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To date, an endonasal approach has not been described that combines different incisions to provide exposure of all of the key anatomical structures, allowing for adequate, comprehensive visualization of the nasal architecture including the complete quadrangular cartilage and its extension with the upper lateral cartilages, including the caudal septal border from the ventral border and anterior nasal spine to the anterior septal angle, the scroll, and internal nasal valve.The endonasal approach that Fausto Lopez-Infante designed, the FLI technique, combines several basic known endonasal incisions that together allow excellent access and great visualization of the intranasal surgical field, enables extensive septal work, and preserves the natural anatomy of the dorsum as well as the tip support structures.This technique and approach to nasal surgery are based on an understanding of anatomy, allow standardization of the surgery, and make it reproducible. It is an outstanding option with excellent cosmetic and functional results.

In the last 50 years, oil extraction activities in the Northeast Amazonian Region (NAR) of Ecuador impacted ecosystems and may still affect the local population health. To our knowledge, no previous studies have determined the concentrations of metal(loid)s in the oil Ecuadorian Amazon environment. A total of 15 small farms, located in the Orellana and Sucumbios provinces, were sampled in order to determine the concentrations of As, Ba, Co, Cu, Cd, Cr, Mn, Mo, Ni, Pb, V and Zn in soils, crops, drinking water and air (PM10). Among non-essential metal(loid)s, Ba concentrations in soils exceeded the Ecuadorian limits of 200 mg kg− 1 in 53% of the sampling sites. In crops, Cd concentrations in cacao and Pb in manioc exceeded the FAO/WHO recommendations. In drinking water and PM10, regulated metal(loid)s did not exceed the international thresholds. Nevertheless metals such as Ba and Mo showed the highest annual mean concentrations in PM10 in both sampling sites. Natural (bedrock, volcanic ashes) and anthropogenic (oil activities, agrochemical products) sources could explain the high content of some meta(loid)s in the environment. According to the hazard quotient and cancer risk indexes, crops and water ingestion represent 71% and 88% of the exposure pathways for non-carcinogenic elements in adults and children respectively while inhalation is the main exposure pathways for carcinogenic elements for the whole population. Both indexes were 2 to 13 times higher than the US EPA recommended values. However, estimates of exposure pathways should be considered taking into account the risk perception of residents: they may be overestimated for people who are able to change their dietary and/or agricultural practices to limit their exposure, or underestimated in the case of persons who are socio-economically vulnerable and who cannot leave the impacted areas.

The unregulated oil exploitation in the Northern Ecuadorian Amazon Region (NEAR), mainly from 1964 to the 90's, led to toxic compounds largely released into the environment. A large majority of people living in the Amazon region have no access to drinking water distribution systems and collects water from rain, wells or small streams. The concentrations of major ions, trace elements, PAHs (polycyclic aromatic hydrocarbons) and BTEX (benzene, toluene, ethylbenzene, xylenes) were analyzed in different water sources to evaluate the impacts of oil extraction and refining. Samples were taken from the NEAR and around the main refinery of the country (Esmeraldas Oil Refinery/State Oil Company of Ecuador) and were compared with domestic waters from the Southern region, not affected by petroleum activities. In most of the samples, microbiological analysis revealed a high level of coliforms representing significant health risks. All measured chemical compounds in waters were in line with national and international guidelines, except for manganese, zinc and aluminum. In several deep-water wells, close to oil camps, toluene concentrations were higher than the natural background while PAHs concentrations never exceeded individually 2 ng·L−1. Water ingestion represented 99% of the total exposure pathways for carcinogenic and non-carcinogenic elements (mainly zinc) in adults and children, while 20% to 49% of the Total Cancer Risk was caused by arsenic concentrations. The health index (HI) indicates acceptable chronic effects for domestic use according the US-EPA thresholds. Nevertheless, these limits do not consider the cocktail effects of metallic and organic compounds. Furthermore, they do not include the social determinants of human exposure, such as socio-economic living conditions or vulnerability. Most (72%) of interviewed families knew sanitary risks but a discrepancy was observed between knowledge and action: religious beliefs, cultural patterns, information sources, experience and emotions play an important role front to exposure.

Cacao from South America is especially used to produce premium quality chocolate. Although the European Food Safety Authority has not established a limit for cadmium (Cd) in chocolate raw material, recent studies demonstrate that Cd concentrations in cacao beans can reach levels higher than the legal limits for dark chocolate (0.8 mg kg−1, effective January 1st, 2019). Despite the fact that the presence of Cd in agricultural soils is related to contamination by fertilizers, other potential sources must be considered in Ecuador. This field study was conducted to investigate Cd content in soils and cacao cultivated on Ecuadorian farms in areas impacted by oil activities. Soils, cacao leaves, and pod husks were collected from 31 farms in the northern Amazon and Pacific coastal regions exposed to oil production and refining and compared to two control areas. Human gastric bioaccessibility was determined in raw cacao beans and cacao liquor samples in order to assess potential health risks involved. Our results show that topsoils (0–20 cm) have higher Cd concentrations than deeper layers, exceeding the Ecuadorian legislation limit in 39% of the sampling sites. Cacao leaves accumulate more Cd than pod husks or beans but, nevertheless, 50% of the sampled beans have Cd contents above 0.8 mg kg−1. Root-to-cacao transfer seems to be the main pathway of Cd uptake, which is not only regulated by physico-chemical soil properties but also agricultural practices. Additionally, natural Cd enrichment by volcanic inputs must not be neglected. Finally, Cd in cacao trees cannot be considered as a tracer of oil activities. Assuming that total Cd content and its bioaccessible fraction (up to 90%) in cacao beans and liquor is directly linked to those in chocolate, the health risk associated with Cd exposure varies from low to moderate.

Protected areas are home to biodiversity, habitats and ecosystem as well as a critical component of human well-being and a generator of leisure-related revenues. However, management is sometimes unsatisfactory and requires new ways of evaluation. Management effectiveness of 36 protected areas in southern Ecuador have been assessed. The protected areas belong to three categories: Heritage of Natural Areas of the Ecuadorian State (PANE), created and funded by the State, Areas of Forest and Protective Vegetation (ABVP), created but no funded by the State, and private reserves, declared and funded by private entities. Management effectiveness was evaluated by answers of managers of the protected areas to questionnaires adapted to the socio-economic and environmental characteristics of the region. Questions were classified into six elements of evaluation: context, planning, inputs, processes, outputs and outcomes as recommended by IUCN. Results were classified into four levels: unsatisfactory, slightly satisfactory, satisfactory and very satisfactory. The PANE areas and private reserves showed higher management effectiveness levels (satisfactory and very satisfactory) than ABVP areas, where slightly satisfactory and unsatisfactory levels prevailed. Resources availability was found as the main reason behind this difference. The extension, age and province of location were found irrelevant. Outputs, inputs and processes require main efforts to improve management effectiveness. Improving planning and input in the PANE areas and inputs and outcomes on ABVP areas is necessary to obtain a similar result in all areas. © 2016 Elsevier Ltd

Background: The objectives of this study were to determine whether intramedullary reaming increases bone temperature in vivo to a level that is high enough to produce bone necrosis and to determine the influence of the size and the condition of the reamers on the temperature increase. Methods: Bone temperature variations were recorded in vivo during intramedullary tibial reaming in fourteen minipigs. The left tibiae were progressively reamed from 6 to 9 mm. The right tibiae were reamed with only 8 and 9-mm reamers. The variables studied were the initial and final temperature and the increase in the temperature. Two weeks after reaming, the tibiae were removed and studied histologically. Results: Intramedullary reaming produced an average increase (and standard deviation) in bone temperature of 6.9°C ± 4.1°C. The peak temperatures ranged from 34.9°C to 49.4°C. The average maximum bone temperature was 38.1°C ± 2.8°C when the reaming was done progressively from 6 to 9 mm and 41.1°C ± 4.4°C when the reaming was done only with the 8 and 9-mm reamers. The mean increase in the temperature in the second group of animals (8.2°C ± 4.3°C) was greater than that in the first group (5.4°C ± 3.5°C). Reaming with sharper reamers in the first seven animals resulted in a smaller mean increase in temperature than did reaming with less sharp reamers in the last seven animals (4.6°C compared with 9.2°C; p = 0.001). Histological examination of the tibiae showed periosteal proliferation and an altered disposition of the osteons at the inner cortex with occasional necrotic bone fragments in the medullary canal. Conclusions: Intramedullary reaming in the minipig increased bone temperature. When the reamer initially used was larger than the diameter of the medullary canal and when the reamers were blunted by repeated use, the maximum temperature reached by the bone was higher. This increase in temperature with use of typical medullary reaming techniques did not exceed the limits that would produce bone necrosis. Clinical Relevance: Use of appropriately sized reamers in good condition reduces the increase in bone temperature that occurs during intramedullary reaming.

Introduction: Shoulder arthroscopy has become increasingly used in recent years, especially in rotator cuff repair. The purpose of this study was to determine whether arthroscopic rotator cuff repair could prevent proximal migration of the humeral head. Material and Methods: We performed a retrospective study of 56 patients suffering from shoulder pain. They were divided into two groups, one comprising patients with impingement syndrome who underwent acromioplasty only and another comprising patients with rotator cuff tear who underwent acromioplasty combined with rotator cuff repair. The pre-operative Hirooka angle and the results of the simple shoulder test (SST) were compared after 1 year. Results: We found no differences between the groups for the Hirooka angle or SST results. We did find a significant difference (P

Objetivo: Determinar las características clínicas de la amiloidosis secundaria. Material y métodos: Se realizó un estudio retrospectivo de 115 pacientes con diagnóstico histopatológico de amiloidosis secundaria entre 1964 y 1997, determinados por biopsia renal (97.5%) o de glándula salival menor (2.5%). Resultados: Como enfermedades determinantes se encontraron TBC pulmonar (90.43%), bronquiectasias (6.08%), osteomielitis (1.74%). Las manifestaciones clínicas fueron: edema en 98.2%, proteinuria 100%, e hipotensión en 30.43%. La proteinuria en 24 horas fluctuó entre 1.26 y 3.23 gr. El rango en que fluctuó la albúmina sérica fue de 0.6 a 3 gr/dl. Se encontró función renal normal en 5% e insuficiencia renal en 95% de los pacientes. ( Rev Med Hered 1999; 10:45-48 ). Objective: To determine the clinical characteristics of secundary amyloidosis. Material and methods: Retrospective study of 115 patients with histopatologic diagnosis of secundary amyloidosis since 1964 up to 1997, performed by renal (97.5%) or minor salival gland biopsy (2.5%). Results: Conditioning diseases were tuberculosis (90.43%), bronchiectasis (6.08%) osteomielitis (1.74%). The clinical manifestations were edema in 98.2% of cases, proteinuria in 100%, hypotension in 30.43% and diahrrea in 33.91% of the patients. Proteinuria in 24 hour fluctuated between 1.26 gr. and 3.23 gr. The ranged in which serum albumin fluctuated was 0.6 to 3 gr/dl. Only 5% of patients had normal renal function and 95% renal insufficiency. ( Rev Med Hered 1999; 10:45-48 ).