[Purtscher's retinopathy: a rare complication of acute non-alcoholic pancreatitis]. / Retinopatía de Purtscher: complicación infrecuente de la pancreatitis aguda no alcohólica.

Purtscher's retinopathy is a rare complication of acute alcoholic pancreatitis that is characterized by the development of cotton-wool exudates and retinal hemorrhages located around the optic disk. Its development is due to ischemic phenomena in the posterior pole of the retina due to microemboli in the retinal arterioles and capillaries. This complication is not related to a poorer prognosis of acute pancreatitis and the retinopathy usually has a favorable outcome with disappearance of the ophthalmic lesions and restoration of visual acuity after 4-6 weeks in most cases. However, some patients may show residual lesions, especially if optical atrophy occurs. We present a 40-year-old woman with loss of visual acuity due to Purtscher's retinopathy during the course of mild acute idiopathic pancreatitis.

Endoscopic follow-up of patients after curative surgery for colorectal cancer: results of a medical assistance protocol.

AIMS: To evaluate the results of an endoscopic follow-up assistance protocol for colorectal cancer (CRC) after curative surgery. PATIENTS AND METHODS: Between 1994 and 1996, 205 patients with CRC were submitted to curative surgery in our hospital. An endoscopic follow-up was proposed to the patients based on an endoscopy six months following surgery, in the case they did not have a complete endoscopy prior to surgery, or one year after surgery if they did, another one two years later, and a third endoscopy between the third and fifth year. We retrospectively analyzed the follow-up outcome and endoscopic findings. RESULTS: 155 patients were submitted to follow-up, of which 74,2% completed the protocol. 3 synchronous tumours, 4 anastomosis relapses and 2 metachronous tumours were detected. Curative surgery was performed on 100% of the synchronous tumours, 50% of the relapses and 50% of the metachronous tumours. 48.3% and 20.6% of the patients had synchronous and metachronous polyps, respectively. 14.7% of the polyps were larger than 1 cm, 21.7% and 4.8% were tubulovillous and villous, respectively, and 3.7% had severe dysplasia. Finally, patients with synchronous polyps had higher risk of developing metachronous polyps (RR 7.1, CI 95% 2.3; 22.2, p<0.0001). CONCLUSIONS: The rate of adenomatous polyps with high risk of malignant degeneration, metachronous tumours or relapses detected by colonoscopy is low in our series. On the other hand, the detection of polyps during follow-up was related to the presence of synchronous polyps.

Seguimiento endoscópico tras resección curativa del cáncer colorrectal: resultados de un protocolo asistencial / Endoscopic follow-up of patients after curative surgery for colorectal cancer: results of a medical assistance protocol

Objetivos: evaluar los resultados de un protocolo asistencial de seguimiento endoscópico tras la resección curativa del cáncer colorectal (CCR).Pacientes y métodos: entre 1994 y 1996, 205 pacientes con CCR fueron intervenidos en nuestro centro con intención curativa. A los pacientes se les propuso un protocolo de seguimiento endoscópico basado en una endoscopia a los 6 meses si no tenían endoscopia preoperatoria completa o al año, si se había realizado a los dos años, y una tercera entre el tercer y el quinto año. Se analizó de forma retrospectiva la adhesión al seguimiento y los hallazgos durante el seguimiento. Resultados: ciento cincuenta y cinco pacientes realizaron seguimiento endoscópico, adhiriéndose completamente al protocolo el 74,2 por ciento de los pacientes. Se detectaron 3 tumores sincrónicos, cuatro recidivas sobre la anastomosis y 2 tumores metacrónicos, realizándose tratamiento con intención curativa en el 100 por ciento de los tumores sincrónicos, el 50 por ciento de las recidivas y el 50 por ciento de los tumores metacrónicos. En el 48,3 y el 20,6 por ciento de los pacientes se hallaron pólipos sincrónicos y metacrónicos respectivamente. El 14,7 por ciento de los pólipos fueron mayores de 1cm, el 21,7 y el 4,8 por ciento fueron tubulovellosos y vellosos respectivamente, y presentaron un grado de displasia severa el 3,7 por ciento. Finalmente los pacientes con pólipos sincrónicos presentaron 7,1 veces mayor riesgo relativo de desarrollar pólipos metacrónicos en el seguimiento (p<0,0001, IC 95 por ciento 2,3; 22,2). Conclusiones: la tasa de adenomas con alto riesgo de malignización, de tumores metacrónicos o recidivas detectadas por colonoscopia en nuestra serie es baja. Por otra parte, la detección de pólipos en el seguimiento endoscópico está en íntima relación con la presencia de pólipos sincrónicos (AU)

Plasma polyphenols and antioxidants, oxidative DNA damage and endothelial function in a diet and wine intervention study in humans.

An intervention study was performed to evaluate the influence of a Mediterranean diet, a high fat diet, and their supplementation with red wine in moderate amounts, on biochemical, physiological, and clinical parameters related to atherosclerosis and other chronic diseases. For 3 months two groups of 21 male volunteers each, received either a Mediterranean diet or a high fat diet; during the second month, red wine was added isocalorically, 240 ml/day. Participants were kept under close medical and nutritional surveillance. At days 0, 30, 60 and 90, clinical, physiological and biochemical evaluations were made. Plasma vitamin C was significantly decreased in the high fat diet group compared to the Mediterranean diet group. After wine supplementation to the Mediterranean diet, a significant 13.5% increase in plasma vitamin C was observed. Furthermore, when wine was added vitamin E decreased significantly in plasma, 15% in the high fat diet and 26% in the Mediterranean diet. Total plasma antioxidant capacity (total antioxidant reactivity) increased 28% above basal levels in the Mediterranean diet group, but not in the high fat diet group. In both groups, wine induced a marked increase in total antioxidant reactivity above basal levels, 56% and 23%, respectively. Oxidative DNA damage, detected as 8-hydroxydeoxyguanosine (8-OHdG) levels in blood leukocyte DNA, was markedly increased by the high fat diet; however, it was strongly reduced, to approximately 50% basal values, after wine supplementation, both in the high fat diet and Mediterranean diet groups. Endothelial function, evaluated noninvasively as flow-mediated vascular reactivity of the brachial artery, was suppressed by the high fat diet, and was normal after wine supplementation. These effects are attributed to oxidative stress associated with a high fat diet, and to the elevated plasma antioxidant capacity associated with wine consumption and the Mediterranean diet. The results presented support the following conclusions: a high fat diet induces oxidative stress; a diet rich in fruits and vegetables enhances antioxidant defenses; wine supplementation to a high fat or a Mediterranean diet increases plasma antioxidant capacity, decreases oxidative DNA damage, and normalizes endothelial function.

[The Protomedicato Tribunal in the Central Administration of the Spanish Crown]. / El Protomedicato en la administración central de la Monarquía hispánica.

The Protomedicato was born, developed, and declined in the central administration of the Castilian Kingdom during the historic period known as the Modern Age (15th-19th centuries). The main objective of this study was to produce a conceptual analysis of this royal institution, a high collegiate court of technical character whose aim was to control all health-related professions in Castile; it had an independent jurisdiction and was not subordinate to the Royal Council (Consejo Real), although it was sometimes influenced by this council. We studied the legislative and everyday life and evolution of this court through different stages in its long life span. The Protomedicato, considered not as an isolated institution but within the bureaucracy of modern administration, is analyzed in the context of its sometimes strained relationship with other national, regional and local institutions of the Kingdom, the University, the Church and the Professional Association.

Riboflavin-photosensitized anaerobic modification of rat lens proteins. A correlation with age-related changes.

When rat lens homogenate or its soluble protein fractions are irradiated in the presence of riboflavin, a photo-adduct is obtained between this vitamin and the lens proteins. Irradiation of these proteins in the presence of riboflavin also leads to a modification in the chromatographic elution pattern with an increase in the high-molecular-weight fraction. In an aging study with rats, it was shown that the proportion of the high-molecular-weight protein fraction significantly increased with age, whereas the proportion of the low-molecular-weight protein fraction concomitantly decreased. It is postulated that aging produces an increase in the accessibility of the tryptophan residues of the lens proteins, as established by iodide fluorescence quenching experiments.