Valoración del riego de adicción a tramadol en pacientes con dolor crónico no oncológico / Risk of addiction in patients with tramadol for chronic no cáncer pain

RESUMEN Objetivo El manejo del dolor crónico no oncológico con analgésicos opioides ha sido de importancia para el control de los síntomas y el restablecimiento de la actividad. Sin embargo, el riesgo de adicción asociado a estos medicamentos es ampliamente conocido y evaluado. Este estudio evalúa el riesgo de adicción que presentaban los pacientes con manejo de tramadol describiendo los factores más frecuentes en la muestra estudiada frente a lo reportado en la literatura. Métodos Una muestra de 76 pacientes de una clínica de dolor que están en manejo con tramadol se les administra un cuestionario con características demográficas y con la escala Opioid Risk Tool para el riesgo de adicción. Resultados El 57,89% de los sujetos fueron mujeres; el 55,20% se encontraba entre los 29 y 59 años. El riesgo de adicción moderado se encontró en el 9,09% de las mujeres y en el 37,05% de los hombres. La inclusión de otras enfermedades como ansiedad y trastorno de estrés postraumático aumenta el riesgo de adicción a severo en 6,06% de los hombres. Conclusiones La valoración del riesgo de adicción a opioides debe tener en cuenta los factores encontrados en la población colombiana.

ABSTRACT Objective The management of chronic non-cancer pain with opioid analgesics has been important for the control of symptoms and the restoration of activity, however, the risk of addiction associated with these drugs is widely known. This study evaluates the risk of addiction presented by patients with tramadol treatment, describing the most frequent factors in the sample studied compared to what was reported in the literature. Methods A sample of 76 patients from a pain clinic who are being managed with tramadol are administered a questionnaire with demographic characteristics and with the Opioid Risk Tool scale for the risk of addiction. Results 57.89% of the subjects were women, 55.20% were affected between 29 and 59 years. A moderate risk of addiction was found in 9.09% of women and 37.05% of men. The inclusion of other diseases such as anxiety and post-traumatic stress disorder increases the risk of addiction to severe in 6.06% of men. Conclusions The assessment of the risk of addiction to opioids must consider the factors found in the Colombian population.

Real-time diagnosis of Barrett's esophagus: a prospective, multicenter study comparing confocal laser endomicroscopy with conventional histology for the identification of intestinal metaplasia in new users.

INTRODUCTION: Endoscopic evaluation with high-definition white light endoscopy and random 4-quadrant biopsy (Seattle Protocol) is the current standard of care for the detection of Barrett's esophagus (BE). Recently, enhanced imaging technologies have become available to provide real-time diagnosis of intestinal metaplasia (IM) and dysplasia, reducing the need for tissue biopsy. Probe-based confocal laser endomicroscopy (pCLE) provides dynamic microscopic mucosal views, rapidly capturing digital images that become optical biopsies. This study examined the role of pCLE in BE screening and surveillance as compared to the Seattle Protocol. METHODS: Patients undergoing BE screening or surveillance endoscopy were enrolled at eight US centers. Optical biopsy using pCLE was interpreted in real time. Endoscopists performing pCLE were new users with a median experience of 8.5 months and no formal training in surgical pathology. Seattle Protocol biopsies were then taken. Recorded pCLE images were reviewed by a blinded expert in optical biopsy interpretation. RESULTS: Early pCLE users identified significantly more patients with IM than the Seattle Protocol overall (99/172 vs. 46/172, p < 0.0001). Early users of pCLE also identified significantly more patients with IM than the Seattle Protocol in the patients with visible columnar lined esophagus (75 vs. 31, p < 0.0001), but not in the 76 patients without columnar lined esophagus (24 vs. 15, p = 0.067). There was no statistically significant difference between early pCLE users and expert review. CONCLUSION: Optical biopsy using pCLE technology allows for the real-time evaluation of entire segments of columnar lined esophagus. Consequently, pCLE is considerably more sensitive in the detection of BE than the Seattle Protocol, which leaves a majority of epithelium unexamined. This effect is seen even in new users and increases with experience. Overall, pCLE provides a promising advance in Barrett's detection which will likely result in superior identification of individuals at risk for esophageal adenocarcinoma.

Waist circumference predicts increased complications in rectal cancer surgery.

BACKGROUND: The impact of obesity on development of postoperative complications after gastrointestinal surgery remains controversial. This may be due to the fact that obesity has been calculated by body mass index, a measure that does not account for fat distribution. We hypothesized that waist circumference, a measure of central obesity, would better predict complications after high-risk gastrointestinal procedures. METHODS: Retrospective review of an institutional cancer database identified consecutive cases of men undergoing elective rectal resections. Waist circumference was calculated from preoperative imaging. RESULTS: From 2002 to 2009, 152 patients with mean age 65.2 ± 0.75 years and body mass index 28.0 ± 0.43 kg/m(2) underwent elective resection of rectal adenoma or carcinoma. Increasing body mass index was not significantly associated with risk of postoperative complications including infection, dehiscence, and reoperation. Greater waist circumference independently predicted increased risk of superficial infections (OR 1.98, 95% CI 1.19-3.30, p < 0.008) and a significantly greater risk of having one or more postoperative complications (OR 1.56, 95% CI 1.04-2.34, p < 0.034). CONCLUSIONS: Waist circumference, a measure of central obesity, is a better predictor of short-term complications than body mass index and can be used to identify patients who may benefit from more aggressive infection control and prevention.

Sebaceous carcinoma: the great masquerader: emgerging concepts in diagnosis and treatment.

Sebaceous carcinoma (SC) is a rare tumor with a high rate of local recurrence and metastasis to lymph nodes and organs. The majority of SCs occur in the periocular region frequently presenting as painless, round subcutaneous nodules with a high tendency of diffuse and invasive growth in the eyelid and conjunctiva. It frequently masquerades as inflammatory conditions or as other tumors leading to delay in diagnosis, inappropriate treatment and increased morbidity and mortality. Sebaceous carcinoma is associated with Muir-Torre syndrome, a genetic condition presenting with sebaceous skin tumors associated with internal malignancy. Therefore, SC patients must be carefully evaluated and referred to an internist or gastroenterologist when indicated. Surgery is the definitive therapy for SC. In recent years, less radical surgical strategies are being used with improved outcomes. Current studies demonstrate that Mohs micrographic surgery (MMS) provides maximal tissue conservation and lower recurrence rates. Greater awareness and understanding of SC and its behavior has led to earlier diagnosis and appropriate treatment.

Oct-4: the almighty POUripotent regulator?

Oct-4 plays an essential role as a central regulator of the undifferentiated state. Grinnell et al. demonstrate for the first time that Oct-4 by itself has the ability to reprogram committed somatic cells, inducing their dedifferentiation by reverting them to a more developmentally potent state. This study provides evidence that Oct-4 might be the master regulator of the pluripotent state in mammalian cells.

p190-B RhoGAP regulates mammary ductal morphogenesis.

Previous studies from our laboratory have demonstrated that p190-B RhoGAP (p190-B) is differentially expressed in the Cap cells of terminal end buds (TEBs) and poorly differentiated rodent mammary tumors. Based on these observations we hypothesized that p190-B might play an essential role in invasion of the TEBs into the surrounding fat pad during ductal morphogenesis. To test this hypothesis, mammary development was studied in p190-B-deficient mice. A haploinsufficiency phenotype was observed in p190-B heterozygous mice as indicated by decreased number and rate of ductal outgrowth(s) at 3, 4, and 5 wk of age when compared with their wild-type littermates. This appeared to result from decreased proliferation in the Cap cells of the TEBs, a phenotype remarkably similar to that observed previously in IGF-I receptor null mammary epithelium. Furthermore, decreased expression of insulin receptor substrates 1 and 2 were observed in TEBs of p190-B heterozygous mice. These findings are consistent with decreased IGF signaling observed previously in p190-B-/- mouse embryo fibroblasts. To further assess if this defect was cell autonomous or due to systemic endocrine effects, the mammary anlagen from p190-B+/+, p190-B+/-, and p190-B-/- mice was rescued by transplantation into the cleared fat pad of recipient Rag1-/- mice. Surprisingly, as opposed to 75-80% outgrowths observed using wild-type donor epithelium, only 40% of the heterozygous and none of the p190-B-/- epithelial transplants displayed any outgrowths. Together, these results suggest that p190-B regulates ductal morphogenesis, at least in part, by modulating the IGF signaling axis.