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BACKGROUND: Doege-Potter syndrome is a rare paraneoplastic phenomenon associated with solitary fibrous tumors of the pleura (SFTPs). It is characterized by the presence of severe, sustained, and treatment-refractory hypoglycemia. Hypoglycaemia, which may be the sole symptom at disease onset, is mediated by the secretion of high-molecular-weight insulin-like growth factor (IGF-2). Most tumors exhibit benign behavior, with a 100% survival rate at 5 years. However, 10% of these tumors may display aggressive behavior with local or metastatic recurrence. We present a clinical case of a patient with a benign solitary fibrous tumor of the pleura who presented with symptomatic hypoglycemia and required pulmonary and pleural surgical resection to control the paraneoplastic phenomenon. CASE PRESENTATION: A Hispanic 46-year-old man presented with a 15-day history of transient alterations in consciousness worsened by fasting. The relevant medical history included obstructive sleep apnea treated with continuous positive air pressure (CPAP) and previous smoking. In-hospital studies revealed noninsulinemic hypoglycemia and a benign SFTP. Complete surgical resection was performed while the patient received dextrose fluids and corticosteroids perioperatively for hypoglycemia. Subsequently, the hypoglycemia resolved, and the patient was followed-up without disease recurrence. CONCLUSION: Doege-Potter syndrome is challenging to recognize. However, effective treatment can be achieved with a high survival rate. Raising awareness among healthcare professionals about the recognition of this paraneoplasic syndrome patients will improve diagnostic suspicion, biochemical confirmation, the development of diagnostic and therapeutic guidelines, and the creation of predictive indices for aggressive presentations requiring closer monitoring.

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Introduction: In developing countries where talc may not be readily available, video-assisted thoracoscopic (VATS) iodopovidone pleurodesis offers an excellent alternative for the treatment of malignant pleural effusions (MPEs). Methods: This study analyzes a retrospective experience using VATS iodopovidone pleurodesis for malignant pleural effusions at a single cardiothoracic center in the capital of Colombia evaluating success according to LENT (Lactate, Eastern Cooperative Oncology Group-ECOG, Neutrophil-Lymphocyte ratio, Tumor type) scores. A total of 75 records of patients taken to VATS iodopovidone pleurodesis for MPEs were retrieved from our institutional database during a 5-year period from 2014-2019. Of these, 45 had complete clinical history data necessary to analyze both LENT scores and post-op follow-up imaging. Results: Of the 45 patients evaluated, 93.3% (42 patients) had either complete resolution of pleural effusions or partial resolution with an asymptomatic recovery within the first month post op. Chest pain was the most common postoperative complaint, which was present in 20% of patients. The mean postoperative ECOG score was 2±1.7. Patients with moderate to high-risk LENT scores had success rates of 96.7% and 92.3% respectively. Conclusion: Video-assisted thoracoscopic pleurodesis using Iodopovidone-iodine is an effective approach for MPEs. In developing countries where Iodopovidone iodine is readily available and affordable, patients may benefit from this agent with excellent results and minimal complications.

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La otitis media con efusión (OME) es un problema de alta prevalencia en niños con labio y paladar hendido (LPH). El objetivo de este estudio fue establecer la prevalencia de OME en niños menores de 1 año con LPH. Pacientes y métodos Fue un estudio observacional y descriptivo en 19 pacientes menores de 1 año y de ambos sexos, valorados en el Hospital Metropolitano, desde enero 2017 hasta noviembre 2019, evaluados mediante otoemisiones acústicas y timpanometría. La presencia intraoperatoria de secreción en oído medio estableció el diagnóstico de certeza de OME. Resultados Doce pacientes fueron varones (63%) y 7 mujeres (37%), 13 niños (68%) tuvieron una edad ≤6 meses, mientras que 6 pacientes (32%) entre 6 meses y 1 año. Los 19 casos fueron diagnosticados clínicamente de OME, a pesar de que el resultado de otoemisiones acústicas y timpanometría no siempre la confirmaron. Con al menos 3 meses de edad fueron sometidos a miringotomía + colocación de tubos de ventilación. En los dos grupos de edad, todos presentaron moco en oído medio confirmando OME, la prevalencia de los casos de menores de 6 meses fue de 100%, IC de 95% (77-100); en los pacientes 6 meses a 1 año fue también de 100%, IC de 95% (60-100). Conclusiones La prevalencia de OME en niños menores de 1 año con LPH es 100%, diagnóstico establecido por la presencia confirmada de secreción en oído medio.

Otitis media with effusion (OME) is a highly prevalent problem in children with cleft lip and palate (CLP). The objective of this study was to establish the prevalence of OME in children with CLP younger than 1 year. Patients and methods Observational and descriptive study in 19 patients younger than 1 year of age and of both genders, evaluated at the Hospital Metropolitano, from January 2017 to November 2019. The results of otoacoustic emissions and tympanometry were taken into account. The intraoperative presence of discharge in the middle ear established the certain diagnosis of OME. Results Twelve patients were men (63%) and 7 women (37%), 13 children (68%) were ≤6 months old, while 6 patients (32%) between 6 months and 1 year. All 19 cases were clinically diagnosed with OME, although the results of acoustic otoemissions and tympanometry were not always confirmed. At least 3 months old, they underwent myringotomy + placement of ventilation tubes. In the two age groups, all presented mucus in the middle ear confirming OME, the prevalence of cases of children under 6 months was 100%, 95% CI (77-100); in patients 6 months to 1 year it was also 100%, 95% CI (60-100). Conclusions The prevalence of OME in children younger than 1 year with CLP is 100%, a diagnosis established by the confirmed presence of a discharge in the middle ear.

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BACKGROUND: The combined treatment of beta-blockers with ablation and Implanted cardioverter defibrillation therapy, continues to be the mainstay treatment for ventricular arrhythmias (VAs). Despite treatment, some patients remain refractory.  Recent studies have shown success rates using video-assisted thoracoscopic (VATS) cardiac denervation as an effective therapeutic option for these patients. CASE SERIES PRESENTATION: During a period of three years, from 2015 through 2017, twenty patients (N = 20) failed traditional medical and interventional treatment for the management of ventricular arrhythmias and electrical storms. After remaining refractory, the patients were referred to our thoracic surgery department for a VATS based treatment. The patients all had ventricular arrhythmias and electrical storms secondary to different cardiomyopathies. The patients were refractory to combined medical (beta-blockers), Implanted Cardioverter defibrillation (ICD) and ablation therapy. All twenty patients agreed to surgery and were taken to cardiac denervation using a bilateral VATS approach by two thoracic surgeons at a single Cardiothoracic center. During the month prior to bilateral VATS denervation a combined total of twenty-nine (N = 29) ICD shocks were registered in addition to six (N = 6) cases of electrical storms averaging three (N = 3) shocks per day. Mean shocks per patient was 2.3. During the first three months following VATS, the patients had a 90% (N = 18/20) total resolution of ICD registered shocks, a 100% (N = 6/6) resolution of electrical storms, and a 92% (N = 11/12) resolution of shocks in patients having previous ablation therapy. No complications were documented following surgery except for one case of pneumothorax as a result of the procedure, and there were no peri-operative mortalities. CONCLUSIONS: Bilateral thoracoscopic cardiac denervation can be a safe and seemingly effective therapeutic option for patients presenting with life-threatening refractory ventricular arrhythmias and electrical storms in a variety of cardiomyopathies including Chagas disease.

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Understanding metabolism and metabolic pathways constitutes one of the central aims for students of biological sciences. Learning metabolic pathways should be focused on the understanding of general concepts and core principles. New technologies such Augmented Reality (AR) have shown potential to improve assimilation of biochemistry abstract concepts because students can manipulate 3D molecules in real time. Here we describe an application named Augmented Reality Metabolic Pathways (ARMET), which allowed students to visualize the 3D molecular structure of substrates and products, thus perceiving changes in each molecule. The structural modification of molecules shows students the flow and exchange of compounds and energy through metabolism. © 2017 by The International Union of Biochemistry and Molecular Biology, 45(5):417-420, 2017.

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La fístula broncobiliar es una entidad poco usual en nuestro medio y poco descrita en la literatura científica. Se caracteriza por una comunicación anómala entre el árbol bronquial y la vía biliar, y se asocia a la presencia de bilis en el esputo (bilioptisis). Según su etiología, puede ser secundaria a la obstrucción distal de la vía biliar por patología benigna, maligna, infecciosa o iatrogénica. Se presenta el caso de un paciente de 33 años, que cursó con una fístula broncobiliar secundaria a la derivación de la vía biliar percutánea por una lesión estenótica del confluente biliar, en quien ­por medio de un abordaje torácico y abdominal­ se practicó una lobectomía inferior por videotoracoscopia (Video-Assisted Thoracoscopy Surgery, VATS) y hepatectomía con reconstrucción de la vía biliar por laparotomía. Teniendo en cuenta lo inusual del caso, con pocos reportes en la literatura, se concluye la dificultad para establecer la posible etiología de las estenosis de la vía biliar en un paciente joven, sin poderse descartar la enfermedad maligna. Al hacer el diagnóstico, se debe tratar y corregir la causa; la cirugía sigue siendo el pilar del tratamiento y, con el advenimiento de la cirugía mínimamente invasiva, se puede hacer un manejo combinado para aprovechar los beneficios de la técnica, como se hizo en este caso

Bronchobiliary fistula is a rare entity in our environment and it is poorly described in the scientific literature. It is characterized by an abnormal communication between the bronchial tree and the biliary tract, and is associated with the presence of bile in the sputum (bilioptysis). According to its etiology, it may be secondary to a distal obstruction of the bile duct due to a benign, malignant, infectious, or iatrogenic pathology. We present the case of a 33-year-old patient who had a bronchobiliary fistula secondary to a percutaneous biliary tract bypass due to a stenotic lesion of the biliary confluent in whom an inferior lobectomy by video-assisted thoracoscopy surgery (VATS) was performed with hepatectomy with biliary tract reconstruction by laparotomy, a combined thoracic and abdominal approach. Given the low incidence of this type of cases and the scarce literature reports, our conclusion is that it is difficult to define the possible etiology of the bile duct stenosis in young patients, and that a malignant pathology cannot be ruled out. Once the diagnosis is established, the cause should be treated. Surgery remains the mainstay of treatment, and with the advent of minimally invasive surgery a combined type of management can be performed so as to take advantage of the benefits of this technology

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Objetivos: Determinar la prevalencia del hirsutismo en la ciudad de Manizales, caracterizar la patología desde su perspectiva demográfica y clínica, y relacionar las diferentes variables con la presencia o no de hirsutismo. Metodología: Investigación de corte transversal de nivel analítico, basada en el estudio de una población de acceso de 830 estudiantes de primer año de las universidades de la ciudad, quienes fueron encuestadas y examinadas aplicando la escala estandarizada de Ferriman y Gallwey modificada (F-Gm), previo consentimiento informado. Resultados: La prevalencia de hirsutismo encontrada para un puntaje de 8 de la escala de F-Gm es del 20,5%, el percentil 95 hallado equivale a 12 puntos. Se encontró mayor frecuencia de hirsutismo en los diferentes puntos de corte evaluados en las mujeres: con edad entre los 20 y 24 años, mestizas, con antecedente y presencia de acné, con padres con calvicie, con hermanas con hirsutismo. Existe correlación negativa entre el puntaje de la escala de F-Gm y edad de la pubarca, presión arterial sistólica y estrato socioeconómico; y correlación positiva con el perímetro abdominal. Conclusiones: Para la población estudiada el signo hirsutismo presenta prevalencia similar a la encontrada en otros estudios publicados, el percentil 95 como parámetro de normalidad de 12 en la escala F-Gm es superior a los puntos de corte informados en la literatura.

Objectives: To determine the prevalence of hirsutism in the city of Manizales (Colombia), to characterize its pathology from its demographic and medical perspective and to relate the different variables with the presence or absence of hirsutism. Methodology: Transversal analytical research based on the study of a population composed by 830 female freshmen attending several local universities who were surveyed and examined applying Ferriman and Gallwey modified scale (F-Gm) previous informed consent. Results: The prevalence of hirsutism for a score of 8 in the F-Gm scale was 20.5%; the 95 percentile found is equivalent to 12 points. An increased frequency of hirsutism was found in the cut off points evaluated in women with the following characteristics: age 20 to 24, mestizo, with a history and presence of acne, bald parents and sisters with hirsutism. There is negative relation between the score in the F-Gm scale and the pubarche age, systolic blood pressure, socio-economic status. On the contrary, it positively correlated with abdominal circumference. Conclusions: For the population studied hirsutism showed a similar prevalence to that found in the population studied compared to published data. Nevertheless, the 95 percentile, as a normality parameter of 12 in the F-Gm scale, is higher than the cut off points informed in the literature.

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Las heridas complejas e infectadas de la pared del tórax, aunque infrecuentes, representan un reto para el cirujano de tórax, especialmente cuando se asocian a compromiso de los órganos torácicos en pacientes con inestabilidad hemodinámica y desnutridos. El cierre asistido por succión en este tipo de heridas no es común y hasta ahora sólo se han reportado en la literatura pequeñas series de casos. Se presentan dos casos con el fin de ilustrar los aspectos clínicos y quirúrgicos de esta técnica de tratamiento.

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Contenido: Cap.1 Aspectos generales.Antecedentes.Zonificacion ganadera del departamento de Oruro.Zonas potenciales y estaciones piloto en ganaderia.Caracteristicas fisiograficas.Posibilidad de empleo de agua para riego.Aspectos agro-economicos.Aspectos socio-economicos Cap.2 Tecnologia agropecuaria.Aspectosagricolas.Aspectos ganaderos Cap.3 Identificacion de problemas agropecuarias en las zonas potenciales.Potencial agropecuario de la region.Sector agricola.Sector pecuario.Analisis de los productos procedentes de Ovinos y Camelidos II.Las pieles ovinas y camelidas como productos para la industrializacion Cap.4 Antecedentes y justificacion Cap.5 Materias primas para el proyecto.Poblacion ganadera actual.Tasas de extraccion.Disponibilidad potencial en provision de pieles.Factoreslimitantes en la provision.Disponibilidad efectiva de pieles en la region Cap.6 Funcionamiento del mercado regional.Caracteristicas de funcionamiento.Condiciones actuales del proceso de curticion.Demandantes regionales.Productores regionales.Politicas de comercializacion y precios existentes III.Planta principal y centros primarios Cap.7 Localizacion Cap.8 Emplazamiento del proyecto Cap.9 Tamano Cap.10 Ingenieria Cap.11 Organizacion Cap.12 Aspectos economico-financieros Cap.13 Evaluacion. Anexos.