Sanabria

    2007-09-01

    Conclusión. Para hombres con dolor en la fosa iliaca derecha, el diagnóstico hecho por el cirujano es mejor que las escalas diagnósticas. Para el caso de las mujeres, la escala de Fenyö ofrece una mejor sensibilidad. La escala de Alvarado puede facilitar la conducta en pacientes con dolor en fosa iliaca derecha.

  15. Quaternary volcanism in Deception Island (Antarctica): South Shetland Trench subduction-related signature in the Bransfield Basin back arc domain; Vulcanismo cuaternario de la Isla Decepcion (Antartida): una signatura relacionada con la subduccion de la Fosa de las Shetland del Sur en el dominio de tras-arco de la Cuenca de Bransfield

    Energy Technology Data Exchange (ETDEWEB)

    Gale, C.; Ubide, T.; Lago, M.; Gil-Imaz, A.; Gil-Pena, I.; Galindo-Zaldivar, J.; Rey, J.; Maestro, A.; Lopez-Martinez, J.

    2014-06-01

    Deception Island shows a volcanism related to the Phoenix Plate subduction and roll-back under South Shetland Block in the present times. The development of the island is related to the evolution and collapse of a volcanic caldera, and this study is focused on the petrology, mineralogy and geochemistry of the post-caldera rocks. We have made a study of the lava flows, dikes and the youngest historic eruption in 1970. These rocks range from dacite to rhyolite and have a microporphyritic texture with olivine and minor clinopyroxene. A pre-caldera basaltic andesite has also been studied. It has a microporphyritic texture with clinopyroxene. The intermediate and acid compositions alternating in the volcanostratigraphic sequence suggest either mafic recharge events or melt extraction from different levels in the deep magmatic system. All the studied compositions share a subduction-related signature similar to other magmatics from the Bransfield Basin. However, compositional differences between pre-caldera and post-caldera rocks indicate a different magma source and depth of crystallisation. According to the geothermobarometric calculations the pre-caldera magmas started to crystallise at deeper levels (13.5-15 km) than the post-caldera magmas (6.2-7.8 km). Specifically, the postcaldera magmas indicate a smaller influence of the subducting slab in the southwestern part of the Bransfield Basin in respect to the available data from other sectors as well as the involvement of crustal contamination in the genesis of the magmas. (Author)

  16. Detection of tumoral lesions in the posterior fossa, in brain computerized tomography scans for various conditions of acquiring a preliminary approach; Deteccion de lesiones tumorales en fosa posterior en imagenes de Tomografia Computarizada cerebral para diversas condiciones de adquisicion: un enfoque preliminar

    Energy Technology Data Exchange (ETDEWEB)

    Perez, M.; Carvalho-Filho, A. E.; Khoury, H. J.; Casas, M. C.; Andrade, M. E.; Paz, J. E.

    2010-07-01

    The present work performs a study over 13 tomographic images, using an anthropomorphic head phantom. It contains small lesions in the posterior fossa. Tube current (I [mA]), slice thickness (E [mm]), were the parameters changed among studies, looking for the best acquisition conditions, which permit good lesion detectability, and applying the lowest dose. Air Kerma in air [mGy] was calculated. Image quality was analyzed by both expert criterion and some merit figures. Two of them were global: contrasts to noise ratio (RCR [dB]) and signal to noise ratio (RSR). The rest of the measures used were relatives to the maximum dose condition: The gain in signal to noise ratio (SNR [dB]) and the maximum signal to noise ratio (PSNR [dB]), the normalized mean squared error (NMSE) and the structural similarity index (SSIM). Objective and subjective results were correlated. It is shown that it is possible to reduce the dose using lower values of mAs without affecting lesion detectability and keeping good image quality for the scanner used. An optimized protocol is also proposed for the technology used. (Author) 27 refs.

  17. 秦皮水提取物与部分西药对含fosA3大肠杆菌的联合作用%The effect of Cortex Fraxini water extractions combined with antibiotics against the resistance gene fosA3 in Escheriohia coli

    Institute of Scientific and Technical Information of China (English)

    陈鹏举; 郭炜彤; 张昊龙; 王汝都; 赵庆枫; 丁壮

    2014-01-01

    本试验初步探讨秦皮水提取物与抗菌药联合诱导含fosA3型耐药基因大肠杆菌传代的体外抑菌活性,为耐药大肠杆菌感染疾病提供治疗参考方案.采用二倍微量稀释法体外分别检测秦皮水提取物与抗菌药物的最小抑菌浓度(MIC),并以1/2 MIC的秦皮水提取物与抗菌药联合诱导含(fosfomycin resistance gene,FosA3)型大肠杆菌的传代试验.秦皮水提取物的MIC为1.0 g/mL,以0.5 g/mL的秦皮水提取物与头孢曲松钠、阿莫西林、诺氟沙星、粘杆菌素、痢菌净、磺胺间甲氧嘧啶、阿米卡星、头孢他啶、头孢噻呋钠、氟苯尼考和磷霉素11种抗菌药联合诱导传代后MIC显著降低.结果显示:秦皮水提取物联合抗菌药诱导耐药细菌体外抗菌活性明显增强,对含fosA3型大肠杆菌具有耐药逆转作用.

  18. De la exhumación de cuerpos al conocimiento histórico. Análisis de la represión irregular franquista a partir de la excavación de fosas comunes en Extremadura (1936-1948)

    OpenAIRE

    Muñoz Encinar, Laura

    2017-01-01

    La represión franquista ejercida en España tras el golpe de estado del 17 de julio de 1936 provocó la muerte de 13.205 personas en Extremadura. Víctimas de las que al menos 9.293 fueron ejecutadas de forma irregular, sin que pasaran por ningún procedimiento judicial. Detenidos ilegalmente por motivos políticos, cuyo rastro se pierde en el proceso represivo, eliminados mediante la aplicación directa de los bandos de guerra entre julio de 1936 y 1948. Los cuerpos de estas personas fueron enterr...

  19. Analysis of Perfluorinated Chemicals and Their Fluorinated Precursors in Sludge: Method Development and Initial Results

    Science.gov (United States)

    A rigorous method was developed to maximize the extraction efficacy for perfluorocarboxylic acids (PFCAs), perfluorosulfonates (PFSAs), fluorotelomer alcohols (FTOHs), fluorotelomer acrylates (FTAc), perfluorosulfonamides (FOSAs), and perfluorosulfonamidoethanols (FOSEs) from was...

  20. Radiation during deep inspiration allows loco-regional treatment of left breast and axillary-, supraclavicular- and internal mammary lymph nodes without compromising target coverage or dose restrictions to organs at risk.

    Science.gov (United States)

    Hjelstuen, Mari H B; Mjaaland, Ingvil; Vikström, Johan; Dybvik, Kjell Ivar

    2012-03-01

    Loco-regional radiotherapy of left-sided breast cancer represents a treatment planning challenge when the internal mammary chain (IMC) lymph nodes are included in the target volume. This treatment planning study evaluates the reduction in cardiopulmonary doses when radiation is given during deep inspiration breath-hold (DIBH). This was achieved without compromising dose coverage to the planning target volume (PTV). Seventeen patients with early breast cancer, referred for adjuvant radiotherapy, were included. For each patient two computed tomography (CT)-scans were acquired; the first during free breathing (FB) and the second during DIBH. The scans were monitored by the Varian RPM respiratory gating system. Audio-visual guidance was used. The treatment planning of the two CT studies was performed focusing on good coverage (V95% > 98%) of the PTV. Doses to the heart, left anterior descending (LAD) coronary artery, lungs and contralateral breast were assessed. With equal PTV coverage, average mean heart dose was reduced from 6.2 Gy to 3.1 Gy in DIBH plans as compared to FB. Average volume receiving 25 Gy or more (V25Gy) was reduced from 6.7% to 1.2%, and the number of patients with V25Gy > 5% was reduced from 8 to 1 utilizing DIBH. The average mean dose to the LAD coronary artery was reduced from 25.0 Gy to 10.9 Gy. The average ipsilateral lung volume receiving 20 Gy or more (V20Gy) was reduced from 44.5% to 32.7% with DIBH. In 11 of the DIBH plans V20Gy was lower than 35%, in accordance with national guidelines, while none of the FB plans fulfilled this recommendation. Respiratory gated radiotherapy during DIBH is a suitable technique for loco-regional breast irradiation even when IMC lymph nodes are included in the PTV. Cardiopulmonary doses are considerably decreased for all dose levels without compromising the dose coverage to PTV.

  1. Radiation during deep inspiration allows loco-regional treatment of left breast and axillary-, supraclavicular- and internal mammary lymph nodes without compromising target coverage or dose restrictions to organs at risk

    Energy Technology Data Exchange (ETDEWEB)

    Hjelstuen, Mari H. B.; Mjaaland, Ingvil; Vikstroem, Johan; Dybvik, Kjell Ivar (Department of Hematology and Oncology, Stavanger University Hospital, Stavanger (Norway)), E-mail: hjem@sus.no

    2012-03-15

    Background and purpose. Loco-regional radiotherapy of left-sided breast cancer represents a treatment planning challenge when the internal mammary chain (IMC) lymph nodes are included in the target volume. This treatment planning study evaluates the reduction in cardiopulmonary doses when radiation is given during deep inspiration breath-hold (DIBH). This was achieved without compromising dose coverage to the planning target volume (PTV). Patients and methods. Seventeen patients with early breast cancer, referred for adjuvant radiotherapy, were included. For each patient two computed tomography (CT)-scans were acquired; the first during free breathing (FB) and the second during DIBH. The scans were monitored by the Varian RPMTM respiratory gating system. Audio-visual guidance was used. The treatment planning of the two CT studies was performed focusing on good coverage (V95% > 98%) of the PTV. Doses to the heart, left anterior descending (LAD) coronary artery, lungs and contralateral breast were assessed. Results. With equal PTV coverage, average mean heart dose was reduced from 6.2 Gy to 3.1 Gy in DIBH plans as compared to FB. Average volume receiving 25 Gy or more (V25Gy) was reduced from 6.7% to 1.2%, and the number of patients with V25Gy > 5% was reduced from 8 to 1 utilizing DIBH. The average mean dose to the LAD coronary artery was reduced from 25.0 Gy to 10.9 Gy. The average ipsilateral lung volume receiving 20 Gy or more (V20Gy) was reduced from 44.5% to 32.7% with DIBH. In 11 of the DIBH plans V20Gy was lower than 35%, in accordance with national guidelines, while none of the FB plans fulfilled this recommendation. Conclusion. Respiratory gated radiotherapy during DIBH is a suitable technique for loco-regional breast irradiation even when IMC lymph nodes are included in the PTV. Cardiopulmonary doses are considerably decreased for all dose levels without compromising the dose coverage to PTV

  2. Toxicidad cutánea a corto plazo de pacientes con cáncer de mama tratados con radioterapia hipofraccionada

    Directory of Open Access Journals (Sweden)

    Rolando Loría-Ruiz

    2013-12-01

    Full Text Available Antecedentes: reportar la factibilidad y resultados de toxicidad cutánea en una cohorte de pacientes portadores de cáncer de mama, tratados con un esquema de hipofraccionamiento de radioterapia externa, con un manejo multidisciplinario. Métodos: utilizando un software SPSS v18, se realizó un análisis retrospectivo de 299 pacientes (6 H y 293 M, tratados entre marzo de 2009 y diciembre de 2011, en el Instituto Oncológico del Sureste, Murcia, España. La mediana de edad fue de 54 años (rango, 31-89; 145 (48,49% pacientes con cáncer de mama derecha y 154 (51,50% de mama izquierda. Con base en la 7ª ed AJCC, la etapificación patológica fue: 118 (39,5% pacientes T1, 114 (38,1% T2, 43 (14,1% T3, 11 (3,8% T4, 5 (1,7% Tis, 4 (1,3% Tx; 137 pacientes (45,8% eran N0, 94 (31,5% N1, 45 (15% N2, 20 (6,70% N3 y 3 (1,00% Nx. Todos los pacientes se sometieron a RTE con técnica 3D conformada con esquema hipofraccionado de 2,67 Gy/día, en 15 fracciones para una dosis total de 40.05 Gy. Se realizó irradiación electiva a la región supraclavicular en 169 pacientes, con igual fraccionamiento. El 100% de la muestra se sometió a cirugía, el 84,3% recibió quimioterapia (66,21% postoperatoria y 18,1% neoadyuvante. Resultados: sesenta y siete pacientes (23,1% presentaron toxicidad cutánea grado 2 al finalizar el tratamiento. No se reportó toxicidad cutánea aguda severa. Conclusión: el esquema de hipofraccionamiento empleado en cáncer de mama es factible y no ha demostrado incremento en la toxicidad aguda severa a nivel de piel.

  3. Fistulación y canulación permanente del compartimento 1 (Rumen en Llamas (Lama glama Permanent fistulation and cannulation of compartment 1 (Rumen of the Llama (Lama glama

    Directory of Open Access Journals (Sweden)

    R. Cabrera

    2000-01-01

    Full Text Available Para realizar estudios de evaluación nutricional de recursos alimentarios potencialmente utilizables por la Llama y relacionarlos con características ruminales de estos animales, hemos practicado fistulaciones permanentes del compartimento 1 (rumen. Cuatro llamas hembras de un peso promedio de 65 kg, fueron fistuladas usando la técnica quirúrgica descrita por Cabrera y col. (1980, 1997. Los animales se mantuvieron sin alimento por 72 h, se atropinizaron, y anestesiaron con Ketamina (Ketostop® i.m. 10 mg/k de peso y se infiltraron localmente con lidocaína al 2%. Se removió un trozo circular de piel de diez cm de diámetro de la fosa lumbar izquierda y los planos musculares subyacentes se separaron usando disección obtusa. El peritoneo fue abierto y la pared ruminal fijada al borde de la piel usando puntos en "U", cuidando de mantener siempre el peritoneo entre las dos capas. Finalmente, el circulo de pared ruminal comprendido entre las suturas, fue removido y la zona fue tratada con Qemispray®. La fístula, fue inmediatamente cerrada con una cánula de goma tipo 10 C (Bar Diamond,Inc., Parma, Idaho, U.S.A. Durante cinco días los animales fueron tratados con antibióticos (I.M. y las suturas fueron removidas al séptimo día. Los animales soportaron muy bien el procedimiento quirúrgico y se adaptaron adecuadamente a la cánula. Actualmente los animales han completado 24 meses de operados sin que hubieran presentado ningún problema derivado de ello, excepto por pequeñas fugas de contenido ruminal en algunas de las cánulas, de escasa trascendenciaTo carry out nutritional evaluation of potentially useful feedstuffs and related ruminal metabolic studies in Llama, we have performed permanent fistulations of compartment 1 (rumen in this specie. Four adult female llamas with a mean weight of 100 kg were fistulated using the surgical technique described by Cabrera et al. (1980, 1997. They were kept without food for 72 hr., atropinized and

  4. Endocardite infecciosa com apresentação inicial de abdome agudo Endocarditis infecciosa con presentación inicial de abdomen agudo Infective endocarditis with initial presentation of acute abdomen

    Directory of Open Access Journals (Sweden)

    Humberto F. G Freitas

    2010-04-01

    Full Text Available Paciente de 35 anos de idade foi atendido em Serviço de Emergência com seis horas de dor em fossa ilíaca direita e febre. Feita hipótese diagnóstica de apendicite aguda e realizada laparotomia exploradora. com apendicectomia. O paciente retornou ao hospital três dias após alta hospitalar. prostrado. febril. com alteração de fala. diminuição de nível de consciência e com hemiparesia completa à esquerda. CT scan de crânio e punção de líquor normal. RMN de encéfalo revelou aspectos compatíveis com AVC isquêmico vertebro-basilar. Ecocardiograma transesofágico demonstrou vegetação em valva aórtica e insuficiência aórtica moderada e hemoculturas foram positivas para Enterococcus bovis.Paciente de 35 años de edad ingresó en el servicio de emergencia con seis horas de dolor en fosa ilíaca derecha y fiebre. Se llevó a cabo la hipótesis diagnóstica de apendicitis aguda y realizada laparotomía exploradora, con apendicectomía. El paciente regresó al hospital tres días tras alta hospitalaria, prostrado, febril, con alteración de habla, disminución de nivel de conciencia y con hemiparesia izquierda completa. Scanner de cráneo y punción de líquido cefalorraquídeo (LCR normal. RMN de encéfalo reveló aspectos compatibles con ACV isquémico vertebrobasilar. El ecocardiograma transesofágico demostró vegetación en válvula aórtica y insuficiencia aórtica moderada y hemocultivos fueron positivas para Enterococcus bovis.A 35-year-old patient was seen in an Emergency Department. with six hours of pain in the right iliac fossa and fever. The hypothesis diagnosis was acute appendicitis and an exploring laparotomy for appendectomy was carried out. The patient returned to the hospital three days after having been discharged. debilitated. feverish. having alterations in speech. reduction in the level of consciousness and complete hemiparesis to the left. The computed tomography scan of the skull and the liquor puncture were

  5. Determinación de los valores normales del índice de tei (índice de performance miocárdico y otros parámetros ecocardiográficos doppler de la función ventricular izquierda en caninos sanos

    Directory of Open Access Journals (Sweden)

    Iván Álvarez

    2010-06-01

    Full Text Available La falla cardiaca está relacionada con anormalidades en la contracción y relajación ventricular. Estudios recientes han mostrado que en la mayoría de los pacientes con insuficiencia cardiaca coexisten alteraciones de la función sistólica y diastólica, y en algunos casos la función sistólica es normal pero la falla cardiaca es generada por disfunción ventricular diastólica. El índice de performance miocárdico (tiempo de contracción isovolumétrica sumado al tiempo de eyección ventricular dividido el tiempo de eyección, “Índice de Tei” ha sido descrito como una manera más efectiva para el análisis de la Disfunción Miocárdica Global que otros parámetros de función sistólica y diastólica. Con base en estos antecedentes, los autores determinaron el valor normal del índice de Tei para el ventrículo izquierdo en caninos sanos en la ciudad de Bogotá (2.600 msnm con el objeto de utilizar dicho valor como índice de la función sistodiastólica. Se obtuvo un valor medio de 0,33 con un desvío estándar de 0,10. Asimismo pudo verificarse que no existe correlación con la frecuencia cardiaca, peso corporal ni con la fracción de eyección ventricular izquierdo (P<0,05.

  6. Rotura de aurícula izquierda y hemopericardio en un cocker spaniel con degeneración de la válvula mitral: caso clínico (Left atrial rupture and hemopericardium in a cocker spaniel with mitral valve degeneration: case report

    Directory of Open Access Journals (Sweden)

    Caro-Vadillo, A.

    2009-04-01

    Full Text Available SummaryA 12 year old male cocker previously diagnosed of mitral valvedegeneration presented to our Hospital stuporous, with hemorrhagicdiarrhea and severe signs of hypovolemia; owners suspected ingestion of large doses of non-steroidal drugs. Emergency treatment (mainly fluid resuscitation and gastrointestinal protective drugs was effective for initial stabilization, but hemodynamic status worsened later; cardiac ultrasound revealed pericardial effusion. Necropsy confirmed left atrial rupture. In spite of severe hypovolemia, Central Venous Pressure (CVP was above normal values at presentation, probably due to the increase in transmuralpressure induced by pericardial effusion associated with left atrial rupture. We conclude that elevated CVP values in hypovolemic patients warrant further investigation of concurrent pathologies.

  7. Preditores de função ventricular esquerda global na síndrome metabólica Predictores de función ventricular izquierda global en el síndrome metabólico Predictors of global left ventricular function in metabolic syndrome

    Directory of Open Access Journals (Sweden)

    Branislava Aleksa Ivanovic

    2011-05-01

    Full Text Available FUNDAMENTO: A síndrome metabólica (SM representa um conjunto de fatores de risco cardiovascular que agem de forma sinérgica. OBJETIVO: O objetivo desse estudo foi determinar quais parâmetros estavam associados de forma independente à função global do ventrículo esquerdo (VE em indivíduos com SM, estimada através do índice Tei. MÉTODOS: O estudo incluiu 234 indivíduos com SM e 96 controles ajustados por idade. A SM foi definida pela presença de três ou mais critérios da ATP-NCEP III. Todos os indivíduos foram submetidos a testes laboratoriais e ecocardiograma bidimensional e com Doppler pulsátil e tecidual. Intervalos de tempo apropriados no Doppler tecidual para a estimativa do índice Tei também foram avaliados. RESULTADOS: O índice Tei estava aumentado em todos os indivíduos com SM (0,35 ± 0,05 vs 0,49 ± 0,10, p FUNDAMENTO: El síndrome metabólico (SM representa un conjunto de factores de riesgo cardiovascular que actúan de forma sinérgica. OBJETIVO: El objetivo de este estudio fue determinar cuales parámetros estaban asociados de forma independiente a la función global del ventrículo izquierdo (VI en individuos con SM, estimada a través del índice Tei. MÉTODOS: El estudio incluyó 234 individuos con SM y 96 controles ajustados por edad. El SM fue definido por la presencia de tres o más criterios ATP-NCEP III. Todos los individuos fueron sometidos a tests de laboratorio y ecocardiograma bidimensional y con Doppler pulsado y tisular. Intervalos de tiempo apropiados en el Doppler tisular para la estimativa del índice Tei también fueron evaluados. RESULTADOS: El índice Tei estaba aumentado en todos los individuos con SM (0,35 ± 0,05 vs 0,49 ± 0,10, p BACKGROUND: The metabolic syndrome (MS represents a cluster of cardiovascular risk factors that act synergistically. OBJECTIVE: The aim of this study was to determine which parameters were independently associated with the global left ventricular (LV function in subjects with MS estimated with the Tei index. METHODS: The study included 234 subjects with MS and 96 controls adjusted by age. MS was defined by the presence of three or more of ATP- NCEP III criteria. All subjects underwent laboratory blood tests and two-dimensional, pulsed and tissue Doppler echocardiography. Appropriate tissue Doppler time intervals for the estimation of the Tei index were also assessed. RESULTS: The Tei index was increased in subjects with MS (0.35 ± 0.05 vs 0.49 ± 0.10, p < 0.001. Multiple regression analysis of the clinical parameters showed that systolic blood pressure (β= 0.289, p < 0.001, fasting glucose (β= 0.205, p = 0.009, LV mass index (β= 0.301, p < 0.001, E/e'septal (β= 0.267, p < 0.001, and e'septal (β= -0.176, p = 0.011 were independently associated with the global left ventricular function estimated by Tei index. CONCLUSION: MS has a significant impact on LV global function. Systolic blood pressure, fasting glucose, LV mass index, E/e'septal, and e'septal were independently associated with the LV global function.

  8. Izquierda y estabilidad de la democracia en América latina: la ideología de la revolución bolivariana y su repercusión sobre el proceso político en Venezuela y América latina

    OpenAIRE

    2003-01-01

    One of the main areas of work in Comparative Politics and Political Theory has been the determination of the variables associated with the stability/instability of political systems in general, and democracy in particular. This paper focuses on one of these variables. One with newly acquired importance after the recent electoral successes by the left, but that nevertheless has not been in the spotlight of scholarly analysis: ideological polarization. Particularly, ideological polarization bro...

  9. Typic Xerofluvent (Clasificación USDA 87). Typic Xerofluvents (Clasificación USDA 98). Fluvisol (Clasificación FAO 90). Área de estudio: Valle del Guadiamar. Tramo intermedio. Localización: Llanura aluvial del río Guadiamar margen izquierda

    OpenAIRE

    Clemente Salas, Luis; Cabrera, Francisco; García, Luis V.; Cara García, Juan S.

    1999-01-01

    3 páginas. Este documento se encuentra en la base de datos citada anteriormente, de Evenor-TEch (Spin-off del CSIC). http://www.evenor-tech.com/banco/seisnet/seisnet.htm., que incluye versiones en tres idiomas más. Se indica el enlace en Digital CSIC al artículo citado: http://hdl.handle.net/10261/47257

  10. Left convex thoracic scoliosis: retrospective analysis of 25 patients after surgical treatment Escoliosis torácica convexa izquierda: análisis retrospectivo de 25 pacientes después de tratamiento quirúrgico Escoliose torácica sinistro-convexa: análise retrospectiva de 25 pacientes após o tratamento cirúrgico

    OpenAIRE

    2011-01-01

    OBJECTIVE: A retrospective analysis of clinical and radiological data was conducted, with an emphasis on perioperative complications and risk factors and a minimum follow-up period of two years. The postoperative quality of life was assessed using the SRS-22 questionnaire. METHODS: Between 1999 and 2009, 25 patients (nine male, 16 female) with LCTS, with a mean age of 13.7 years (2.3-29.8 years), were treated with correction and instrumented fusion at a single institution. Seven patients had ...

  11. Left ventricle function in patients with ischemic cardiopathy: determination of the expulsion fraction of the left ventricle with gated-SPECT. Experience in the CMN 20 de Noviembre ISSSTE; Funcion ventricular izquierda en pacientes con cardiopatia isquemica: determinacion de la fraccion de expulsion del ventriculo izquierdo con gated-SPECT. Experiencia en el CMN 20 de Noviembre ISSSTE

    Energy Technology Data Exchange (ETDEWEB)

    Mendoza, L.; Puente, A.; Hernandez, T.; Jimenez, L. [Departamento de Medicina Nuclear y Cardiologia, Hospital CMN 20 de Noviembre, ISSSTE, 03000 Mexico D.F. (Mexico)

    2007-07-01

    The objective of this work is to correlate the expulsion fraction of the left ventricle (FEVI) obtained by means of g-SPECT and other diagnostic methods: ECO 2D and ventriculography for heart catheterization (CTT). (Author)

  12. Left convex thoracic scoliosis: retrospective analysis of 25 patients after surgical treatment Escoliosis torácica convexa izquierda: análisis retrospectivo de 25 pacientes después de tratamiento quirúrgico Escoliose torácica sinistro-convexa: análise retrospectiva de 25 pacientes após o tratamento cirúrgico

    Directory of Open Access Journals (Sweden)

    Birgit Deetjen

    2011-01-01

    Full Text Available OBJECTIVE: A retrospective analysis of clinical and radiological data was conducted, with an emphasis on perioperative complications and risk factors and a minimum follow-up period of two years. The postoperative quality of life was assessed using the SRS-22 questionnaire. METHODS: Between 1999 and 2009, 25 patients (nine male, 16 female with LCTS, with a mean age of 13.7 years (2.3-29.8 years, were treated with correction and instrumented fusion at a single institution. Seven patients had congenital scoliosis and 18 patients had noncongenital scoliosis (idiopathic, n = 5; neuropathic, n = 4; neoplasm-associated/iatrogenic, n = 3; secondary to other conditions, n = 6. The average preoperative Cobb angle was 74° (49-102°. RESULTS: A mean correction of 51% was achieved postoperatively. The mean Cobb angle at the final follow-up examination was 45° (19-85°, with a significant loss of correction of 8.8° on average. Major complications affected five patients (20%: respiratory insufficiency requiring prolonged intubation, intraoperative cardiac arrest with resuscitation being necessary twice in one patient, persistent clonus, low-grade infection, implant-based complications requiring revision surgery, and adding-on. Minor complications were observed in 22 patients (88%, mainly gastrointestinal and pulmonary. No cases of paraplegia or death occurred. A noncongenital etiology had been diagnosed before the age of 10 years in all of the patients who had major complications. The best score on the SRS-22 questionnaire was achieved in the domain of pain (87%, while the poorest was in the domain of self-image (68%. CONCLUSIONS: The results of this study emphasize an increased complication rate in patients with LCTS scheduled for scoliosis surgery. Additional preoperative examinations (MRI, paediatric consultation, cardiologic consultation, pulmonary function test are mandatory in patients with LCTS. Preoperatively, patients should be informed about the increased cardiopulmonary and neurological risk which may be associated with scoliosis surgery.OBJETIVO: Fue realizado un análisis retrospectivo de datos clínicos y radiológicos, con énfasis en complicaciones perioperatorias y factores de riesgos, y un período mínimo de seguimiento de 2 años. La calidad de vida posoperatoria fue evaluada usándose el cuestionario SRS-22. MÉTODOS: entre 1999 y 2009, 25 pacientes (nueve del sexo masculino, 16 del sexo femenino con ETCI, con edad promedio de 13,7 años (2,3 - 29,8 años fueron tratados con corrección y fusión instrumentada, en una única institución. Siete pacientes tenían escoliosis congénita y 18 pacientes tenían escoliosis no congénita (idiopática, n = 5; neuropática, n = 4; asociada a neoplasma/iatrogénica, n = 3; secundaria de otras condiciones, n = 6. El ángulo de Cobb preoperativo promedio fue 74º (49-102º. RESULTADOS: una corrección promedio de 51% fue alcanzada después de la operación. El ángulo de Cobb promedio, en el examen final de seguimiento, fue 45º (19-85º, con una pérdida significativa de corrección de 8,8º en promedio. Complicaciones graves afectaron a cinco pacientes (20%: insuficiencia respiratoria que requirió intubación prolongada, paro cardíaco intraoperativo con resucitación siendo necesaria dos veces para un paciente, clonus persistente, infección leve, complicaciones con implantes que precisaron de otra cirugía, y accesorios. Complicaciones de menor importancia fueron observadas en 22 pacientes (88%, principalmente gastrointestinales y pulmonares. No ocurrieron casos de paraplejía ni de muerte. Una etiología no congénita fue diagnosticada, antes de la edad de 10 años, en todos los pacientes que tuvieron complicaciones graves. La mejor puntuación en el cuestionario SRS-22 fue obtenida en el dominio de dolor (87%, mientras que la peor se registró en el dominio de la autoimagen (68%. CONCLUSIONES: Los resultados de este estudio enfatizan una tasa de complicación aumentada en pacientes portadores de ETCI con programación de cirugía de escoliosis. Exámenes preoperatorios adicionales (IRM, consulta pediátrica, consulta cardiológica, prueba de función pulmonar son obligatorios en pacientes con ETCI. Antes de la operación, los pacientes deben ser informados sobre los mayores riesgos cardiopulmonar y neurológico que pueden estar vinculados a la cirugía de escoliosis.OBJETIVO: Foi realizado estudo retrospectivo baseado em parâmetros clínicos e radiológicos, com ênfase nas complicações, fatores de risco e seguimento mínimo de dois anos. A qualidade de vida pós-operatória foi avaliada por meio do questionário SRS-22. MÉTODOS: No período de 1999 a 2009, 25 pacientes (nove do sexo masculino e 16 do sexo feminino com idade variando de 2,3 a 29,8 anos (média de idade de 13,7 anos foram submetidos a tratamento cirúrgico por meio de instrumentação e artrodese. Sete pacientes apresentavam escoliose congenital, cinco apresentavam escoliose idiopática, quatro neuropática, três associada à neoplasia ou iatrogenia, e seis associada a outras doenças. A média dos valores pré-operatórios do ângulo de Cobb foi 74° (49-102°. RESULTADOS: A média de correção no pós-operatório foi de 51%. Na avaliação de seguimento final, o valor médio do ângulo de Cobb foi 45° com variação de 19 a 85°, tendo ocorrido significante perda da correção com o valor médio de 8.8°. Complicações maiores ocorreram em cinco pacientes (20%: insuficiência respiratória requerendo entubação prolongada, parada cardíaca intraoperatória com ressuscitação, clônus persistente, infecção de baixo grau, complicações com implantes requerendo revisão cirúrgica, e descompensação do tronco. Complicações menores foram observadas em 22 pacientes (88%, sendo principalmente gastrointestinais e pulmonares. Nenhum caso de paraplegia ou morte ocorreu na série de pacientes estudados. As curvas de etiologia não congênita foram diagnosticadas antes dos 10 anos de idade em todos os pacientes que apresentaram complicações maiores. O melhor escore do questionário SRS-22 foi observado no domínio da dor (87%, e o pior no domínio da autoimagem (68%. CONCLUSÕES: O resultado do estudo enfatiza as altas taxas de complicação nos pacientes portadores de escoliose torácica sinistro-convexa que são submetidos ao tratamento cirúrgico. Avaliações pré-operatórias adicionais (RNM, avaliação pediátrica, avaliação cardiológica, teste de função pulmonar devem ser realizadas nesse grupo de pacientes. Antes do procedimento, os pacientes devem ser informados acerca do alto risco de complicações cardiopulmonares e neurológicas associadas ao tratamento cirúrgico da deformidade.

  13. Reliability and agreement of adipose tissue fat fraction measurements with water-fat MRI in patients with manifest cardiovascular disease

    NARCIS (Netherlands)

    Franssens, Bas T; Eikendal, Anouk L; Leiner, Tim; van der Graaf, Yolanda|info:eu-repo/dai/nl/072825847; Visseren, Frank L J|info:eu-repo/dai/nl/166267678; Hoogduin, J M|info:eu-repo/dai/nl/158071956

    2016-01-01

    The supraclavicular fat depot is known for brown adipose tissue presence. To unravel adipose tissue physiology and metabolism, high quality and reproducible imaging is required. In this study we quantified the reliability and agreement of MRI fat fraction measurements in supraclavicular and subcutan

  14. Reliability and agreement of adipose tissue fat fraction measurements with water-fat MRI in patients with manifest cardiovascular disease

    NARCIS (Netherlands)

    Franssens, Bas T; Eikendal, Anouk L; Leiner, Tim; van der Graaf, Yolanda; Visseren, Frank L J; Hoogduin, J M

    2016-01-01

    The supraclavicular fat depot is known for brown adipose tissue presence. To unravel adipose tissue physiology and metabolism, high quality and reproducible imaging is required. In this study we quantified the reliability and agreement of MRI fat fraction measurements in supraclavicular and subcutan

  15. Is It Possible to Detect Activated Brown Adipose Tissue in Humans Using Single-Time-Point Infrared Thermography under Thermoneutral Conditions? Impact of BMI and Subcutaneous Adipose Tissue Thickness.

    Directory of Open Access Journals (Sweden)

    Sergios Gatidis

    Full Text Available To evaluate the feasibility to detect activated brown adipose tissue (BAT using single-time-point infrared thermography of the supraclavicular skin region under thermoneutral conditions. To this end, infrared thermography was compared with 18-F-FDG PET, the current reference standard for the detection of activated BAT.120 patients were enrolled in this study. After exclusion of 18 patients, 102 patients (44 female, 58 male, mean age 58±17 years were included for final analysis. All patients underwent a clinically indicated 18F-FDG-PET/CT examination. Immediately prior to tracer injection skin temperatures of the supraclavicular, presternal and jugular regions were measured using spatially resolved infrared thermography at room temperature. The presence of activated BAT was determined in PET by typical FDG uptake within the supraclavicular adipose tissue compartments. Local thickness of supraclavicular subcutaneous adipose tissue (SCAT was measured on CT. Measured skin temperatures were statistically correlated with the presence of activated BAT and anthropometric data.Activated BAT was detected in 9 of 102 patients (8.8%. Local skin temperature of the supraclavicular region was significantly higher in individuals with active BAT compared to individuals without active BAT. However, after statistical correction for the influence of BMI, no predictive value of activated BAT on skin temperature of the supraclavicular region could be observed. Supraclavicular skin temperature was significantly negatively correlated with supraclavicular SCAT thickness.We conclude that supraclavicular SCAT thickness influences supraclavicular skin temperature and thus makes a specific detection of activated BAT using single-time-point thermography difficult. Further studies are necessary to evaluate the possibility of BAT detection using alternative thermographic methods, e.g. dynamic thermography or MR-based thermometry taking into account BMI as a confounding factor.

  16. Tratamiento endovascular exitoso del síndrome de cascanueces con stent autoexpandible

    OpenAIRE

    Alcocer-Gamba,Marco Antonio; Martínez-Chávez,Jorge A.; Alcántara-Razo,Mónica; Eid-Lidt,Guering; Lugo-Gavidia,Leslie M.; García-Hernández, Enrique; Montalvo-Ramos,Aquiles; Torres-Quiroz,Ivonne A.; Velázquez-Verduzco,Arturo

    2012-01-01

    El síndrome de cascanueces (nutcracker's syndrome) se produce por compresión de la vena renal izquierda a su paso por la horquilla vascular, formada por la aorta y la arteria mesentérica superior, causando una compresión extrínseca que genera estenosis funcional de la misma. Esto produce congestión e hipertensión de la vena renal izquierda que se traduce en insuficiencia y várices de la vena gonadal izquierda, hematuria unilateral y dolor lumbar izquierdo, el diagnóstico pocas veces se realiz...

  17. Trombosis de la arteria renal en un recién nacido. Presentación de un caso y revisión

    OpenAIRE

    Ana Lucía Torres; Javier Torres; Jorge Andrés Cifuentes

    2009-01-01

    Se describe un neonato que presenta cifras tensionales elevadas y ausencia de pulsos en miembros inferiores en su cuarto día de vida después de la colocación de un catéter umbilical arterial, evidenciando trombosis en arteria aorta y renal izquierda. Se realizó gammagrafía con MAG 3 que mostró exclusión renal izquierda y angioresonancia de aorta y renal izquierda. Se inició manejo con heparina no fraccionada y estreptoquinasa durante 6 horas. Se recuperó totalmente el compromiso en miembros i...

  18. Comparação entre dois métodos de posicionamento para realização do raio X e sua repercussão na avaliação da cifose torácica utilizando o método de Cobb e no equilíbrio sagital Comparación entre dos métodos de posicionamiento para la realización del rayo X y sus efectos sobre evaluación de la cifosis torácica usando el método de Cobb y el sagital equilibrio Comparison between two positioning methods for X-ray and its impact on the evaluation of thoracic kyphosis by Cobb's method and sagittal balance

    Directory of Open Access Journals (Sweden)

    Carlos Henrique Maçaneiro

    2010-12-01

    Full Text Available INTRODUÇÃO: o tratamento da cifose torácica é baseado na aferição da magnitude da curva baseada em mensurações radiográficas, e proporcionar o correto equilíbrio sagital pela correção cirúrgica de uma gibosidade é de importância fundamental. OBJETIVO: análise radiográfica prospectiva do efeito da variação da posição dos braços sobre a aferição da cifose torácica e do equilíbrio sagital entre pacientes com idades pré-estabelecidas. MÉTODOS: foram realizadas radiografias na posição lateral da coluna vertebral utilizando-se dois métodos posicionais: posição 1, em que o paciente permanecia de pé, com os joelhos juntos, pés alinhados com os ombros, cabeça reta direcionada para a frente, braços estendidos a 90º em relação ao tronco, mantendo os membros superiores estendidos e paralelos ao chão; uma segunda radiografia foi obtida com o paciente de pé, com os joelhos juntos, pés alinhados com os ombros, cabeça reta direcionada para a frente, com os cotovelos fletidos e os dedos repousando sobre a fossa supraclavicular bilateralmente. Os braços devem formar um ângulo de aproximadamente 45º com o corpo. Foram mensurados os ângulos de Cobb e o equilíbrio sagital nas duas radiografias. RESULTADOS: não houve correlação entre a posição dos braços, os valores angulares de Cobb e o equilíbrio sagital. CONCLUSÃO: em nosso trabalho, observamos que a posição dos braços (90º versus 45º, não interfere estatisticamente no valor da cifose torácica e na variação do equilíbrio sagital.INTRODUCCIÓN: el tratamiento de la cifosis torácica se basa en la medición de la magnitud de la curva a partir de mediciones radiológicas, y proporcionar el equilibrio adecuado para la corrección quirúrgica de la deformidad de la columna sagital es de una importancia fundamental. OBJETIVO: un análisis prospectivo radiográfico del efecto de la variación en la posición de los brazos en la medición de la cifosis tor

  19. Distribution of perfluorinated compounds in blood compartments during prenatal exposure

    DEFF Research Database (Denmark)

    Nielsen, Flemming; Weihe, Pál; Grandjean, Philippe

    carboxylic acids (PFCAs) and perfluoroalkyl sulfonates (PFSAs) ranging from C4-C12, as well as perfluorooctanesulfonamides (FOSAs) and perfluorooctanesulfonamidoacetic acids (FOSAAs). Maternal and foetal levels were significantly correlated for nearly all PFCs with median concentrations in cord serum ranging...... between 30-95% of the maternal concentration, while cord whole blood levels were lower. The only exception was FOSA that binds to erythrocytes and therefore occur at significantly higher concentration in whole blood. The apparent partition of the PFCs across the placental barrier varied according to chain...

  20. Simas, cavernas y pozos para ocultar cadáveres en la Guerra Civil española (1936-1939). Aportaciones desde la Antropología Forense

    OpenAIRE

    Etxeberria, F.

    2014-01-01

    Son miles las víctimas de la Guerra Civil (1936-1939) que permanecen enterradas en fosas comunes repartidas por todo el territorio. Pero además de las fosas en zonas marginales o en cementerios, se emplearon también pozos artificiales y simas naturales para hacer desaparecer las evidencias de los crímenes cometidos. Este recurso ha sido utilizado a lo largo de toda la historia en situaciones de conflicto y explica algunos hallazgos que se han realizado: la ocultación de los cuerpos en espacio...

  1. Prevención de úlceras por presión y lesiones musculoesqueléticas: paciente con ictus Pressure ulcer prevention and muscular and skeletal injuries: Patient with stoke

    National Research Council Canada - National Science Library

    Carlos Luque Moreno; Marta Peña Salinas; Fátima Rodríguez Pappalardo; Luis López Rodríguez

    2012-01-01

    Planteamos un caso clínico en el que enfermera y fisioterapeuta ponen en común procedimientos para mejorar la higiene postural de un paciente encamado con un accidente cerebrovascular y hemiplejia izquierda. Describimos...

  2. UNIVERSIDAD Y GLOBALIZACIÓN EN COLOMBIA: ENTRE EL CONFLICTO Y LA INCERTIDUMBRE DE LA PAZ

    National Research Council Canada - National Science Library

    Álvaro Acevedo Tarazona

    2017-01-01

    La universidad colombiana ha sido enclave de formación ideológica estudiantil revolucionaria con el objetivo de transformar una sociedad considerada por distintas tendencias de izquierda muy injusta y muy desigual...

  3. Caso clínico de traumatología

    OpenAIRE

    2012-01-01

    Es referido a la consulta un perro Golden Retriever, macho no castrado, de 6 meses de edad y 20 kg de peso por un problema de cojera aguda en la extremidad posterior izquierda. Presenta una historia de traumatismo previo, al caer de la mesa en la peluquería. El animal manifiesta dolor a la manipulación de la articulación coxo-femoral izquierda en extensión y en flexión.

  4. Axillary Lymph Nodes and Breast Cancer

    Science.gov (United States)

    ... more likely to affect arm function and cause lymphedema. For this reason, sentinel node biopsy is the ... OR supraclavicular (above the clavicle) nodes have cancer Lymphedema Lymphedema [lim-fa-DEE-ma] is a build- ...

  5. Fine-needle aspiration biopsy of lymph nodes

    African Journals Online (AJOL)

    2012-02-02

    Feb 2, 2012 ... Lymph nodes in the posterior cervical triangle and supraclavicular nodes are more suspicious for malignancy. ... exclusively primary or recurrent breast carcinoma in aspirates ... Lung carcinoma – small cell and non- small cell.

  6. Lymphatic system (image)

    Science.gov (United States)

    ... referring to swollen lymph nodes. Common areas where lymph nodes can be easily felt, especially if they are enlarged, are: the groin, armpits (axilla), above the clavicle (supraclavicular), in the neck (cervical), and the back of ...

  7. Chalet en la playa de Javea

    Directory of Open Access Journals (Sweden)

    García-Ordóñez, Fernando M.

    1961-05-01

    Full Text Available El terreno destinado a la construcción era un alargado retazo de 20 m de profundidad por 200 de longitud. Se encuentra inmediatamente lindando con el mar; es de naturaleza rocosa, muy accidentado y con pendiente hacia el mar, Dentro del solar existen grandes fosas naturales y artificiales producidas por explotaciones de canteras.

  8. Concentrations of organochlorine pesticides, polybrominated diphenyl ethers and perfluorinated compounds in the atmosphere of North Greenland

    DEFF Research Database (Denmark)

    Bossi, Rossana; Vorkamp, Katrin; Skov, Henrik

    2016-01-01

    sulfonamides (FOSA) and perfluoroalkyl sulfonamidoethanols (FOSE) were also detected but at much lower concentrations than FTOHs. Temporal trends were investigated for all measured compounds but no significant trend in concentration was observed. Monthly average concentrations for the six years were calculated...

  9. 78 FR 27372 - Combined Notice of Filings

    Science.gov (United States)

    2013-05-10

    ... 2013 Filing to be effective 8/ 1/2013. Filed Date: 5/1/13. Accession Number: 20130501-5062. Comments Due: 5 p.m. ET 5/13/13. Docket Numbers: RP13-863-000. Applicants: Big Sandy Pipeline, LLC. Description: FOSA Modifications May 2013 Filing to be effective 8/ 1/2013. Filed Date: 5/1/13. Accession...

  10. Fosfomycin Resistance in Escherichia coli, Pennsylvania, USA.

    Science.gov (United States)

    Alrowais, Hind; McElheny, Christi L; Spychala, Caressa N; Sastry, Sangeeta; Guo, Qinglan; Butt, Adeel A; Doi, Yohei

    2015-11-01

    Fosfomycin resistance in Escherichia coli is rare in the United States. An extended-spectrum β-lactamase-producing E. coli clinical strain identified in Pennsylvania, USA, showed high-level fosfomycin resistance caused by the fosA3 gene. The IncFII plasmid carrying this gene had a structure similar to those found in China, where fosfomycin resistance is commonly described.

  11. Pemakaian Alloplastik Untuk Rekonstruksi Ankilosis Sendi Temporomandibula

    OpenAIRE

    Mohd. Noor Izuddin Bin Mohd Salleh

    2009-01-01

    Salah satu dari berbagai gangguan sendi temporomandibula adalah ankilosis. Kata ankilosis berasal dari perkataan Greek yang artinya kekakuan pada sendi akibat proses penyakit, dengan penyatuan jaringan fibrous atau tulang pada sendi. Apabila kelainan ini terjadi dalam sendi temporomandibula, di mana kepala kondilar mandibula melekat dengan fosa glenoid, akan menyebabkan gangguan pada artikulasi yang normal dan menyebabkan kekakuan pada mandibula. Ankilosis sendi temporomandibula dapat dis...

  12. Liberación de iones flúor en materiales dentales

    OpenAIRE

    Salmeron-Váldes, Elías Nahum

    2016-01-01

    Tesis de Doctorado que contiene el análisis y la cuantificación del flúor liberado en algunos materiales dentales como lo son Cementos de Ionómero de vidrio, Selladores de fosas y fisuras, pastas dentales y barnices.

  13. Explotación de 100 vacas para la producción de leche, en régimen de estabulación libre con cubículos, en Villamuriel de Cerrato (Palencia)

    OpenAIRE

    Antón Jiménez, Sergio

    2013-01-01

    Explotación para 100 vacas de leche y 40 novillas en Villamuriel de Cerrato, con la construcción de una nave ganadera, con cubículos, lecheria, sala de ordeño y espera y oficina , fosas de purines 3 silos tipo bunker , almacén de materías primas y hénil

  14. El aumento de la expresión del ARNm de la enzima convertidora de angiotensina I homóloga (ECA-2 inducido por atorvastatina se asocia a menor fibrosis e hipertrofia ventricular izquierda en un modelo de cardiomiopatía diabética Atorvastatin induced increase in homologous angiotensin i converting enzyme (ACE2 mRNA is associated to decreased fibrosis and decreased left ventricular hypertrophy in a rat model of diabetic cardiomyopathy

    Directory of Open Access Journals (Sweden)

    Cristian Aguilar

    2011-06-01

    Full Text Available Objetivos. Evaluar el efecto de atorvastatina sobre la progresión del remodelado cardiaco y la expresión de ECA-2 en el miocardio de ratas diabéticas. Materiales y métodos. La diabetes fue inducida en ratas Holtzman con una inyección intraperitoneal de estreptozotocina. Los animales fueron divididos en tres grupos: (1 ratas control, (2 ratas diabéticas y (3 ratas diabéticas tratadas con atorvastatina (50 mg/kg/día. Después de ocho semanas de tratamiento, los corazones fueron extraídos para el análisis morfométrico, la cuantificación de colágeno y la determinación de los niveles de ARNm de ECA y ECA-2. Resultados. El índice de hipertrofia ventricular y el depósito de colágeno se incrementaron significativamente en las ratas diabéticas. La administración de atorvastatina previno estos cambios sin modificar los niveles de colesterol. La hiperglicemia produjo un incremento significativo en los niveles del ARNm de ECA y una marcada disminución en la expresión de ECA-2 en el miocardio de ratas diabéticas. La administración de atorvastatina indujo la expresión del ARNm de ECA-2 e inhibió la sobreexpresión del ARNm de ECA en el miocardio de las ratas diabéticas. Conclusiones. Nuestros resultados indican que la atorvastatina, independientemente de su capacidad para disminuir el colesterol, normaliza la relación de la expresión de ECA/ECA-2 y atenúa el desarrollo del remodelado adverso en el corazón diabético.Objectives. This study has investigated the effect of atorvastatin on the progression of cardiac remodelling and ACE- 2 expression in diabetic myocardium in rats. Materials and Methods. Diabetes was induced in Holtzman rats with an intraperitoneal injection of streptozotocin. The animals were divided into 3 groups: (1 normal control rats, (2 diabetic rats and (3 diabetic rats treated orally with atorvastatin (50 mg/kg/day. After eight weeks of treatment, the hearts were removed for morphometric studies, collagen content assay and genetic expressions of ACE and ACE2 mRNA. Results. Myocardial hypertrophy index and collagen deposition were increased in diabetic rats, but not in the treated-diabetic rats, without producing changes in cholesterol levels. Myocardial ACE mRNA levels were increased while ACE2 mRNA levels were decreased in diabetic rats. Atorvastatin administration attenuated overexpression of ACE mRNA and overexpression of ACE-2 mRNA in diabetic rats. Conclusions. Our results indicate that atorvastatin, independently of its cholesterol-lowering capacity, lowers the ACE/ACE2 ratio to normal values and attenuates the development of adverse remodeling in the diabetic heart.

  15. The left and the democratic stability in Latin America: the ideology of the Bolivarian Revolution and its impact on the political processes in Venezuela and Latin America Izquierda y estabilidad de la democracia en América latina: la ideología de la revolución bolivariana y su repercusión sobre el proceso político en Venezuela y América latina

    OpenAIRE

    2010-01-01

    One of the main areas of work in Comparative Politics and Political Theory has been the determination of the variables associated with the stability/instability of political systems in general, and democracy in particular. This paper focuses on one of these variables. One with newly acquired importance after the recent electoral successes by the left, but that nevertheless has not been in the spotlight of scholarly analysis: ideological polarization. Particularly, ideological polarization bro...

  16. Magnetic resonance imaging findings of a nonfunctional mediastinal paraganglioma with an unusual presentation

    Energy Technology Data Exchange (ETDEWEB)

    Sahin-Akyar, G. [Department of Radiology, University of Ankara, Faculty of Medicine, Ibn-i Sina Hospital, Samanpazari, TR-06100 Ankara (Turkey); Erden, I. [Department of Radiology, University of Ankara, Faculty of Medicine, Ibn-i Sina Hospital, Samanpazari, TR-06100 Ankara (Turkey); Yagci, C. [Department of Radiology, University of Ankara, Faculty of Medicine, Ibn-i Sina Hospital, Samanpazari, TR-06100 Ankara (Turkey); Akyar, S. [Department of Radiology, University of Ankara, Faculty of Medicine, Ibn-i Sina Hospital, Samanpazari, TR-06100 Ankara (Turkey); Erekul, S. [Department of Pathology, University of Ankara, Faculty of Medicine, Ibn-i Sina Hospital, Samanpazari, TR-06100 Ankara (Turkey)

    1997-09-01

    A case of histologically proven mediastinal paraganglioma presenting with metastatic spread to supraclavicular lymph nodes is presented. Mediastinal paragangliomas are extremely rare tumors and their CT and MR imaging features have not been well documented in the radiologic literature. The T 1-weighted and T 2-weighted spin-echo MR findings of a locally invasive mediastinal paraganglioma with metastasis to the supraclavicular lymph nodes are described and the literature is briefly reviewed. (orig.). With 4 figs.

  17. Perirenal 18F-FDG Uptake in a Patient with a Pheochromocytoma

    OpenAIRE

    Park, Jihyun; Byun, Byung Hyun; Jung, Chang Won; Moon, Hansol; Chang, Kyoung Jin; Lim, Ilhan; Kim, Byung Il; Choi, Chang Woon; Lim, Sang Moo

    2014-01-01

    Increased 18F-fluorodeoxyglucose (FDG) uptake of brown fat on 18F-FDG positron emission tomography (PET) originating from physiological activation is a common incidental finding and is usually located in the neck, shoulder, and supraclavicular areas. We present a case of an incidental pheochromocytoma showing diffusely increased 18F-FDG uptake in bilateral perirenal fat tissue as well as supraclavicular and paravertebral fat tissue on 18F-FDG PET/CT. The patient had no clinical symptoms excep...

  18. Ganglioneuroma, heterochromia iridis, and Horner's syndrome.

    Science.gov (United States)

    McRae, D; Shaw, A

    1979-10-01

    A child with mediastinal and supraclavicular ganglioneuroma, heterochromia iridis, and Horner's syndrome is described. The authors postulate that the thoracic neoplasm originated as a congenital neuroblastoma with metastasis to the supraclavicular lymph nodes and subsequent benign transformation, and that the ocular abnormalities resulted from sympathetic ganglion injury by the tumor in infancy. This seems to be the first published report of such ocular abnormalities associated with mediastinal ganglioneuroma.

  19. Síndrome del Outlet Torácico: ¿Una Patología Siempre Quirúrgica? Análisis de una Serie de 31 Cirugías Realizadas por Vía Supraclavicular Serie clínica

    Science.gov (United States)

    Socolovsky, Mariano; Di Masi, Gilda; Binaghi, Daniela; Campero, Álvaro; Páez, Miguel Domínguez; Dubrovsky, Alberto

    2014-01-01

    Introducción: El síndrome de outlet torácico es una compresión del plexo braquial que suscita polémica. Se clasifica en Outlet Torácico Verdadero o neurogénico (OTV) y Outlet Torácico Disputado o no neurogénico (OTD). El primero presenta síntomas motores en la mano, mientras que el segundo sólo síntomas sensitivos en el miembro superior. El objetivo de este trabajo es analizar los resultados obtenidos en una serie de 31 cirugías. Métodos: Se analizaron las cirugías de nervios efectuadas entre 2003-2012, tomando los diagnósticos de outlet torácico cuyo período de seguimiento post-operatorio mínimo fuera de 6 meses. Se buscaron los siguientes datos: edad, sexo, presencia de síntomas sensitivos y/o motores, clasificación, resultado de los estudios neurofisiológicos y de imágenes, resultado de la cirugía, complicaciones post-operatorias y recidivas. Resultados: Se incluyeron 31 cirugías realizadas en 30 pacientes, 9 OTV (8 mujeres) de 24.3 años, y 21 con OTD (18 mujeres) de 37.4 años de edad en promedio. Un 90% presentaron alteraciones neurofisiológicas preoperatorias, y 66,6% imagenológicas. En el intraoperatorio, el 100% de los OTV presentó una alteración anatómica relacionada con la sintomatología, hecho observado sólo en el 36.7% de los OTD operados. El 87,5% de los OTV mejoraron sensitivamente, mientras que 77,7% mejoraron la atrofia. Por el contrario, 45.4% de los OTD mejoraron permanentemente, 36.3% no tuvieron cambios, 13.6% mejoraron transitoriamente y 4.5% (un caso) empeoró. Las complicaciones post-operatorias fueron más frecuentes aunque transitorias en el grupo de OTV (3 casos sobre 9 operados, 33.3%) que en los OTD (3 casos sobre 22, un 13.6%). Conclusión: El OTV suele mayormente mejorar luego de la cirugía, igual que el OTD aunque en una proporción mucho menor. Estos hallazgos coinciden con otros reportes recientes de esta patología. PMID:25165614

  20. Síndrome del Outlet Torácico: ¿Una Patología Siempre Quirúrgica? Análisis de una Serie de 31 Cirugías Realizadas por Vía Supraclavicular Serie clínica

    Directory of Open Access Journals (Sweden)

    Mariano Socolovsky

    2014-01-01

    Full Text Available Background: Thoracic Outlet Syndrome is a compression of the brachial plexus that remains highly controversial. Classification in True or Neurogenic Outlet (TTO and Disputed or Non-neurogenic Outlet (DTO is becoming very popular. The former is characterized by a muscular atrophy of the intrinsic muscles of the hand, while the latter has only sensitive symptoms. The purpose of this article is to analyze the results obtained in a series of 31 patients. Methods: All patients with diagnosis of Thoracic Outlet operated between January 2003 and December 2012 with a minimum follow-up of six months where included. Age, sex, symptoms, classification, preoperative studies results, complications and recurrences were analyzed. Results: 31 surgeries performed in 30 patients, 9 with TTO (8 women, mean age 24.3 years and 21 with DTO (18 women, mean age 37.4 years, 1 recurrence were included. Ninety percent of patients presented neurophysiological and 66.6% imagenological preoperative disturbances. All TTO and only 36.7% of DTO showed clear pathological findings during surgical exploration. A high percentage (87,5% sensitive and 77.7% motor of TTO ameliorated after surgical decompression. Only 45.5% of DTO showed permanent positive changes, 13.6% temporary, 36.6% no changes, and 4.5%(one case showed deterioration after decompresive surgery. Complications after surgery were more frequent -but temporary- in TTO cases (33.3%, than in DTO (13.6%. Conclusions: TTO showed a favorable outcome after surgery. DTO showed a worst -but still positive- postoperative result if patients are selected properly. These data are in concordance with other recent reports.