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Aortic Coarctation. Evaluation by doppler ultrasound in the emergency room. A case report.

Resumen: El cáncer a la próstata es un serio problema de salud en el mundo occidental. Es el cáncer más común en hombres luego del cáncer a la piel, estimándose que uno de cada seis hombres desarrollará la enfermedad en el transcurso de su vida. Corresponde a la segunda causa de muerte en hombres mayores de 50 años después del cáncer de pulmón. En Chile, la mortalidad por cáncer de próstata ha ido en aumento durante los últimos años, alcanzando una tasa de 20.9 por 100000 en el año 2009 y ocupa el segundo lugar en las causas de muerte por cáncer en el hombre.Las herramientas con que se dispone para detectar precozmente la enfermedad son el tacto rectal (TR) y el antígeno prostático específico (APE), pero en el último tiempo se han estudiado una serie de nuevos marcadores como el PCA3, el pro-APE, TMPRSS2-ERG, 4K Score, SelectMDx®, ConfirmMDx® y ExoDx®. Algunos ya se encuentran en una fase inicial de uso clínico y pretenden aumentar la especificidad, especialmente en el diagnóstico de tumores más agresivos.Existe suficiente evidencia que la detección precoz de cáncer de próstata disminuye la mortalidad, ya que se cuenta con tratamiento efectivos para la enfermedad diagnosticada en etapas tempranas. El desafío está en encontrar nuevos marcadores que permitan identificar aquellos hombres que se encuentren en mayor riesgo, evitando así procedimientos innecesarios. Summary: Prostate Cancer is a serious health problem in the western world. It is the most common cancer in men after cancer of the skin, estimated that one in six men will develop the disease in the course of his life. Corresponds to the second cause of death in men older than 50 years after lung cancer. In Chile, mortality from prostate cancer has been increasing in recent years reaching a rate of 20.9 per 100,000 in 2009 and ranks second in the causes of cancer death in men.The tools available to detect the early disease early are the digital rectal examination (DRE) and prostate specific antigen (PSA), but recently a series of new markers such as PCa3, pro-PSA, TMPRSS2-ERG, 4K Score, Select MDX and Exo Dx. Some are already in an initial phase of clinical use and aim to increase specificity, especially in the diagnosis of more aggressive tumors.There is sufficient evidence that the early detection of prostate cancer reduces mortality, since effective treatment is available for the disease diagnosed in the early stages. The challenge is to find new markers to identify those men who are at greater risk, thus avoiding unnecessary procedures. Palabras clave: Cáncer de próstata, detección precoz, marcadores, Keywords: Prostate cancer, early detection, markers

A partir de un enfoque mixto se abordan las principales características del perfil del profesor de Bibliotecología-Archivística en Colombia, caracterización precedida de una amplia búsqueda documental en el contexto de Iberoamérica, la cual evidenció su ausencia de las agendas de investigación. El trabajo afirma que dadas las dinámi¬cas propias de cada universidad y de cada programa de formación profesional, no es posible hablar de un perfil único del profesor, ya que este depende del tipo de insti¬tución, del modelo educativo, de las áreas de desempeño y, fundamentalmente, de los criterios de vinculación, donde si bien se tienen en cuenta criterios de formación, experiencia laboral e investigativa y producción académica, no es explícito el de competencia pedagógica, ni los aportes al desarrollo disciplinar, que resultan esen¬ciales en el perfil del profesor universitario. Por esas razones es conveniente que los profesores de Bibliotecología-Archivística incursionen con mayor fuerza en la inves¬tigación, para la contribución a la visibilidad académica y al avance y posición cien-tífica del área, con el fin de generar valor al programa académico y a la institución y, con ello, elevar la calidad de la universidad a la cual se encuentran adscritos = This paper identifies from a mixed approach the main characteristics of the profile of the Library-Archivology professor in Colombia, characterization preceded by an extensive documentary search in the context of Ibero-America, which evidenced the absence of the subject in the research agendas. It also affirms that given the dynamics of each university and each professional’s training program, it is not possible to talk about a unique professor’s profile, since it depends on the type of institution, educa¬tional model, areas of performance and fundamentally, the criteria of affiliation, where although training, work experience, research and academic production are taken into account, it is not explicit the pedagogical competence, nor the contributions to the disciplinary development, which are essential in the profile of the university profes¬sor. For these reasons, it is advisable for library-archivology professor to carry out research, to contribute to academic visibility, and to the advancement and scientific position of the area, in order to generate value for the academic program and the institution and thus, increase the quality of the university to which they are affiliated.

INTRODUCTION: Chronic kidney disease-mineral and bone disorders (CKD-MBD) are associated with costly complications and dismal hard-outcomes. AREAS COVERED: In two comprehensive articles we review contemporary and future pharmacological options for treatment of phosphate (P) imbalance (part 1) and hyperparathyroidism (this part 2), taking into account CKD-accelerated cardiovascular calcification (CVC) processes. EXPERT OPINION: Improvements in CKD-MBD require an integral approach, addressing all three components of the CKD-MBD triad. Here, initial guidance to control hyperparathyroidism is provided, taking into account the presence/absence of CVC. We include also measures for patients at risk of adynamic bone disease or suffering from calciphylaxis. Many epidemiological studies (relating to vitamin D) and thorough analyses of recent randomized clinical trials (of cinacalcet) point towards benefits of attempting to improve biochemical parameters while trying to, at least, avoid progression of CVC by more rational use of intestinal P-binders and low-dose vitamin D derivatives and/or calcimimetics. This approach does not seem to be far away from significantly improving hard-outcomes, at least in the dialysis population. The availability of new drugs and the performance of randomized clinical trials should ultimately lead to define earlier, clearer, and more cost-effective patient stratification and biochemical targets with consequent significant clinical improvements. J Bover belongs to the Spanish National Network of Kidney Research RedinRen (RD06/0016/0001 and RD12/0021/0033) and the Spanish National Biobank network RD09/0076/00064. He also belongs to the Catalan Nephrology Research Group AGAUR 2009 SGR-1116. J Bover and M.M. Diaz-Encarnacion collaborate with the Spanish ‘Fundación Iñigo Alvarez de Toledo’ (FRIAT)

Introduction: Chronic kidney disease-mineral and bone disorders (CKD-MBD), involving a triad of laboratory and bone abnormalities, and tissue calcifications, are associated with dismal hard-outcomes. Areas covered: In two comprehensive articles, we review contemporary and future pharmacological options for treatment of phosphate (P) imbalance (this part 1) and hyperparathyroidism (part 2), taking into account CKD-accelerated atheromatosis/atherosclerosis and/or cardiovascular calcification (CVC) processes. Expert opinion: Improvements in CKD-MBD require an integral approach, addressing all three components of the CKD-MBD triad. Individualization of treatment with P-binders and combinations of anti-parathyroid agents may improve biochemical control with lower incidence of undesirable effects. Isolated biochemical parameters do not accurately reflect calcium or P load or bone activity and do not stratify high cardiovascular risk patients with CKD. Initial guidance is provided on reasonable therapeutic strategies which consider the presence of CVC. This part reflects that although there is not an absolute evidence, many studies point to the need to improve P imbalance while trying to, at least, avoid progression of CVC by restriction of Ca-based P-binders if economically feasible. The availability of new drugs (i.e. inhibitors of intestinal transporters), and studies including early CKD should ultimately lead to clearer and more cost/effective clinical targets for CKD-MBD.

Introducción: La vasectomía es una técnica segura y efectiva para el control de la fertilidad masculina. A pesar de esto, en el mundo se realizan el doble de esterilizaciones femeninas respecto a vasectomías, lo cual es más acentuado en países en vías de desarrollo. Objetivos: El objetivo de este trabajo es presentar nuestra experiencia y resultados en pacientes sometidos a una vasectomía sin bisturí. Materiales y Métodos: Se incluyó un total de 309 pacientes sometidos a una vasectomía sin bisturí entre junio de 2009 y mayo de 2010. En cada caso se evaluó la edad, tiempo operatorio, espermiograma a los 3 y 6 meses (en caso de ser necesario) y la morbilidad perioperatoria. Resultados: 281 pacientes (91%) se controlaron con al menos un espermiograma. En 189 pacientes (67%) se evidenció azoospermia en el espermiograma a los 3 meses. En 81 pacientes (29%) se evidenció un recuento con ≤ 100.000 espermatozoides 100% inmóviles. En 9 pacientes (3,2%) se necesitó un segundo espermiograma para obtener menos de 100.000 espermatozoides 100% inmóviles. Seis pacientes (2%) consultaron por complicaciones menores: orquialgia, epididimitos o hematoma del sitio operatorio. A 2 años de seguimiento, no se registraron embarazos. Conclusiones: La vasectomía sin bisturí es un método seguro y reproducible de anticoncepción masculina, presentando tasas de efectividad superiores al resto de los métodos anticonceptivos. Un espermiograma de control debe ser realizado a los 3 meses de realizado el procedimiento. La tasa de falla temprana se estima en 0,3% de los pacientes.

Introduction and objectiveActive surveillance (AS) has become an accepted alternative for patients with low risk prostate cancer. The purpose of AS is to defer definitive therapy in these patients to avoid treatment-related complications. Our aim was to determine the pathological features of the surgical specimen from potential AS candidates that underwent radical prostatectomy (RP).Materials and MethodsWe retrospectively reviewed a group of patients submitted to RP who met criteria for AS: Gleason score (GS) ≤ 3+3 = 6, PSA ≤ 10ng/mL, T1c - T2a, < 1/3 of positive cores, < 50% of involvement in any core and PSA density < 0.15. We determined the concordance between GS in biopsy and RP specimen (RPS). Other pathological features of the RPS were also analyzed, including surgical margins, extracapsular extension, seminal vesicles and lymph node involvement.ResultsWe identified 167 patients subjected to RP that met the criteria for AS. Fifty two patients (31.1%) had a GS > 6 in the RPS (GS 7 n = 49; GS 8 n = 3). Extracapsular extension, seminal vesicle and lymph node involvement was found in 6.1%, 3.1% and 1.2% of the specimens, respectively.ConclusionIn this study a significant proportion of potential candidates for AS showed features of aggressive and/or high-risk tumors in the RPS. Therefore, before considering a patient for an AS protocol, a proper and strict selection must be performed, and informed consent is crucial for these patients.

Introducción: La vasectomía es una técnica segura y efectiva para el control de la fertilidad masculina. A pesar de esto, en el mundo se realizan el doble de esterilizaciones femeninas respecto a vasectomías, lo cual es más acentuado en países en vías de desarrollo. Objetivos: El objetivo de este trabajo es presentar nuestra experiencia y resultados en pacientes sometidos a una vasectomía sin bisturí. Materiales y Métodos: Se incluyó un total de 309 pacientes sometidos a una vasectomía sin bisturí entre junio de 2009 y mayo de 2010. En cada caso se evaluó la edad, tiempo operatorio, espermiograma a los 3 y 6 meses (en caso de ser necesario) y la morbilidad perioperatoria. Resultados: 281 pacientes (91%) se controlaron con al menos un espermiograma. En 189 pacientes (67%) se evidenció azoospermia en el espermiograma a los 3 meses. En 81 pacientes (29%) se evidenció un recuento con ≤ 100.000 espermatozoides 100% inmóviles. En 9 pacientes (3,2%) se necesitó un segundo espermiograma para obtener menos de 100.000 espermatozoides 100% inmóviles. Seis pacientes (2%) consultaron por complicaciones menores: orquialgia, epididimitos o hematoma del sitio operatorio. A 2 años de seguimiento, no se registraron embarazos. Conclusiones: La vasectomía sin bisturí es un método seguro y reproducible de anticoncepción masculina, presentando tasas de efectividad superiores al resto de los métodos anticonceptivos. Un espermiograma de control debe ser realizado a los 3 meses de realizado el procedimiento. La tasa de falla temprana se estima en 0,3% de los pacientes. Introduction: Vasectomy is a safe and effective technique of male fertility control. Despite this, in the world are carried out more than double female sterilization in comparison with vasectomies, that is more pronounced in less developed countries. Aims: To present our experience and results in patients undergoing a no-scalpel vasectomy. Methods and Material: A total of 309 patients undergoing a no-scalpel vasectomy between June 2009 and May 2010 were included. For each case was record age, operative time, sperm count at 3 months post vasectomy and peri-operative morbidity. Results: 309 vasectomies were performed, 281 patients (91%) were controlled with at least one sperm count. Azoospermia was obtained in the first sperm count at 3 months in 189 patients (67%). In 81 patients (29%) were observed ≤ 100,000 sperm 100% immobile. 9 patients (3.2%) needed a second semen analysis and 2 patients a third one for less than 100,000 sperm that were 100% immobile. 6 patients (2%) consulted by minor complications such as postoperative pain, epididymitis or hematoma with spontaneous resolution. Conclusions: Vasectomy is a safe and reproducible method of male contraception, presenting an effectiveness rates higher than others contraceptive methods. There are no absolute contraindications for performing the procedure. A sperm count should be done at 3 months of the procedure. The early failure rate in our study is 0.3%.

The purpose of the present study was the characterization of the receptors participating in the regulatory mechanism of glial Na+/K+-ATPase by serotonin (5-HT) in rat brain. The activity of the Na+ pump was measured in four brain regions after incubation with various concentrations of serotoninergic agonists or antagonists. A concentration-dependent increase in enzyme activity was observed with the 5-HT1A agonist R (+)-2-dipropylamino-8-hydroxy-1,2,3, 4-tetrahydronaphthalene hydrobromide (8-OH-DPAT) in homogenates or in glial membrane enriched fractions from cerebral cortex and in hippocampus. Spiperone, a 5-HT1A antagonist, completely inhibited the response to 8-OH-DPAT but had no effect on Na+/K+-ATPase activity in cerebellum where LSD, a 5-HT6 agonist, elicited a dose-dependent response similar to that of 5-HT. In brainstem, a lack of reponse to 5-HT and other agonists was confirmed. Altogether, these results show that serotonin modulates glial Na+/K+-ATPase activity in the brain, apparently not through only one type of 5-HT receptor. It seems that the receptor system involved is different according to the brain region. In cerebral cortex, the response seems to be mediated by 5-HT1A as well as in hippocampus but not in cerebellum where 5-HT6 appears as the receptor system involved.

Our economies are rapidly evolving toward being primarily service-driven, with information and communication as fundamental drivers for the service deployment. Strategic choices are increasingly driven by other parameters than the traditional goods-driven industrial type of economies. In this paper, the major drivers for making strategic choices in a competitive service economy are examined. It is shown how the competition in services based on information and communication technology (ICT) is competence-based. Competition aims at bringing additional value through services, but may also deploy specific techniques to stop value from leaking in particular business processes. Value creation and prevention of value leaks cannot just rely on the traditional material-based techniques, which are grounded in the strong tangible nature of the traditional economies. Today ICT-based services involve creative combinations of technologies, resources, and assets to answer as well as anticipate the growing demand for flexible solutions that create sustained added value. In this paper, the particular role of imperfections in service systems is explored, extending the well-known theories of information imperfections. Imperfections are not always solved but are sometimes even maintained in favor of sustained competitive advantage. Various ways to realize service rent are discussed with extensive examples. The concluding part of the paper points to some crucial service configuration issues, including the need for a sufficient degree of corporate-wide standardized service components and interfaces to address the growing demand for agility in competence-driven markets.

Kampo medicine has been the primary medical model in Japan until the mid 1800s, regained a prominent role in today's Japanese medical system. Today, 148 herbal Kampo formulas can be prescribed under the national health insurance system, allowing physicians to integrate Kampo in their daily practice. This article aims to provide information about the extent to which Kampo is now used in clinics throughout Japan and about physician's current attitudes toward Kampo. We used the results of a 2008 survey that was administered to physicians throughout Japan (n = 684). The data showed that 83.5% of physicians currently use Kampo in the clinic, although the distribution of physicians who use Kampo differ widely depending on the specialty and provided a breakdown of Kampo usage by specialty. It will be interesting to see how each specialty incorporates Kampo into its respective field as Kampo continues to play a pertinent role in Japanese medical system.

Introduccion. La sialorrea es la incapacidad para retener la saliva dentro de la boca y su progresion al tracto digestivo, y es un problema frecuente en pacientes pediatricos con patologia neurologica, por lo que se estan utilizando diferentes medidas para su tratamiento. Objetivo. Evaluar la eficacia y seguridad del trihexifenidilo, la escopolamina y la infiltracion de toxina botulinica en el tratamiento del babeo en ninos con patologia neurologica. Pacientes y metodos. Es un estudio de tipo abierto y prospectivo. Incluye pacientes atendidos en el servicio de neurologia que presentaban babeo excesivo, con repercusion en su calidad de vida, entre 2009 y 2013. Resultados. En 46 pacientes se indico tratamiento con trihexifenidilo oral, y se obtuvo buena respuesta en 15 (32,6%), tres con efecto transitorio y el resto mantenido. Presentaron efectos secundarios tres pacientes (6,5%). De los 11 pacientes a los que se indicaron parches de escopolamina, se hallo efecto beneficioso en cuatro (36,36%), uno fue retirado por falta de eficacia y seis por efectos secundarios. Veinticinco pacientes fueron infiltrados con toxina botulinica, con disminucion significativa del babeo en 16 (64%) tras la primera infiltracion. No observamos cambios significativos en nueve casos. Solo uno presento efectos secundarios (disfagia leve). Conclusiones. Por no haber una opcion terapeutica totalmente eficaz para los pacientes con sialorrea, recomendamos iniciar el tratamiento con trihexifenidilo; como segunda opcion, los parches de escopolamina, y como tercera opcion, la toxina botulinica. La infiltracion de toxina botulinica en glandulas salivales se muestra como una alternativa eficaz y segura segun nuestra serie.