Um paciente do sexo masculino com 17 anos de idade apresentando-se com ferimento abdominal por arma de fogo e choque hipovolêmico grave foi inicialmente operado e apresentava várias lesões no intestino delgado e ceco associadas a hemorragia grave. O paciente teve que ser operado duas vezes devido a hipotermia, acidose e coagulopatia. No período pós-operatório tardio, foram observados sopro e frêmito. Angiografia revelou um pseudoaneurisma associado a fístulas arteriovenosas nos vasos ilíacos externos ao lado esquerdo. As lesões foram tratadas mediante a colocação de stent na artéria ilíaca externa, com desfecho satisfatório. Tomografia computadorizada de controle realizada após 6 meses evidenciou integridade da artéria, com o fechamento das fístulas. O tratamento endovascular deve ser o método de escolha nesse tipo de complicação vascular traumática.

A 17-year-old male patient presenting with an abdominal gunshot wound and severe hypovolemic shock was initially operated and presented several injuries to the small bowel and cecum associated with severe hemorrhage. The patient had to be operated twice due to hypothermia, acidosis, and coagulopathy. In the late postoperative period, murmur and fremitus were observed. Angiography revealed a pseudoaneurysm associated with arteriovenous fistulae at the left external iliac vessels. Lesions were repaired with a stent graft placed in the external iliac artery, with a satisfactory outcome. Control computed tomography performed 6 months later evidenced artery integrity with closure of the fistulae. Endovascular therapy should be the preferred method in this type of vascular trauma complications.

The clinical aspects of the anticoagulant treatment in pregnant patient are commented

Se comentan los aspectos clínicos del tratamiento anticoagulante en la paciente embarazada

Background: After cesarean delivery, hysterectomy it is the second most frequently performed major surgical procedure. Objective: To study de relation cost/effectivity between vaginal and abdominal hysterectomy. Method: Retrospective and observational study in 2338 hysterectomy, performed between January 1997 and December 2005. Clinical and cost variables were analysed between both surgical routes. Results: The study included 2338 patients aged 27 to 86 years in whom hysterectomy was performed for benign gynaecologic disorders. Of 2338 hysterectomies, 36.9% were performed vaginally and an abdominal approach was required in 63.1%. The overall complication rate was 29.8 per 100 women for vaginal hysterectomy and 42.8 per 100 women for abdominal hysterectomy. Conclusion: This study suggests that vaginal route presents some advantages in comparison to abdominal hysterectomy that include less expensive, fewer complications, shorter operating times and shorter stays

Antecedentes: La histerectomía es una intervención quirúrgica frecuente y de alto costo. Después de la operación cesárea, es el segundo procedimiento quirúrgico más frecuente en ginecología. Objetivos: Evaluar la relación costo/efectividad de la histerectomía vaginal versus la histerectomía abdominal. Método: Estudio retrospectivo observacional, en 2.338 pacientes sometidas a histerectomía por patología benigna en el Servicio de Ginecología del Hospital Clínico de la Universidad de Chile, en el período comprendido entre enero de 1997 a diciembre de 2005. Se analizaron variables clínicas y de costo entre las dos vías de abordaje. Resultados: La edad de las pacientes fluctuó entre 27 y 86 años. De las 2.338 histerectomías, la vía vaginal correspondió al 36,9% y la abdominal en el 63,1%; con una tasa de complicaciones de 29,8/100 mujeres operadas vaginalmente y de 42,8/100 mujeres operadas abdominalmente. Conclusión: Este estudio sugiere que el abordaje vaginal se asoció a tiempos operatorios más cortos, menor número de complicaciones y a costos más bajos que la vía abdominal

The number of patients with bariatric surgery has increased quickly on the world. This revision tries to describe the published literature relative to the nutritional deficiencies due to bariatric surgery and its importance in the pregnancy

El número de pacientes sometidos a cirugía bariátrica ha aumentado rápidamente en el mundo. Esta revisión pretende describir la literatura publicada relativa a las deficiencias nutricionales posteriores a la cirugía bariátrica y su importancia en el embarazo

We report two cases of vaginal cysts: clinical presentation and diagnostic difficulties are analysed

Se reportan dos casos de quistes vaginales: se analiza el cuadro clínico y su dificultad diagnóstica

Background: Pregnancy is a physiological hypercoagulable state with an increased incidence of thromboembolic phenomena. There is an increase in the concentrations of most clotting factors, a decrease in concentration of some of the natural anticoagulants and reduced fibrinolytic activity. Changes in PS levels have also been reported. Aim: To establish referral range values of functional PS and free PS antigen, during the second (2nd T) and third trimester (3rd T) of normal gestation. Patients and methods: Forty one normal pregnant women were included in our study, 20 during the 2nd T (22-24 weeks) and 21 during the 3rd T (29-38 weeks). Functional PS was measured by a clot based test and free PS antigen by ELISA. Results: Free PS Antigen was 65.8±18.3% during the 2nd T and 62.3±16.5% during the 3rd T. The figures for normal controls were 106±6.5%. Functional PS was 43.8±13.3 and 25.9±14.6% during the 2nd T and 3rd T, respectively. The figures for normal controls were 97±24% (p <0.001 compared with pregnant women). Free PS antigen did not change from the 2nd to the 3rd T (p=NS), however functional PS fell significantly from the 2nd to the 3rd T (p <0.001) and was significantly lower than free PS antigen in both trimesters (p <0.001). Conclusions: Pregnancy is associated to a decrease in PS. This abnormality is more pronounced for functional PS than free PS antigen and functional PS falls progressively during pregnancy. These assays should not be used to screen for PS deficiency during pregnancy because they could lead to a misdiagnosis

Prunus persica has been proposed as a genomic model for deciduous trees and the Rosaceae family. Optimized protocols for RNA isolation are necessary to further advance studies in this model species such that functional genomics analyses may be performed. Here we present an optimized protocol to rapidly and efficiently purify high quality total RNA from peach fruits (Prunus persica). Isolating high-quality RNA from fruit tissue is often difficult due to large quantities of polysaccharides and polyphenolic compounds that accumulate in this tissue and co-purify with the RNA. Here we demonstrate that a modified version of the method used to isolate RNA from pine trees and the woody plant Cinnamomun tenuipilum is ideal for isolating high quality RNA from the fruits of Prunus persica. This RNA may be used for many functional genomic based experiments such as RT-PCR and the construction of large-insert cDNA libraries.