Actinotignum schaalii infection: Challenges in diagnosis and treatment.

Actinotignum schaalii affects elderly people and is associated with individuals with urological-related predispositions, but can be found in a variety of locations, such as cutaneous, intraabdominal, genitourinary and surgical infections. Disseminated infections occur less frequently and are by and large related to urinary tract colonisation. This pathogen is often neglected due to growth requirements, especially in urinary tract infections. We present 107 Actinotignum schaalii isolated from genitourinary samples (80.4%), from skin and soft tissue infections (13.1%), from bone and deep tissue infection (4.7%) and from blood cultures (1.9%). The automated system Alfred 60/AST was paramount for the isolation of 77.6% of the UTI. All the isolates tested were susceptible to penicillin, ampicillin, linezolid, vancomycin, teicoplanin, rifampicin and tetracycline. In conclusion, we present a large series of Actinotignum schaalii infections. This pathogen is hard to isolate, and is resistant to commonly used empirical antimicrobials.

Refractive index of ZnO ultrathin films alternated with Al2O3 in multilayer heterostructures.

The design of optoelectronic devices made with ZnO superlattices requires the knowledge of the refractive index, which currently can be done only for films thicker than 30 nm. In this work, we present an effective medium approach to determine the refractive index of ZnO layers as thin as 2 nm. The approach was implemented by determining the refractive index of ZnO layers ranging from 2 nm to 20 nm using spectroscopic ellipsometry measurements in multilayers. For a precise control of morphology and thickness, the superlattices were fabricated with atomic layer deposition (ALD) with alternating layers of 2 nm thick Al2O3 and ZnO, labeled as N ZnO-Al2O3, where N = 10, 20, 30, 50, 75 and 100. The total thickness of all superlattices was kept at 100 nm. The approach was validated by applying it to similar superlattices reported in the literature and fitting the transmittance spectra of the superlattices.

Quantum dynamics of the intramolecular vibrational energy redistribution in OCS: From localization to quasi-thermalization.

We report a fully quantum-dynamical study of the intramolecular vibrational energy redistribution (IVR) in the electronic ground state of carbonyl sulfide, which is a prototype of an isolated many-body quantum system with strong internal couplings and non-Rice-Ramsperger-Kassel-Marcus (RRKM) behavior. We pay particular attention to the role of many-body localization and the approach to thermalization, which currently are topics of considerable interest, as they pertain to the very foundations of statistical mechanics and thermodynamics. We employ local-mode (valence) coordinates and consider initial excitations localized in one local mode, with energies ranging from low to near the dissociation threshold, where the classical dynamics have been shown to be chaotic. We propagate the nuclear wavepacket on the potential energy surface by means of the numerically exact multiconfiguration time-dependent Hartree method and employ mean local energies, time-dependent and time-averaged populations in quantum number space, energy distributions, entanglement entropies, local population distributions, microcanonical averages, and dissociation probabilities, as diagnostic tools. This allows us to identify a continuous localization → delocalization transition in the energy flow, associated with the onset of quantum chaos, as the excitation energy increases up to near the dissociation threshold. Moreover, we find that at this energy and ∼1 ps the molecule nearly thermalizes. Furthermore, we observe that IVR is so slow that the molecule begins to dissociate well before such quasi-thermalization is complete, in accordance with earlier classical-mechanical predictions of non-RRKM behavior.

Pseudoaneurisma de arteria segmentaria lumbar tras introducción de tornillo transpedicular L5. Una rara complicación vascular / Lumbar segmental artery pseudoaneurysm after L5 pedicle screw placement. A rare vascular complication

La fusión instrumentada lumbar por vía posterior se realiza de manera habitual hoy en día, aunque en algunas ocasiones puede inducir complicaciones que pueden llegar a ser devastadoras. Una de las causas, aunque poco frecuentes, de complicación mayor es la malposición de los tornillos pediculares, de ahí la importancia de ser metódicos a la hora de su colocación, comprobando el correcto labrado del trayecto y su introducción. Presentamos un caso de sangrado masivo tras la introducción de un tornillo pedicular lumbar durante una cirugía por estenosis de canal. La malposición del tornillo conllevó la inestabilidad hemodinámica intraoperatoria de la paciente tras el fracaso de los métodos habituales de control de sangrado en el campo quirúrgico. La realización de una TAC con contraste evidenció lesión de la arteria intersegmentaria lumbar que fue finalmente controlada mediante embolización e implantación de coil vascular (AU)

Posterior lumbar screw fixation is a common surgical procedure nowadays. However, it can sometimes produce complications that can be devastating. One of the less common causes of major complication is the misplacement of a pedicle screw. This highlights the importance of being methodical when placing pedicle screws, and checking that the pathway has been created correctly and their placement. We present a case of a massive bleed after a pedicular screw placement during lumbar canal stenosis surgery. Screw malposition led to intraoperative haemodynamic instability after failed attempts to control bleeding in the surgical site. Contrast enhanced CT imaging revealed a lumbar intersegmentary artery injury that was eventually controlled by means of a coil embolisation (AU)

Lumbar segmental artery pseudoaneurysm after L5 pedicle screw placement. A rare vascular complication. / Pseudoaneurisma de arteria segmentaria lumbar tras introducción de tornillo transpedicular L5. Una rara complicación vascular.

Posterior lumbar screw fixation is a common surgical procedure nowadays. However, it can sometimes produce complications that can be devastating. One of the less common causes of major complication is the misplacement of a pedicle screw. This highlights the importance of being methodical when placing pedicle screws, and checking that the pathway has been created correctly and their placement. We present a case of a massive bleed after a pedicular screw placement during lumbar canal stenosis surgery. Screw malposition led to intraoperative haemodynamic instability after failed attempts to control bleeding in the surgical site. Contrast enhanced CT imaging revealed a lumbar intersegmentary artery injury that was eventually controlled by means of a coil embolisation.

Sistema electrónico para reeducación postural estática en tiempo real / Electronic system for Static Postural Re-education in Real Time

Resumen: En este trabajo se presenta un sistema electrónico, basado en la medición de la distribución del peso en los pies, cuyo objetivo es coadyuvar en la evaluación postural. La evaluación postural utilizada por los fisioterapeutas para corregir problemas musculo-esqueléticos derivados por la edad, accidentes, enfermedades, etc. El sistema electrónico construido se validó preliminarmente utilizando videocámaras para corroborar la postura en un sujeto. Con los datos obtenidos se pudo confirmar que el sistema propuesto es capaz de ayudar en la corrección de la postura en tiempo real. La limitación principal de este trabajo es el reducido número de pruebas, por lo que sólo se presentan resultados preliminares. La originalidad de este trabajo reside principalmente en la solución propuesta para evaluar y corregir la postura por medio de un sistema electrónico, novedoso por el método empleado y su portabilidad. Derivado de los resultados presentados se puede concluir que sistema propuesto es capaz de ayudar a corregir la postura en tiempo real.

Abstract: This paper presents an electronic system aimed to assist on the postural evaluation by measuring the weight distribution on the feet. Postural evaluation is commonly used by physiotherapists in order to correct muscle-skeletal problems such as those derived from ageing, accidents, diseases, etc. The developed electronic system was validated preliminary using video cameras to confirm the correct postures of the subject under test. With the obtained data it is possible to corroborate that the proposed system is capable to assist on the correction of the postural position in real time. The main limitation of this work is the reduced number of tests, due to this only preliminary results are presented. The main novelty of this work is the proposed solution to evaluate and help to correct the posture by using a portable electronic device based on force sensors. Derived from the presented results it can be concluded that the proposed system is capable to assist on the evaluation and correction of postural position in real time.

Capnophilic Enterobacteriaceae.

Bacteria use bicarbonate as substrate for crucial metabolic reactions. We report the first case of bacteremia by capnophilic E. coli without the YadF gene (also known as CynT2 or Can2) that needs high concentrations of CO2 to non-enzymatically produce bicarbonate. This lack may also apply to previously reported capnophilic Enterobacteriaceae.

Inhibition of Notch1 signaling overcomes resistance to the death ligand Trail by specificity protein 1-dependent upregulation of death receptor 5.

The Notch1 signaling pathway contributes to tumorigenesis by influencing differentiation, proliferation and apoptosis. Here, we demonstrate that inhibition of the Notch1 signaling pathway sensitizes glioblastoma cell lines and glioblastoma initiating cells to apoptosis induced by the death ligand TRAIL. This sensitization occurs through transcriptional upregulation of the death receptor 5 (DR5, TRAIL-R2). The increase in DR5 expression is abrogated by concomitant repression of the transcription factor Sp1, which directly binds to the DR5 promoter in the absence of Notch1 as revealed by chromatin immunoprecipitation. Consistent with these findings, Notch1 inhibition resulted in increased DR5 promoter activity, which was impaired by mutation of one out of two Sp1-binding sites within the proximal DR5 promoter. Moreover, we demonstrate that JNK signaling contributes to the regulation of DR5 expression by Notch1. Taken together, our results identify Notch1 as key driver for TRAIL resistance and suggest Notch1 as a promising target for anti-glioblastoma therapy.

Extensively drug-resistant tuberculosis. La salida del callejón: «tuberculosis ultrarresistente» / Extensively drug-resistant tuberculosis. The way out from the alley: «tuberculosis ultrarresistente»

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Alteraciones en el procesamiento visual de formas: clasificación clínica integradora / Visual form-processing deficits: a global clinical classification

Introducción: Los pacientes que presentan dificultades para el reconocimiento visual de formas estimulares son considerados habitualmente como pacientes con agnosia visual. No obstante, estudios recientes permiten identificar diferentes manifestaciones clínicas que podrían corresponderse con entidades diagnósticas que reflejan déficits diferenciados a lo largo del continuo del procesamiento visual cortical de las formas. Desarrollo: Revisamos diferentes casos clínicos publicados en la literatura científica así como propuestas de clasificación de este déficit con la finalidad de dar una visión integradora del mismo. Exponemos los principales hallazgos en cuanto a las bases neuroanatómicas del procesamiento visual de formas y discutimos acerca de los criterios para evaluar dicho procesamiento cuando pueda estar alterado. Asimismo, presentamos un esquema de los déficits de procesamiento visual de formas que pretende integrar los distintos casos clínicos descritos en la literatura científica. Finalmente, proponemos un árbol de decisión que puede ser útil para guiar el proceso diagnóstico de estos casos. Conclusiones: Existe un amplio consenso en cuanto a las áreas corticales y circuitos neuronales que participan en el procesamiento visual, aunque futuros estudios con las nuevas técnicas de neuroimagen funcional permitirán profundizar en este aspecto. Una evaluación estructurada y exhaustiva de las diferentes etapas del procesamiento visual realizada a partir de una visión integradora del déficit nos facilitara un diagnóstico más objetivo, lo que nos permitirá conocer mejor el pronóstico y será de utilidad para guiar el diseño de estrategias individualizadas de psicoestimulación o rehabilitación

Introduction: Patients who have difficulties recognising visual form stimuli are usually labelled as having visual agnosia. However, recent studies let us identify different clinical manifestations corresponding to discrete diagnostic entities which reflect a variety of deficits along the continuum of cortical visual processing. Development: We reviewed different clinical cases published in medical literature as well as proposals for classifying deficits in order to provide a global perspective of the subject. Here, we present the main findings on the neuroanatomical basis of visual form processing and discuss the criteria for evaluating processing which may be abnormal. We also include an inclusive diagram of visual form processing deficits which represents the different clinical cases described in the literature. Lastly, we propose a boosted decision tree to serve as a guide in the process of diagnosing such cases. Conclusions: Although the medical community largely agrees on which cortical areas and neuronal circuits are involved in visual processing, future studies making use of new functional neuroimaging techniques will provide more in-depth information. A well-structured and exhaustive assessment of the different stages of visual processing, designed with a global view of the deficit in mind, will give a better idea of the prognosis and serve as a basis for planning personalised psychostimulation and rehabilitation strategies

Visual form-processing deficits: a global clinical classification.

INTRODUCTION: Patients who have difficulties recognising visual form stimuli are usually labelled as having visual agnosia. However, recent studies let us identify different clinical manifestations corresponding to discrete diagnostic entities which reflect a variety of deficits along the continuum of cortical visual processing. DEVELOPMENT: We reviewed different clinical cases published in medical literature as well as proposals for classifying deficits in order to provide a global perspective of the subject. Here, we present the main findings on the neuroanatomical basis of visual form processing and discuss the criteria for evaluating processing which may be abnormal. We also include an inclusive diagram of visual form processing deficits which represents the different clinical cases described in the literature. Lastly, we propose a boosted decision tree to serve as a guide in the process of diagnosing such cases. CONCLUSIONS: Although the medical community largely agrees on which cortical areas and neuronal circuits are involved in visual processing, future studies making use of new functional neuroimaging techniques will provide more in-depth information. A well-structured and exhaustive assessment of the different stages of visual processing, designed with a global view of the deficit in mind, will give a better idea of the prognosis and serve as a basis for planning personalised psychostimulation and rehabilitation strategies.

[Periprosthetic hip fractures]. / Fracturas periprotésicas de cadera.

UNLABELLED: The incidence rate of periprosthetic fractures has increased in the past decade. Osteolysis, age and preoperative function are factors that influence morbidity. Treatment options include conservative and surgical treatment. OBJECTIVES: To conduct a study analyzing the functional results of the surgical treatment of periprosthetic hip fractures at the ABC Medical Center considering preoperative and postoperative variables. MATERIAL AND METHODS: Cross-sectional retrospective study of patients with a diagnosis of periprosthetic hip fracture between January 2000 and December 2011, classified using the Vancouver system. The Oxford Hip Score was used pre- and postoperatively as a functional measure. The variables to evaluate included age, sex, surgical technique, and the time elapsed between primary surgery and the periprosthetic fracture. RESULTS: Twenty-five patients were analyzed; frequency was 3.3 cases per year. 80% of periprosthetic fractures were postoperative; 72% were total hip arthroplasties. The time elapsed between primary surgery and the traumatic event was 2 to 4 years (68%), with a mean of 4.5 years for hemiarthroplasties and 3.9 years for total arthroplasties. Patients who according to the Oxford Hip Score had good function maintained their results; 75% of those with moderate function maintained their score. Patients with poor function improved. CONCLUSIONS: At the ABC Medical Center, the outcomes of the treatment of periprosthetic hip fractures are considered as good according to the Oxford Hip Score.

Occupational Allergy to Aquarium Fish Food: Red Midge Larva, Freshwater Shrimp, and Earthworm. A Clinical and Immunological Study

Background: Chironomids seem to be the main cause of occupational allergy to aquarium fish food. Objective: The aim of this study was to investigate the pattern of occupational sensitization to 3 different arthropod species used as components of aquarium fish food. Methods: The study sample comprised 8 workers from a fish food packing department. The control group comprised 40 atopic patients (20 of whom were allergic to mites). We performed prick tests with extracts of red midge larva (Chironomus thummi), freshwater shrimp (Gammarus species), earthworm (Tubifex species), and other arthropod species and a battery of common inhalant allergens. We measured peak expiratory flow rate (PEFR) and specific immunoglobulin (Ig) E and performed a methacholine challenge test, nasal challenge test, and immunoblotting. Cross-reactivity analyses were completed using immunoblotting and CAP inhibition. Results: Prick test results were positive to red midge larvae in 7 patients (87.5%), Gammarus in 5 (62.5%), Tubifex in 3 (37.5%), and mites in 6 (75%). In the mite-allergic controls, 30% had positive prick test results to red midge larvae. PEFR decreased 􀀪20% during the packing process in all patients, and in 1 patient it indicated a dual asthmatic response. Methacholine challenge test results were positive in all participants. Nasal challenge tests were performed in 4 patients, and the results were positive. Specific IgE to red midge larvae was detected in 62.5%, Gammarus in 50%, and Tubifex in 16%. Bands of approximately 14-15 kDa and 31 kDa were observed in Gammarus and red midge larvae extracts. Cross-reactivity assays demonstrated that Gammarus totally inhibited red midge larvae, while Tubifex did so partially. Dermatophagoides pteronyssinus showed very low inhibitory capacity. Conclusions: Aquarium fish food arthropods are potent allergens with an elevated prevalence of sensitization and variable degree of cross-reactivity. This is the first report of occupational allergy to Tubifex. More data are necessary to identify and characterize the responsible allergens (AU)

Introducción: Los quironómidos parecen ser la principal causa de alergia ocupacional a la comida para peces de acuario. Objetivo: El objetivo de este estudio fue investigar el patrón de sensibilización ocupacional a tres diferentes especies de artrópodos que componen la comida para peces de acuario en 8 de 10 trabajadores expuestos con rinitis y asma en el lugar del trabajo. Métodos: Se realizaron prick-tests con extractos de Chironomus thummi, Gammarus y Tubifex, otras especies de artrópodos y batería de alérgenos inhalantes comunes. Cuarenta pacientes atópicos (20 de ellos alérgicos a ácaros) fueron utilizados como controles. Se realizaron mediciones de peak-flow, test de metacolina, pruebas de provocación nasal, determinación de IgE específica e inmunoblotting. El estudio de la reactividad cruzada se completó mediante inmunoblotting y CAP-inhibición. Resultados: 87.5% de los pacientes presentaron prick-tests positivos a larva roja (Chironomus thummi), 62.5% a Gammarus y 37.5% a Tubifex. El prick-test fue también positivo a ácaros en el 75% de los pacientes. El 30% de los pacientes controles alérgicos a ácaros tuvieron prick-tests positivos a larva roja. El peak-flow cayó ≥ 20% en todos los pacientes durante el proceso de empaquetado. En un paciente el peak-flow demostró una respuesta asmática dual. El test de metacolina fue positivo en todos. Las provocaciones nasales fueron realizadas en cuatro pacientes con resultados positivos. 62.5% de los pacientes tuvieron IgE específica positiva a larva roja, 50% a Gammarus y 16% a Tubifex. Se observaron bandas de 14-15 y 31 kDa en los extractos de Gammarus y larva roja. Las pruebas de reactividad cruzada demostraron que Gammarus inhibía totalmente a larva roja mientras que Tubifex solo lo hacía parcialmente y el extracto de D. pteronyssinus demostró muy baja capacidad de inhibición. Conclusiones: Los artrópodos componentes de la comida para peces de acuario son potentes alérgenos con una elevada prevalencia de sensibilización. Presentan un grado variable de reactividad cruzada. Es el primer caso descrito de alergia ocupacional a Tubifex. Se necesitan más datos para identificar los alérgenos responsables y su naturaleza (AU)

The use of anatomical models for learning anesthesia techniques in oral surgery.

AIM: The objective of this work is to present a new collaborative method for teaching administration of anesthetic block in dentistry, with three-dimensional anatomical models used to improve learning and thereby increase safety, reduce anxiety, and improve the performance of students during the administration of anesthesia in the patients. MATERIALS AND METHODS: Three-dimensional (3D) models of skulls were made that reproduced all innervations of the V th cranial nerve (trigeminal nerve), as well as some blood vessels, glands, and muscles of mastication. For teaching the local anesthetic techniques we prepared pictures and videos of the administration of anesthesia in the models , which were presented to 130 students in two universities in Brazil. With the help of the models the students could follow the path of the nerves to be anesthetized and identify the anatomical points of reference for the correct positioning of the needle in the tissues. After the presentation the students answered a questionnaire aiming to assess the effect of the 3D models on learning. RESULTS: Eighty-eight percent of students rated the material as excellent, 12% as good, 0% as regular, and 0% as bad (unnecessary materials). After the presentation, 70% of the students felt confident about being able to achieve the nerve block in patients. CONCLUSION: When exposed to an appropriate method, students recognized the importance of knowledge of anatomy for learning local anesthetic techniques. This method improved the quality of education and increased patient safety during the first injection.

Occupational allergy to aquarium fish food: red midge larva, freshwater shrimp, and earthworm. A clinical and immunological study.

BACKGROUND: Chironomids seem to be the main cause of occupational allergy to aquarium fish food. OBJECTIVE: The aim of this study was to investigate the pattern of occupational sensitization to 3 different arthropod species used as components of aquarium fish food. METHODS: The study sample comprised 8 workers from a fish food packing department. The control group comprised 40 atopic patients (20 of whom were allergic to mites). We performed prick tests with extracts of red midge larva (Chironomus thummi), freshwater shrimp (Gammarus species), earthworm (Tubifex species), and other arthropod species and a battery of common inhalant allergens. We measured peak expiratory flow rate (PEFR) and specific immunoglobulin (Ig) E and performed a methacholine challenge test, nasal challenge test, and immunoblotting. Cross-reactivity analyses were completed using immunoblotting and CAP inhibition. RESULTS: Prick test results were positive to red midge larvae in 7 patients (87.5%), Gammarus in 5 (62.5%), Tubifex in 3 (37.5%), and mites in 6 (75%). In the mite-allergic controls, 30% had positive prick test results to red midge larvae. PEFR decreased > or = 20% during the packing process in all patients, and in 1 patient it indicated a dual asthmatic response. Methacholine challenge test results were positive in all participants. Nasal challenge tests were performed in 4 patients, and the results were positive. Specific IgE to red midge larvae was detected in 62.5%, Gammarus in 50%, and Tubifex in 16%. Bands of approximately 14-15 kDa and 31 kDa were observed in Gammarus and red midge larvae extracts. Cross-reactivity assays demonstrated that Gammarus totally inhibited red midge larvae, while Tubifex did so partially. Dermatophagoides pteronyssinus showed very low inhibitory capacity. CONCLUSIONS: Aquarium fish food arthropods are potent allergens with an elevated prevalence of sensitization and variable degree of crossreactivity. This is the first report of occupational allergy to Tubifex. More data are necessary to identify and characterize the responsible allergens.

Correlación de resultados clínicos y perfil sagital en escoliosis del adulto. Valor del ángulo espinosacro y del ángulo de inclinación del raquis / Relationship between clinical results and sagittal profile in adult scoliosis. Value of the spinal-sacral angle and the spinal inclination angle

Objetivos. Evaluar la validez clínica en EA de 2 nuevos parámetros (ASS y ST) descritos recientemente para la evaluación del perfil sagital espinopélvicos, y cuyo papel en EA no está aún definido. Material y método. Análisis prospectivo (no concurrente) radiográfico y clínico de 59 cirugías primarias de EA (Cobb > 40°), mínimo 2 años de seguimiento. Para este trabajo dispusimos de radiografías y cuestionarios de salud de 49 pacientes. Se evaluó el cambio de los parámetros radiográficos tras cirugía (test Wilcoxon) y la correlación resultados clínicos-radiográficos-edad (test de Spearman y regresión lineal múltiple). Resultados. Mediana de seguimiento postoperatorio 8,5 años. Mediana edad 49,5 años. Hubo cambio estadísticamente significativo con la cirugía en ASS y ST (en ambos inferior a 5°), cifosis torácica (CT), lordosis lumbar (LL), rotación pélvica (RP), balance sagital (BS) y Cobb frontal. No hubo correlación entre dolor y ASS-ST. Hubo correlación significativa entre actividad y ASS, ST, LL, BS) y edad. Tras análisis multivariante solo la edad (ni ASS ni ST) persistió como posible predictor de menor actividad. Discusión. Cuando predomina la deformidad frontal, los parámetros radiográficos sagitales, incluidos los más novedosos ángulos, si bien sí influyen en la actividad del paciente cuando se analizan de forma aislada, pierden esta influencia cuando se analizan en conjunto y junto a otros parámetros clínicos. Conclusiones. Los valores de SSA y ST varían escasamente con la cirugía. Solo se correlacionan con la actividad pero no pueden considerarse predictores de la misma. No parecen pues medidas de utilidad en EA (AU)

Objectives. To assess the clinical validity of two new recently described parameters (spinal-sacral angle (SSA) and spinal inclination angle (SIA) in adult scoliosis (AS) for evaluating the spinal-pelvic sagittal profile, as well as their still undefined role in AS. Material and method. A non-concurrent prospective radiographic and clinical study was conducted on 59 primary surgeries of AS (Cobb>40°), with a minimum of 2 years follow-up. The available X-rays and health questionnaires of 49 patients were used in the study. The changes in X-ray parameters after surgery were evaluated (Wilcoxon test), as well as the correlations as regards the clinical-radiography-age parameters (Spearman test and multiple linear regression). Results. The median post-surgical follow-up was 8.5 years, and the median age of the patients was 49.5 years. There was a statistically significant change with the surgery in the SSA and SIA (less than 5° in both), thoracic kyphosis, lumbar lordosis (LL), pelvic rotation, sagittal balance (SB) and frontal Cobb. There was no correlation between pain and SSA-ST. There was a significant relationship between activity and SSA, ST, LL, SB, and age. After the multivariate analysis only age (not SSA or SIA) remained as a possible predictor of lower activity. Discussion. When frontal deformity predominates, the sagittal radiographic parameters, including the newest angles, although they have an influence patient activity when analysed individually, they lose this influence when they are analysed together and with other clinical parameters. Conclusions. The SSA and SIA hardly change with surgery. They only correlate with activity, but cannot be considered predictors of this. Thus they do seem to be useful measurements in AS (AU)

[Epidemiologic behavior of malignant digestive tract tumors over a five year period in Veracruz, Mexico]. / Comportamiento epidemiológico de las neoplasias malignas del tracto digestivo en un periodo de 5 años en Veracruz, Mexico.

INTRODUCTION: Tumors of the digestive system are considered to be a public health problem because of their elevated mortality rate. In Mexico, gastric cancer and colon cancer rank fourth and fifth, respectively, following tracheal, bronchial, and lung cancer, and there has been an increase in their frequency in the last few years. However, there are no specific studies that have evaluated their epidemiologic behavior in Veracruz. OBJECTIVE: To determine the frequency of digestive system cancer in five health institutions in the city of Veracruz and to describe its epidemiologic behavior over a five-year period. MATERIAL AND METHODS: Annual statistics from the following hospitals were reviewed: the Instituto Mexicano del Seguro Social, the Secretaría de Salud, the Instituto de Seguridad y Servicios Sociales de los Trabajadores del Estado, Petróleos Mexicanos, and the Secretaría de la Defensa Nacional within the time frame of January 2005 to December 2009. Diagnoses based on histopathology were recorded, along with patient age and sex. RESULTS: A total of 1803 cases of digestive tract cancers were detected: 52% were men and 48% were women. A yearly increase in the number of cases was observed with colon cancer being in first place, followed by stomach cancer and rectal cancer. CONCLUSIONS: The increase in digestive system cancer cases over the last five years in Veracruz underlines the need to evaluate the implementation of screening programs for the at-risk population and to study the different etiologic factors involved in its manifestation.