Background: The laparoscopic cholecystectomy’s technique has a great relevance in training programs. Their teaching requires a methodology that incorporates technical details that are lost with just reading or watching the procedure. Aim: This study presents the description of the surgical steps associated to an anatomical e-learning support that includes strategic and technical elements. Materials and Method: A standard laparoscopic cholecystectomy was used to make an educational video highlighting the critical aspect and concepts of its execution. The video incorporated drawings, painting and animations that fa- cilitate understanding. It was split and linked to Qr codes. Results: The detailed description of the steps of a cholecystectomy, such as a proper exposure of the surgical field, the dissection of the hepatocystic triangle, the safety view or gallbladder release, was associated with a Qr link. Conclusión: A step-by-step laparoscopic cholecystectomy in a dynamic and innovative way with an audiovisual support that facilitate learning.

Resumen Introducción: La Colecistectomía laparoscópica es una de las cirugías más frecuentes en nuestro país. Diversas dificultades han limitado una buena formación al respecto. Contar con un apoyo educativo capaz de transmitir la experiencia quirúrgica que facilite su aprendizaje, resulta imprescindible. Objetivo: Describir la técnica quirúrgica de una colecistectomía laparoscópica estándar incorporando elementos propios de la decisión quirúrgica, apoyado en tecnología e-learning. Materiales y Método: Estudio descriptivo. Se confeccionó material audiovisual de una colecistectomía laparoscópica, editado con apoyo de dibujo y animación 3D, e incorporando elementos técnicos propios del acto quirúrgico. Finalmente se redactó el texto de la técnica y se enlazó a través de códigos QR a capsulas del material audiovisual confeccionado. Resultados: Cinco pasos descriptivos claves de la colecistectomía laparoscópica apoyados con enlaces directos, tanto a través de un link asociado al texto como a través de una imagen QR anexa, a capsulas audiovisuales con información técnica y estratégica propia del ejercicio quirúrgico intraoperatorio. Conclusión: Técnica quirúrgica de una colecistectomía laparoscópica expuesta paso a paso apoyado con material audiovisual de una forma dinámica e innovadora, basado en nuevas tecnologías facilitadoras del aprendizaje.

Abstract BACKGROUND: Vulvar cancer is relatively rare, representing less than 1% of malignant tumors in women; its incidence increases with age. The most frequent variety is squamous cell carcinoma (80 to 90%), followed by melanoma. In this report we review a carcinoma of glandular origin, such as papilliferous hydradenoma of the vulva of the mammary gland (mammary-like) type. CLINICAL CASE: We present a 50-year-old patient with 2 years evolution of a papular lesion on the vulva with slow and progressive growth, intermitent sensation of mass and pain, with negative colposcopy, no history of breast pathology and with a previous biopsy that reported vulvar papilliferous hydradenoma. She was treated with complete resection of the lesion under regional anesthesia, with free margins, without identifying an infiltrating component and currently without evidence of relapse or requirement of additional treatments. CONCLUSION: Papilliferous hidradenoma is a rare benign lesion related to the mammary-like anogenital glands, with a good prognosis and its recommended treatment is surgical excision, which is generally curative.

Resumen ANTECEDENTES: El cáncer de vulva es relativamente raro, representa menos del 1% de los tumores malignos de la mujer; su incidencia aumenta con la edad. La variedad más frecuente es el carcinoma escamoso (80 al 90%), seguido del melanoma. En este reporte se revisa un carcinoma de origen glandular, como el hidradenoma papilífero del tipo glándula mamaria (mammary-like) de la vulva. CASO CLÍNICO: Paciente de 50 años, con una lesión papular en la vulva de dos años de evolución, con crecimiento lento y progresivo, ocasional sensación de masa y dolor, con colposcopia negativa, sin antecedentes de patología mamaria y con una biopsia previa que reportó hidradenoma papilífero vulvar. Se trató con resección completa de la lesión, con anestesia regional, con bordes libres, no se identificó algún componente infiltrante. En la actualidad permanece sin evidencia de recaída ni requerimiento de tratamientos adicionales durante el seguimiento. CONCLUSIÓN: El hidradenoma papilífero es una lesión benigna, poco frecuente, relacionada con las glándulas anogenitales de tipo mammary-like, con buen pronóstico. El tratamiento recomendado es la escisión quirúrgica, que casi siempre es curativa.

Resumen Hicimos un muestreo de las mariposas de algunos bosques del municipio de Solano, departamento de Caquetá, en la Amazonia colombiana. La recolección de mariposas se llevó a cabo durante cuatro días consecutivos en cuatro localidades de estudio, utilizando trampas con atrayentes y redes de búsqueda activa. Cada localidad contó con 12 puntos de muestreo con distancia de 250 m entre puntos, para un recorrido total de tres kilómetros. Se recolectaron 487 individuos, pertenecientes a 110 especies, 80 géneros, 28 tribus, 17 subfamilias y seis familias. Las familias con mayores abundancias y número de especies fueron Nymphalidae, con 68.2 % (75 spp.), Riodinidae 11.8 % (13 spp.) y Pieridae 10 % (11 spp.). La subfamilia mejor representada fue Satyrinae (N=228), destacando la tribu Morphini (N=65). Se destacan el hallazgo de seis especies de Marpesia, la tercera parte de las especies descritas para el género, y el de Gunayan rubricollis, una especie rara en Colombia. La presente investigación confirma la diversidad de mariposas en bosques amazónicos, donde más del 40 % de las especies son indicadoras de buen estado de conservación de los bosques.

Abstract We sampled the butterfly community in the municipality of Solano, department of Caquetá, in Colombian Amazonia. The collection of butterflies was carried out during four consecutive days at four study locations, using bait traps and active search nets. Each location had 12 sampling points, with a distance of 250 m between points, for a total sampling length of three kilometers. We collected 487 individuals belonging to 110 species, 80 genera, 28 tribes, 17 subfamilies and six families. The families with the highest abundance and number of species were Nymphalidae, with 68.2 % (75 spp.), Riodinidae 11.8 % (13 spp.) and Pieridae 10 % (11 spp.). The best represented subfamily was Satyrinae (N=228), particularly the tribe Morphini (N=65). Remarkable findings include six species of Marpesia, one third of the species described for the genus, and Gunayan rubricollis, a rare species in Colombia. The present research confirms the diversity of butterflies in Amazon forests, where more than 40 % of the species are indicators of the forest’s good state of conservation.

Background: The Chilean allocation system for liver transplantation (LT) uses the MELD/PELD score to prioritize candidates on the waiting list. Aim: To assess if the Chilean allocation system for LT is equitable for pediatric candidates compared to their adult counterparts. Material and Methods: We used the Public Health Institute's registry between October 2011 and December 2017. We analyzed candidates with chronic hepatic diseases listed for LT. The primary outcome was the cadaveric liver transplantation (CLT) rate. Secondary outcomes were death or disease progression in the waiting list and living donor liver transplant (LDLT) rate. Results: We analyzed 122 pediatric and 735 adult candidates. Forty one percent of pediatric candidates obtained a CLT compared to 48% of adults (p = NS). Among patients aged under two years of age, the access to CLT on the waiting list there was 28% of CLT, compared to 48% in adults (p = 0.001). Fifty-seven percent of candidates aged under two years were listed for cholestatic diseases, obtaining a CLT in 18% and requiring a LDLT in 49%. The median time in the waiting list for CLT was 5.9 months in pediatric candidates and 5.1 in adults, while the median time to death in the waiting list was 2.8 and 5.6 months, respectively. The mortality rate at one year in candidates under two years old was 38.1% compared to 32.5% in adults. Conclusions: Pediatric candidates with chronic liver diseases, especially under two years of age, have greater access difficulties to CLT than adults. Half of the pediatric candidates die on the waiting list before three months. The mortality among candidates under two years of age in the waiting list is excessively high.

The Chilean Academy of Medicine designated a group of specialists to evaluate the practice and to propose reforms for organ donation and transplantation, due to the general insufficiencies at the national level with these procedures. In the last six years the mean number of organ transplants in Chile was 340 cases per year while effective cadaveric donors ranged between 6 and 10 per million inhabitants. These averages remained stable during this period and are among the lowest in the region. Our analysis attributed these deficient results mainly to low organ donation and inefficient procurement due to lack of compliance with protocols and little accountability. The committee proposes several measures for improvement. These are a systematic and obligatory report of potential organ donors by all emergency and critical care centers, frequent evaluation of results, empowering of health authorities to correct insufficiencies in organ procurement, education programs for primary, secondary, technical and university students to improve their knowledge about the social significance and solidarity required for transplantation policies and specialized updated training of all health professionals involved. Organ donation and transplantation must be based on clear and fair ethical considerations in order to be accepted by the general public.

Resumo Os localizadores eletrônicos apicais têm sido usados para estabelecer o comprimento de trabalho no tratamento do canal radicular. Nos dentes diagnosticados com periodontite apical, a reabsorção das estruturas apicais dos dentes pode levar a dificuldades na obtenção de uma odontometria apropriada. Este estudo comparou três localizadores apicais (Root ZX II, Raypex 6 e Endo-Eze Quill) para localizar a ponta do instrumento K-file entre 0 a -0,5 mm do forame apical em dentes com diagnóstico de periodontite apical assintomática. O comprimento de trabalho eletrônico foi realizado em 60 dentes com periodontite apical assintomática. Uma lima K-file de número 15 foi inserida no canal radicular até a localização do forame apical, e seguida foi reajustada para -0,5 mm por meio de observação no visor do localizador eletrônico apical. A lima K-file foi fixada ao dente usando compósito, e a seguir os dentes foram extraídos. Os 4 milímetros apicais foram desgastados até que a lima K-file pudesse ser visualizada para as medidas de distância no forame apical por meio de microscópio eletrônico de varredura. O comprimento de trabalho apropriado foi determinado quando a ponta do instrumento estivesse localizada entre 0 a -0,5 mm do forame apical. O Root ZX II apresentou o melhor desempenho (p<0,01) que o Raypex 6 ou Endo-Eze Quill em dentes humanos com periodontite apical assintomática.

Abstract Electronic apex locators (EAL) have been used to establish the working length (WL) in root canal treatment. In teeth diagnosed with apical periodontitis, resorption of tooth apical structures can lead to difficulties to obtain an appropriate WL. The aim was to compare the capacity of three EAL’s (Root ZX II, Raypex 6 and Endo-Eze Quill) to locate the tip of the K-file between 0 to -0.5 mm from the apical foramen (AF) on teeth diagnosed with asymptomatic apical periodontitis (AAP). Electronic working length was performed on 60 roots with AAP. A K-file #15 was inserted in the root canal until the apical foramen (AF) was located, and followed was re-adjusted to -0.5 mm through observation in EAL display. The K-file was fixed to the tooth with composite and teeth were extracted. The 4 apical millimeters were worn out until the K-file could be seen and were prepared and measured its distance to AF in a scanning electron microscope. Appropriate WL was when the tip of the K-file was located between 0 to -0.5 mm from AF. Results: Root ZX II showed significant difference (p<0.01) with the other two EALs. Root ZX II presented the better performance than Raypex 6 or Endo-Eze Quill in teeth with AAP.

Se plantea el coeficiente de dependencia asintótica, basado en cópulas, como una medida para la administración del riesgo en portafolios de acciones. Se describen algunos aspectos de las estructuras macro y microeconómicas del mercado en Colombia, motivando la introducción de medidas como la propuesta. La aplicación a catorce de las acciones más líquidas en el período de estudio (2007-2012) permite dar algunas recomendaciones de diversificación en caso de materialización de eventos extremos. En consecuencia, con la hipótesis de partida, se encuentran indicios de una alta vulnerabilidad del mercado de acciones colombiano ante eventos de tipo sistémico.

É proposto o coeficiente de dependência assintótica, baseado em cópulas, como uma medida para a administração do risco em portfólios de ações. São descritos alguns aspectos das estruturas macro e microeconômicas do mercado na Colômbia, motivando a introdução de medidas como a proposta. A aplicação a quatorze das ações mais líquidas no período de estudo (2007-2012) permite dar algumas recomendações de diversificação em caso de materialização de eventos extremos. Em consequência, com a hipótese de partida, s&etilde;o encontrados indícios de uma alta vulnerabilidade do mercado de ações colombiano diante de eventos de tipo sistêmico.

The coefficients of tail dependence, based on copulas, are proposed as a measure for portfolio risk management. Some aspects of the macro and microstructures of the Colombian stock market are described. Such features encourage the use of measures such as the one proposed herein. The application of the proposed methodology to the fourteen most liquid shares in the study period (2007-2012) derived in some diversification recommendations under extreme events. The main conclusion, based on the starting hypothesis, is related to the evidence of high vulnerability in the Colombian stock market to an event of systemic risk.

Le coefficient de dépendance asymptotique par copules est proposé comme moyen de mesure pour la gestion du risque dans les portefeuilles d'actions. Certains aspects des structures macro et microéconomiques du marché en Colombie sont décrits, motivant l'introduction de mesures comme celle qui est proposée. L'application à quatorze des actions les plus liquides pour la période d'étude (2007-2012) permet de faire certaines recommandations de diversification dans le cas de matérialisation d'évènements extrêmes. Par conséquent, avec l'hypothèse de départ, certains indices démontrent une haute vulnérabilité du marché d'actions colombien face à des évènements de type systémique.

Objetivo: Determinar la frecuencia de los diagnósticos histológicos finales en el seguimiento de los estudios de citología por aspiración con aguja fina de tiroides implementados con el Sistema Bethesda (SB). Métodos: Se realizó un estudio de tipo corte transversal comparando los resultados de citología aspirativa de tiroides implementados con el SB y el resultado final de histopatología de pacientes con lesiones en la glándula tiroides que consultaron al Instituto Nacional de Cancerología, Colombia, durante los años 2010 a 2012. Resultados: Se revisaron informes de citopatología y de histopatología de 104 pacientes (n = 104) con nódulos tiroideos. La edad promedio de los pacientes fue de 51,59 años. Los resultados de citopatología, por categorias del SB, fueron: 37,5% categoria V, 30,8% categoria VI, 15,4% categoria IV, 6,7% categorias I y II, y 2,9% categoria III. Entre los diagnósticos de histopatología, el carcinoma papilar fue el más frecuente con 76%, seguido de bocio con 6,7% de los casos. En el análisis comparativo, las categorias IV, V y VI de la citologia tenían en el diagnóstico final de histopatologia una lesión maligna en el 89,8% de los casos, y los de citologia de categoria II, benignos, en el 77% de los mismos el resultado final de histopatologia era una lesión benigna. Conclusiones: La citologia aspirativa de la glándula tiroides interpretada con el SB en el Instituto Nacional de Cancerologia tiene una alta calidad diagnóstica en la detección de malignidad tiroidea al compararla con el diagnóstico final de histopatologia.

Objective: To determine the frequency of the final histological diagnosis in the follow-up of cytology results of thyroid fine needle aspirates implemented using the Bethesda system (BS). Methods: A cross-sectional study was conducted comparing the cytology results of thyroid fine needle aspirates implemented with the BS, and the final histopathology result in patients with thyroid gland lesions, who were seen in the Colombia National Cancerology Institute during the years 2010 to 2012. Results: A review was made of the cytopathology and histopathology reports of 104 patients with thyroid nodules. The mean age of the patients was 51.9 years. The results of the cytopathology by BS categories were: 37.5% category V, 30.8% category VI, 15.4% category IV, 6.7% categories I and II, and 2.9% category III. Papillary carcinoma was the most frequent histopathology diagnosis of all the cases, with 76%, followed by goiter with 6.7%. In the comparative analysis, the cytology categories IV, V and VI, 89.8% of the cases had a malignant lesion in the final histology report, and 77% of those of category II (benign) had the same result in the final histopathology diagnosis. Conclusions: The cytology of thyroid fine needle aspirates interpreted using the BS in the National Institute of Cancerology is of high diagnostic quality in the detection of thyroid malignancy when compared with the final histopathology diagnosis.

La colitis linfocítica y la colitis colagenosa son las dos formas histológicas de la colitis microscópica (CM), condición médica reconocida hace más de 30 años, habitual en pacientes adultos con diarrea crónica acuosa, sin cambios endoscópicos en la mucosa del colon y cuyo diagnóstico se establece exclusivamente en el examen histopatológico de las biopsias de colon. El objetivo de la presente revisión es familiarizar a los médicos patólogos quirúrgicos en práctica general con la morfología de la colitis linfocítica y la colitis colagenosa, así como con la importancia de los informes de patología y la de una buena comunicación con el médico endoscopista para el correcto diagnóstico de estas entidades, y brindar a estos pacientes el tratamiento adecuado

Lymphocytic colitis and collagenous colitis are two histologic forms of microscopic colitis, a condition which was first recognized over 30 years ago. It is often found in adults with chronic, watery diarrhea although endoscopic examination of the colon is frequently normal. The diagnosis is based on microscopic examination of colonic biopsies. The aim of this review is to familiarize general surgical pathologists with the morphologic features of lymphocytic and collagenous colitis. In additional, this review emphasizes good communication with the endoscopist to allow correct recognition and ensure appropriate treatment

Los tumores del estroma gastrointestinal GIST, se originan en la pared del tracto digestivo desde el esófago al ano. Aproximadamente 25% de los GIST gástricos son clínicamente malignos y desarrollan metástasis principalmente al hígado, menos comúnmente a tejidos blandos y hueso. Se presenta el caso de un paciente con GIST gástrico y metástasis al hígado e inusualmente al cráneo

Gastrointestinal stromal tumors (GISTs) originate in the wall of the digestive tract from the esophagus to the anus. Approximately 25% of gastric GISTs are clinically malignant. Most often they metastasize to the liver, less commonly to soft tissues and bone. The clinical case of a patient with a gastric GIST, liver and unusual cranial metastasis is presented

Introducción: El tumor fusocelular hialinizante con rosetas gigantes es una neoplasia constituida por dos componentes histológicos, uno celular con elementos fusiformes, y el segundo representado por islas bien delimitadas casi acelulares, llenas de material hialino, rodeadas de células redondas u ovales, las cuales muestran un perfil inmunohistoquímico inusual, e histogénesis incierta. Objetivo: Instruir a los patólogos y clínicos sobre este tumor, su forma de presentación y diagnósticos diferenciales. Metodología y resultados: Se presenta el caso de una mujer de 42 años con masa ubicada en región inguinal, de crecimiento progresivo (1 año), que se reseca quirúrgicamente anatomía patológica informó un tumor fusocelular hialinizante con rosetas gigantes, según hallazgos morfológicos e inmuno histoquímicos, en correlación con su localización y cuadro clínico. Conclusión: Se hace necesario ampliar el conocimiento sobre esta entidad y de esta forma obtener una adecuada evaluación de sus criterios pronósticos histológicos, comportamiento clínico y tratamiento. Salud UIS 2010; 42: 282-286

Introduction: The hyalinizing spindle cell tumor with giant rosettes is a neoplasia characterized by both histologic components, one of which is cellular, with spindle-shaped elements and the second represented by well defined almost acellular islands filled with hyaline material surrounded by round to oval cells, which shows an unusual immunohistochemical profile and uncertain histogenesis. Objective: Educate pathologists and clinicians about this tumor, its presentation and differential diagnosis. Methods and results: A case of a 42 year old woman with a mass located in the inguinal region, with progressive growth (1 year), surgically resected and histopathology reported as Hyalinizing spindle cell tumor with giant rosettes according to morphological, immunohistochemical findings correlates with its location and clinical. Conclusion: It is necessary to expand awareness about this condition and thus obtain a proper assessment of histological prognostic criteria, clinical behavior and treatment. Salud UIS 2010; 42: 282-286

We report a 33 year-old female with a diagnosis of halothane-induce fulminant hepatic failure who was subjected to a liver transplant with an ABO-incompatible graft. The patient received a therapeutic protocol that included total plasma exchange, splenectomy and quadruple immunosuppression. After 5 years, the patient remains asymptomatic and with normal liver enzymes, while she has been treated with low dose of immunosuppressive drugs. This case demonstrates an example of how the immunological process of accomodation opens the possibility of using ABO-incompatible organs as a definitive grafts.

This is a translation into Spanish, done by Mario Uribe, M.D., F.A.C.S., and authorized by the Conference Organization, of the official statements signed by The Transplantation Society, The International Society of Nephrology and the representatives who participated at a WHO sponsored Conference held in Istambul, Turkey, April 30 to May 2, 2008.

Although the use of cadaveric split or living donor liver transplantation is a valid option for liver transplants, they have several complications, being the "small-for-size syndrome" one of the most frequent. This entity is mainly due to the incapacity that the graft has to meet the blood drainage demands. We report a 61 year-old patient with sub-acute liver failure, transplanted with a partial liver graft that developed hyperbilirubinemia, ascites and liver function deterioration. A meso-caval shunt was performed, after which the ascites resolved, serum bilirubin normalized and the synthetic function of the liver improved. After one month, a follow-up CT seen showed the absence of blood flow in the shunt, possible due to the reduction of the hyper-perfusion of the liver. The clinical and biochemical condition of the patient continued improving despite the lack of flow through the shunt.