FV, FA and IJV depth and diameter correlated with weight, size, age and body surface area in the studied pediatric patients. Correlation was better for femoral than for jugular vessels. Depth could be estimated from patients' weight and size, while diameter could be estimated from the size. Such estimations may facilitate the choice of vessels to be cannulated, length and diameter of cannulation needles and the diameter of catheters to be used in pediatric patients.

SUMMARYCritically ill patients with brain injury associated with organ dysfunction among which include pulmonary involvement as a determinant of morbidity and mortality. The aim of this paper is to review the major complications associated with brain injury in patients with brain injury, etiology, clinical, prevention and treatment.

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In pediatric patients, major vessels can be located and their depth and diameter measured by vascular ultrasound. In younger patients, jugular and femoral vessels had similar depth values; in older ones, they had similar diameters. Ultrasound measurements in pediatric patients could facilitate the choice of the vessel to be cannulated, the catheter diameter, and the length of the needle to be used. Vascular canalization of IJV may be recommended as the first choice because of its low depth and large diameter.

Fibrolamellar carcinoma (FLC) is an uncommon form of primary liver malignancy with unique clinical, histological, and biological characteristics. It is usually seen in young adults without underlying liver disease. Histologically, it shows large cells with abundant eosinophilic cytoplasm, large vesicular nuclei, prominent nucleoli, and lamellar type fibrosis. In contrast, classical hepatocellular carcinoma (HCC) is typically present in elderly male patients with cirrhosis. It is the most common histological subtype, and it is characterized by its resemblance to the normal liver, both in its growth pattern and its cytology. The unusual case of a liver carcinoma that presented with histological features of both FLC and classical HCC is herein reported. This was the case of a 37-year-old female complaining of diffuse abdominal discomfort and epigastric pain for two months. She was referred to us for further management after she was diagnosed with HCC in a noncirrhotic liver. She underwent a left-sided hepatectomy. A yellow nodular mass with well-defined borders and a necrotic center was present in the resection specimen. The morphological features and immunohistochemical studies were consistent with a diagnosis of FLC mixed with classical HCC. The patient was followed up for five months, and no signs of recurrence were evident.

The aim of the study was to determine the current prevalence of Helicobacter pylori in symptomatic Colombian children and evaluate the presence of mutations associated with clarithromycin resistance. Biopsies from 133 children were analyzed. The gastric fragment was used for urease test and reused for polymerase chain reaction sequencing of the 23SrDNA gene. Mutations were detected by bioinformatic analysis. Polymerase chain reaction sequencing established that H pylori infection was present in 47% of patients. Bioinformatics analysis of the 62 positive sequences for 23SrDNA revealed that 92% exhibited a genotype susceptible to clarithromycin, whereas the remaining strains (8%) showed mutations associated with clarithromycin resistance. The low rate of resistance to clarithromycin (8%) suggests that conventional treatment methods are an appropriate choice for children. Recycling a biopsy that is normally discarded reduces the risks associated with the procedure. The 23SrDNA gene amplification could be used for a dual purpose: detection of H pylori and determination of susceptibility to clarithromycin.

Introduction: The presence of H. pylori in the stomach is associated with gastric pathologies. However, its diagnosis through culture methods is challenging because of its complex nutritional requirements and microaerophilic conditions for optimal growth. The preferred method for rapid diagnosis of H. pylori is the Rapid Urease Test (RUT) from human biopsies, which relies on the high activity of the urease enzyme present in H. pylori. However, RUT cannot say much more information about H. pylori. This makes evident the need for bacterial culture to know essential information such as the strain type, the kind of infection present and the bacteria’s antibiotic susceptibility. Methodology: Gastric biopsies from 347 patients were used for H. pylori isolation. We correlated the culture results with the RUT and histological grading used at Hospital Universitario Fundación SantaFe de Bogotá (HU-FSFB), Colombia. The concordance between techniques was determined by the Cohen’s Kappa coefficient (K). The sensitivity, specificity, positive predictive value (PPV) and negative predictive value (NPV) were also calculated. Results: The culture standardization was successful, and it could be applied for diagnosis in the clinical practice. H. pylori was positive by culture in 88 (26.34%) patients. The concordance of RUT and culture was strong (K= 0.805), and between histology and culture was moderate (K= 0.763) as well as for the gold standard defined and culture (K= 0.80). Conclusions: We present evidence that RUT and histological methods will be better interpreted for diagnosis of H. pylori if combined with bacterial isolation in cholesterol enriched culture.

Contribución de los autores:Guillermo Campos: realización de los procedimientos quirúrgicos, revisión del manuscrito. Diana Palacios, Johanna Álvarez y Margarita Baldión: realización del estudio histopatológico, revisión y comentario del manuscrito. Leonardo Jurado: revisión de la historia clínica y la literatura científica pertinente, interpretación de los análisis moleculares microbiológicos y redacción del manuscrito. La tuberculosis laríngea primaria es una enfermedad rara con una amplia gama de manifestaciones clínicas. Se reporta el caso de un médico otorrinolaringólogo con diabetes de tipo II y con diagnóstico de tuberculosis laríngea primaria. El diagnóstico de cáncer de cuerda vocal se había considerado en otra institución, y al ingreso el paciente sólo presentaba disfonía de seis meses de evolución. En el estudio histopatológico se encontraron granulomas, células gigantes multinucleadas, fibrosis y necrosis, y en la tinción de Ziehl-Neelsen, bacilos ácido-alcohol resistentes. El cultivo del tejido de cuerda vocal para micobacterias y la PCR-IS6110 fueron positivos. La cepa de Mycobacterium tuberculosis demostró sensibilidad a todos los medicamentos de primera línea. Se inició tratamiento según la estrategia DOTS (Directly Observed Treatment, Short-course). Se discute la presentación clínica, los diagnósticos diferenciales, el abordaje diagnóstico y los factores de riesgo asociados y se hace una breve revisión de la literatura.Palabras clave: Mycobacterium tuberculosis, reacción en cadena de la polimerasa, tuberculosis laríngea, granuloma, disfonía. doi: http://dx.doi.org/10.7705/biomedica.v34i1.1624 Pathological and molecular diagnosis in a case of primary laryngeal tuberculosis in a physicianPrimary laryngeal tuberculosis is a rare disease with a wide variety of clinical manifestations. We report the case of an ear-nose and throat diabetic physician with primary laryngeal tuberculosis. The diagnosis of laryngeal cancer had been considered before in another institution, and at the patient's admission, he only presented dysphonia with a six-month evolution. The vocal cord histological examination showed granulomas, giant cells, fibrosis and necrosis, and the Ziehl-Neelsen staining showed acid-alcohol resistant bacilli. The culture from vocal cord tissue was positive for mycobacteria, and IS6110-PCR was positive too. The Mycobacterium tuberculosis strain was sensitive to first line drugs. Treatment using directly observed therapy short-course (DOTS) was initiated. Clinical presentation, differential diagnosis, diagnostic workup, associated risk factors and a brief literature revision are discussed in this article.