Exactitud diagnóstica de la tomografía computarizada en la estadificación del cáncer de colon / Diagnostic accuracy of computed tomography in colon cancer staging

Resumen Introducción: Una terapia emergente para el cáncer de colon es la neoadyuvancia, en casos seleccionados. Dicha selección se basa en el análisis preoperatorio de imágenes mediante tomografía computada. Objetivo: Nuestro objetivo es determinar la exactitud diagnóstica del examen para estadificar el cáncer de colon y su correlación entre radiólogos expertos. Materiales y Método: Estudio de exactitud diagnóstica. Previo cálculo muestral se seleccionaron aleatoriamente 47 pacientes con adenocarcinoma colónico resecado con intención curativa e imágenes hasta 60 días previo cirugía. Se evaluó profundidad de invasión tumoral e invasión linfonodal por 2 radiólogos expertos y ciegos entre sí. Las diferencias fueron auditadas por un tercer radiólogo experto. Se compararon resultados con la biopsia, calculando la sensibilidad, especificidad, valor predictivo negativo, valor predictivo positivo y exactitud diagnóstica del examen. Se calculó la concordancia entre radiólogos mediante el índice de kappa. Resultados: La exactitud para diferenciar tumores T3-T4 de T1-T2 fue del 89,4%. En cambio, la capacidad para diferenciar tumores T4 de los T3 fue de un 65,9%. La exactitud para determinar un N (+) fue de un 66%. La concordancia entre radiólogos fue de 0,929 para identificar tumores T1-2, de 0,602 para T3, de 0,584 para T4. Para determinar un N (+), la concordancia fue de 0,521. Conclusión: La exactitud diagnóstica de la tomografía computada en cáncer de colon es adecuada para distinguir tumores avanzados. Sin embargo, su capacidad para discriminar entre T3 y T4, los N (+) y la baja concordancia entre radiólogos, sugiere la necesidad de buscar técnicas imagenológicas complementarias.

Introduction: Neoadjuvant therapy is an emerging treatment for selected cases of colon cancer. The decision is based on the analysis of preoperative images taken by computed tomography. However, its ability to discriminate those who could benefit from this therapy is unknown. Aim: Our objective is to determine the diagnostic accuracy of computed tomography to evaluate the colon cancer stage and its correlation among expert radiologists. Materials and Method: Diagnostic accuracy study. After sample size calculation, we randomly selected 47 patients who underwent a colonic adenocarcinoma resection with curative intent and had available images up to 60 days after surgery. The depth of tumor and lymph nodal invasion were evaluated by two expert radiologists, blinded to each other. The differences between radiologists were audited by a third one. The results were correlated with biopsy as the gold standard. We calculated sensitivity, specificity, negative predictive value, positive predictive value, and diagnostic accuracy of computed tomography. The agreement between radiologists was calculated using the kappa index. Results: The accuracy to differentiate T3-T4 tumors from T1-T2 was 89.4%. In contrast, ability to differentiate T4 tumors from T3 tumors was 65.9%. The accuracy to determine an N (+) was 66%. Agreement between radiologists was 0.929 to identify T1-2, 0.602 for T3, 0.584 for T4 tumors. To determine an N (+), the concordance was 0.521. Conclusion: Diagnostic computed tomography accuracy in colon cancer is adequate to differentiate advanced tumors. However, its ability to discriminate between T3 and T4, N (+) and the low agreement between radiologists suggests the need for complementary imaging techniques.

Lesión osteocondral extensa de cóndilo femoral; tratamiento en un tiempo con matriz colágena y concentrado de médula ósea: reporte de un caso / Big osteochondral lesion; treatment with collagen scaffold and bone marrow concentrate: case report

El tratamiento de las lesiones osteocondrales de gran tamaño y profundidad resultan un desafío debido a que las técnicas habituales (microfractura o transplante osteocondral autólogo), son insuficientes para cubrir el defecto; eso es particularmente importante en pacientes jóvenes, pues se debe intentar técnicas que generen la menor comorbilidad posible. Presentamos un caso de un paciente de 18 años con una lesión osteocondral de 6 cm2 por 14 mm de profundidad, tratado mediante autoinjerto óseo, concentrado de médula ósea y matriz colágena, con resultados satisfactorios tanto en lo funcional como en lo imagenológico. Esa técnica presenta la ventaja de realizarse en un tiempo y con una fuente de células troncales mesenquimáticas (Médula ósea), validada en la literatura y altamente reproducible.

The treatment of large osteochondral defects represent a challenge, because the common techniques used (micro fracture or osteochondral autologous transplantation) are insufficient to cover the defect; this is particularly important in young patients where we expect the least comorbidity. We report a case of an 18-year-old patient with an ostechondral injury of 6 cm2 and 14 mm deep, treated with bone autograft, bone marrow concentrate and a matrix of collagen with satisfactory functional and images results. This technique has the advantage to be performed in one single time and with a source of mesenchymal stem cells (bone marrow) validated in the literature.

Diabetes-accelerated experimental osteoarthritis is prevented by autophagy activation.

OBJECTIVE: Type 2 Diabetes (T2D) is a risk factor for osteoarthritis (OA). Autophagy, an essential homeostasis mechanism in articular cartilage, is defective in T2D and OA. However, how T2D may influence OA progression is still unknown. We aimed to determine how diabetes affects cartilage integrity and whether pharmacological activation of autophagy has efficacy in diabetic mice (db/db mice) with OA. DESIGN: Experimental OA was performed in the right knee of 9 weeks-old C57Bl/6J male mice (Lean group, N = 8) and of 9 weeks-old B6.BKS (D)-Leprdb male mice (db/db group, N = 16) by transection of medial meniscotibial and medial collateral ligaments. Left knee was employed as control knee. Rapamycin (2 mg/kg weight/day) or Vehicle (dimethyl sulfoxide) were administered intraperitoneally three times a week for 10 weeks. Histopathology of articular cartilage and synovium was evaluated by using semiquantitative scoring and synovitis grading systems, respectively. Immunohistochemistry was employed to evaluate the effect of diabetes and Rapamycin on cartilage integrity and OA biomarkers. RESULTS: Cartilage damage was increased in db/db mice compared to Lean mice after experimental OA, while no differences are observed in the control knee. Cartilage damage and synovium inflammation were reduced by Rapamycin treatment of OA-db/db mice. This protection was accompanied with a decrease in MMP-13 expression and decreased interleukin 12 (IL-12) levels. Furthermore, autophagy was increased and cartilage cellularity was maintained, suggesting that mammalian target of rapamycin (mTOR) targeting prevents joint physical harm. CONCLUSION: Our findings indicate that diabetic mice exhibit increased joint damage after experimental OA, and that autophagy activation might be an effective therapy for diabetes-accelerated OA.

Insulin decreases autophagy and leads to cartilage degradation.

OBJECTIVE: Autophagy, a key homeostasis mechanism, is defective in Osteoarthritis (OA) and Type 2 Diabetes (T2D). T2D has been proposed as a risk factor for OA. We hypothesized that diabetes impairs articular cartilage integrity by decreasing autophagy. Our objective was to investigate the effects of high glucose and insulin, characteristics of T2D, on cartilage homeostasis. METHODS: Immortalized human chondrocytes (TC28a2) and primary human chondrocytes (HC) were cultured in 25 mM or 0 mM glucose and treated with insulin (10, 100, 500 nM) for 2, 6 or 24 h. Activity of LC3-II, Akt and rpS6 was evaluated by Western blotting (WB). Human cartilage explants were cultivated with 25 mM glucose and insulin (100,1000 nM) for 24 h to evaluate histopathology. MMP-13 and IL-1ß expression was determined by immunohistochemistry and WB. Effects of Rapamycin (10 µM) were analyzed by WB. LC3 and rpS6 expression was determined by WB in chondrocytes from Healthy, Non Diabetic-OA and Diabetic-OA patients. RESULTS: Insulin downregulates autophagy by reducing LC3 II expression and increasing Akt and rpS6 phosphorylation. Loss of proteoglycans and increased MMP-13 and IL-1ß expression was observed after insulin treatment. Autophagy activation by rapamycin reversed insulin effects. Importantly, chondrocytes from diabetic-OA patients showed decreased LC3 and increased p-rpS6 expression compared to Healthy and Non-Diabetic OA patients. CONCLUSIONS: These results suggest that decreased autophagy might be a mechanism by which diabetes influences cartilage degradation. Pharmacological activation of autophagy may be an effective therapeutic approach to prevent T2D-induced cartilage damage.

Synthesis of Culn(1-x)Ga(x)Se2 Nanoparticles by Thermal Decomposition Method with Tunable Ga Content.

Chalcopyrite Culn(1-x)Ga(x)Se2 (CIGS) nanoparticles were synthesized by mixing copper (I) chloride (CuCl), Indium (III) chloride (InCl3), gallium (III) chloride (GaCl3) and selenium (Se) in oleylamine (OLA) at 260 degrees C for 4 h under nitrogen atmosphere. The Ga/(In+ Ga) ratio was tuned across the entire stoichiometric range from 0 to 1. X-ray diffraction analysis (XRD) revealed chalcopyrite crystal structure for samples prepared with x = 0, 0.3, 0.5, 0.7 and 1. The lattice parameters a and c decreased linearly with increasing Ga concentration which is consistent with Vegard's law. Raman spectra exhibited A, optical phonon vibrational mode for synthesized nanoparticles which gradually shifted to higher wavenumber with increasing Ga content. Field emission scanning electron microscopy (FE-SEM) and transmission electron microscopy (TEM) images showed irregular as well as hexagonal plate like morphologies in the size range of 100 to 400 nm. High-resolution transmission electron microscopy (HR-TEM) images showed well-defined lattice fringes and d-spacing correspond to (112) plane which gradually decreases with increasing Ga content. The material compositions of synthesized CIGS nanoparticles with x = 0, 0.3, 0.5, 0.7 and 1 were very close to the desired stoichiometry which was confirmed by energy dispersive X-ray analysis (EDAX). Ultraviolet visible near infrared (UV-VIS-NIR) absorption spectra of the synthesized CIGS nanoparticles revealed that the bandgap could be tuned over the range 1 to 1.7 eV by varying the Ga/(In+Ga) ratio.

Synthesis and Characterization of Cadmium Sulfide Nanoparticles by Chemical Precipitation Method.

Cadmium sulfide (CdS) nanoparticles were synthesized by chemical precipitation method using cadmium chloride (CdCl2), sodium sulfide (Na2S) and water as a solvent by varying temperatures from 20-80 degrees C. The nanoparticles were characterized by X-ray diffraction (XRD), Raman spectroscopy, field emission scanning electron microscopy (FE-SEM), energy dispersive spectroscopy (EDS), High-resolution transmission electron microscopy (HR-TEM) and UV-Visible spectroscopy. XRD pattern revealed cubic crystal structure for all the synthesized CdS nanoparticles. Raman spectra showed first and second order longitudinal optical (LO) phonon vibrational modes of CdS. The size of CdS nanoparticles was found to be in the range of 15-80 nm by FE-SEM analysis, in all cases. The atomic percentage of cadmium and sulfur was confirmed to be 1:1 from EDS analysis. TEM micrograph depicts the spherical shape of the particles and the size is in the range of 15-85 nm while HR-TEM images of CdS nanoparticles exhibit well-resolved lattice fringes of the cubic structure of CdS. The optical properties of CdS were examined by UV-Visible spectroscopy which showed variation in absorption band from 460-480 nm. The band gap was calculated from the absorption edge and found to be in the range of 3.2-3.5 eV which is greater than the bulk CdS.

Reconstrucción anatómica de ligamento cruzado anterior con banda simple a través del uso de un portal medial accesorio: resultados clínicos e imagenológicos en seguimiento a mediano plazo / Anatomic anterior cruciate ligament reconstruction with single band through an accessory medial portal

Objetivo: Evaluar los resultados clínicos de la reconstrucción anatómica de Ligamento Cruzado Anterior (LCA) con una banda a través de un portal medial accesorio. Material y método: serie prospectiva, 52 pacientes con reconstrucción anatómica de LCA a través de un portal medial accesorio. Edad promedio: 26,4 años (15-39), 68 por ciento hombres, 32 por ciento mujeres. Seguimiento promedio: 39 meses (36-53). Evaluación de estabilidad anteroposterior mediante la prueba artrométrica KT-1000 y estabilidad rotacional con test de Pivot-shift. Resultados clínicos evaluados con scores de Lysholm e International Knee Documentation Committee Score (IKDC). Se solicitó resonancia magnética (RM) 6 meses post-reconstrucción para evaluar la madurez e incorporación del injerto. También se registraron las complicaciones. Resultados: diferencia promedio de KT-1000 entre ambas rodillas: 2,09 mm, 92,4 por ciento de los pacientes entre 1-3 mm, 3,8 por ciento entre 3-5 mm, y 3,8 por ciento con más de 5 mm. Pivot Shift negativo en 86,5 por ciento y presente en 13,5 por ciento de los pacientes. IKDC promedio: 89,2 puntos, Lysholm promedio: 93,8 puntos. Integración del injerto en RM: 100 por ciento de los pacientes. 3 pacientes (5,8 por ciento) presentaron una re-rotura del injerto (20 meses promedio) y 1 paciente (1,9 por ciento) presentó una lesión condral femoral sintomática (12 meses). Discusión y Conclusiones: nuestro estudio muestra buenos y excelentes resultados para la reconstrucción anatómica de LCA con banda simple con respecto a estabilidad anterior y rotacional, scores clínicos e integración del injerto. Nuestra tasa de re-roturas es similar a las tasas descritas en la literatura para reconstrucciones transtibiales, lo que podría explicarse por otros factores involucrados en este proceso independientes de la posición del injerto. Nivel de evidencia: III. Tipo de estudio: Estudio de cohorte prospectivo

Introduction: The aim of this study was to evaluate the clinical results of anatomic single bundle anterior cruciate ligament (ACL) reconstruction through an accessory medial portal. Methods: prospective case series. Fifty-two patients undergoing arthroscopic hamstring ACL reconstruction through an accessory medial portal were prospectively studied. Mean age: 26,4 years (15-39) Men: 68% Female: 32%. Average follow-up: 39 months. (36-53) Anteroposterior stability was assessed by using KT-1000 arthrometer. Rotational stability was determined by Lateral Pivot-Shift test. Clinical results were asses by International Knee Documentation Committee (IKDC) and Lysholm scores. Magnetic Resonance Imaging (MRI) was taken at 6 months post-operatively to evaluate graft maturation and incorporation. Results: the average KT-1000 side-to-side difference was 2,09 mm with 92,4% between 1-3 mm, 3,8% between 3-5 mm and 3,8% more than 5 mm. Pivot-Shift test was negative in 86,5% and positive in 13,5% of the patients. IKDC mean score: 89,2; Lysholm mean score: 93,8. Graft integration at MRI: 100% of the patients. 3 patients (5,8%) had an ACL re-rupture (mean 20 months) and 1 patient (1,9%) presented a symptomatic femoral chondral lesion (12 months). Discussion and conclusion: our study shows good and excellent results in anterior and rotational stability as well as IKDC, and Lysholm scores and Graft integration measured by MRI for the anatomic single bundle ACL reconstruction. Re-rupture rate is similar to series with transtibial non-anatomic technique; this is probably due to other factors that do not include the position of the graft. Level of evidence: III. Type of study: Prospective cohort study

Reconstrucción anatómica de ligamento cruzado anterior con banda simple a través del uso de un portal medial accesorio: resultados clínicos e imagenológicos en seguimiento a mediano plazo / Anatomic anterior cruciate ligament reconstruction with single band through an accessory medial portal

Objetivo: Evaluar los resultados clínicos de la reconstrucción anatómica de Ligamento Cruzado Anterior (LCA) con una banda a través de un portal medial accesorio. Material y método: serie prospectiva, 52 pacientes con reconstrucción anatómica de LCA a través de un portal medial accesorio. Edad promedio: 26,4 años (15-39), 68 por ciento hombres, 32 por ciento mujeres. Seguimiento promedio: 39 meses (36-53). Evaluación de estabilidad anteroposterior mediante la prueba artrométrica KT-1000 y estabilidad rotacional con test de Pivot-shift. Resultados clínicos evaluados con scores de Lysholm e International Knee Documentation Committee Score (IKDC). Se solicitó resonancia magnética (RM) 6 meses post-reconstrucción para evaluar la madurez e incorporación del injerto. También se registraron las complicaciones. Resultados: diferencia promedio de KT-1000 entre ambas rodillas: 2,09 mm, 92,4 por ciento de los pacientes entre 1-3 mm, 3,8 por ciento entre 3-5 mm, y 3,8 por ciento con más de 5 mm. Pivot Shift negativo en 86,5 por ciento y presente en 13,5 por ciento de los pacientes. IKDC promedio: 89,2 puntos, Lysholm promedio: 93,8 puntos. Integración del injerto en RM: 100 por ciento de los pacientes. 3 pacientes (5,8 por ciento) presentaron una re-rotura del injerto (20 meses promedio) y 1 paciente (1,9 por ciento) presentó una lesión condral femoral sintomática (12 meses). Discusión y Conclusiones: nuestro estudio muestra buenos y excelentes resultados para la reconstrucción anatómica de LCA con banda simple con respecto a estabilidad anterior y rotacional, scores clínicos e integración del injerto. Nuestra tasa de re-roturas es similar a las tasas descritas en la literatura para reconstrucciones transtibiales, lo que podría explicarse por otros factores involucrados en este proceso independientes de la posición del injerto. Nivel de evidencia: III. Tipo de estudio: Estudio de cohorte prospectivo (AU)

Introduction: The aim of this study was to evaluate the clinical results of anatomic single bundle anterior cruciate ligament (ACL) reconstruction through an accessory medial portal. Methods: prospective case series. Fifty-two patients undergoing arthroscopic hamstring ACL reconstruction through an accessory medial portal were prospectively studied. Mean age: 26,4 years (15-39) Men: 68% Female: 32%. Average follow-up: 39 months. (36-53) Anteroposterior stability was assessed by using KT-1000 arthrometer. Rotational stability was determined by Lateral Pivot-Shift test. Clinical results were asses by International Knee Documentation Committee (IKDC) and Lysholm scores. Magnetic Resonance Imaging (MRI) was taken at 6 months post-operatively to evaluate graft maturation and incorporation. Results: the average KT-1000 side-to-side difference was 2,09 mm with 92,4% between 1-3 mm, 3,8% between 3-5 mm and 3,8% more than 5 mm. Pivot-Shift test was negative in 86,5% and positive in 13,5% of the patients. IKDC mean score: 89,2; Lysholm mean score: 93,8. Graft integration at MRI: 100% of the patients. 3 patients (5,8%) had an ACL re-rupture (mean 20 months) and 1 patient (1,9%) presented a symptomatic femoral chondral lesion (12 months). Discussion and conclusion: our study shows good and excellent results in anterior and rotational stability as well as IKDC, and Lysholm scores and Graft integration measured by MRI for the anatomic single bundle ACL reconstruction. Re-rupture rate is similar to series with transtibial non-anatomic technique; this is probably due to other factors that do not include the position of the graft. Level of evidence: III. Type of study: Prospective cohort study (AU)

Efficacy of IgE-targeted vs empiric six-food elimination diets for adult eosinophilic oesophagitis.

BACKGROUND: Skin testing-guided elimination diet has proved unsuccessful for adult eosinophilic oesophagitis (EoE), whereas empiric six-food elimination diet (SFED) achieves an efficacy of 70%. OBJECTIVE: To compare the efficacy of food-specific serum IgE-targeted elimination diet (sIgE-ED) and SFED. METHODS: Prospective study in adult patients with EoE. Food-specific serum IgE, skin prick test (SPT) and atopy patch test (APT) to foods included in SFED were performed. Those with ≥1 positive IgE test, defined by ≥0.1 kU/l, followed a 6-week sIgE-ED, whereas non-IgE-sensitized patients underwent a 6-week SFED. Responders to diet (<15 eos/HPF) underwent individual reintroduction of foods followed by histological assessment. RESULTS: Forty-three EoE patients were included (26 sIgE-ED and 17 SFED). Regarding sIgE-ED, the mean number of eliminated foods per patient was significantly lower than in SFED (3.81 vs 6; P < 0.001), being wheat (85%), nuts (73%) and cow's milk (61%) the most commonly foods withdrawn. No difference in histological response was observed between sIgE-ED and SFED (73% vs 53%, P = 0.17). Causative foods identified by food challenge were cow's milk (64%), wheat (28%), egg (21%) and legumes (7%), with a single food trigger in 71% of patients. sIgE exhibited the higher accuracy to predict offending foods in IgE-sensitized patients (sensitivity 87.5%, specificity 68% (κ = 0.43)), with k values of 1 for cow's milk. APT results were all negative. CONCLUSIONS: Histological remission was accomplished in 73% of patients undergoing sIgE-ED, which was nonsignificantly superior to SFED. sIgE effectively identified cow's milk as a food trigger in IgE-sensitized patients.

Reconstrucción anatómica de ligamento cruzado anterior utilizando técnica de retroconstrucción con FlipCutter / Anatomic reconstruction of anterior cruciate ligament with FlipCutter retroconstruction technique

El posicionamiento anatómico de los túneles en cirugía de ligamento cruzado anterior, ha sido sugerido como una estrategia para reducir la inestabilidad rotacional y por tanto la artrosis futura. Las técnicas más comunes utilizadas para posicionar el túnel femoral son: la técnica transtibial y la técnica de portal anteromedial. Ha sido reportado que un posicionamiento anatómico del túnel femoral es imposible mediante la técnica transtibial, incluso con modificaciones. Por otra parte, la técnica de portal anteromedial si bien logra un posicionamiento más anatómico del túnel femoral, puede resultar en un túnel más corto, además de la posibilidad de causar daño al cartílago articular del cóndilo femoral medial durante el proceso de realización de este; y por último, existe el riesgo de dañar las estructuras neurovasculares al pasar las guías y brocas de medial a lateral. En un esfuerzo por ir mejorando las técnicas quirúrgicas disponibles, se ha desarrollado la técnica de túnel femoral retrogrado o retroconstrucción, la cual lograría posicionar un túnel femoral anatómico evitando las complicaciones de la técnica de portal anteromedial. En este artículo, presentaremos la técnica de Retroconstrucción de LCA con autoinjerto semitendinoso-gracillis, utilizando el instrumental FlipCutterTM (Arthrex Inc, Naples) con método de fijación femoral suspensorio Tight RopeTM (Arthrex Inc, Naples) y fijación tibial con tornillo interferencial BiocompositeTM (Arthrex Inc, Naples).

The anatomical positioning of tunnels in Anterior Cruciate Ligament (ACL) surgery has been suggested as a strategy to reduce rotational instability and osteoarthritis. Usual techniques used to make the femoral tunnel are the transtibial technique and the anteromedial portal technique. It has been reported that it is impossible to make an anatomical femoral tunnel using the transtibial technique, even with variations. Furthemore, the anteromedial portal technique can locate a more anatomical tunnel but has complications like short tunnel, damage to the medial femoral condyle and risks for the lateral neurovascular bundle. In an effort to improve our capacity of positioning an anatomical femoral tunnel with less complications, the retroconstruction technique has been developed. In this article we present the ACL retroconstruction technique using autologous semitendinous-gracillis graft with FlipCutterTM (Arthrex Inc, Naples).

Uso del plasma rico en plaquetas en cirugía ligamentosa de rodilla / Use of platelet rich plasma in knee ligament surgery

Platelet Rich Plasma (PRP) is used in musculoskeletal lesion surgery, including muscle, bone, tendons and ligaments. PRP might accelerate the healing process and the integration of the graft, allowing an earlier return to sports activities of patients. PRP is obtained from autologous blood, which is centrifuged, obtaining platelet and supposedly growth factor concentrations three to five times higher than those of regular blood. The clinical results of studies performed in Chile and elsewhere on PRP use in knee anterior cruciate ligament (ACL) reconstruction have been variable. Therefore, there is not enough evidence to support or deny the usefulness of PRP in ACL reconstructions.

[Use of platelet rich plasma in knee ligament surgery]. / Uso del plasma rico en plaquetas en cirugía ligamentosa de rodilla.

Platelet Rich Plasma (PRP) is used in musculoskeletal lesion surgery, including muscle, bone, tendons and ligaments. PRP might accelerate the healing process and the integration of the graft, allowing an earlier return to sports activities of patients. PRP is obtained from autologous blood, which is centrifuged, obtaining platelet and supposedly growth factor concentrations three to five times higher than those of regular blood. The clinical results of studies performed in Chile and elsewhere on PRP use in knee anterior cruciate ligament (ACL) reconstruction have been variable. Therefore, there is not enough evidence to support or deny the usefulness of PRP in ACL reconstructions.

Resultado neonatal e infantil de niños con y sin transfusión intrauterina por isoinmunización Rh durante el embarazo / Neonatal outcome of children with and without intrauterine transfusion for Rh isoimmunization during pregnancy

Objetivo: Comparar la morbilidad neonatal y a seis meses de vida de hijos de pacientes con isoinmunización Rh que recibieron al menos una transfusión intrauterina (TIU), con aquellos que no la requirieron. Método: Estudio de caso y control de pacientes con diagnóstico de isoinmunización Rh controladas en la Unidad de Medicina Fetal del Hospital Clínico Universidad de Chile. Se comparó el resultado perinatal y hasta 6 meses de vida de recién nacidos (RN) con TIU (9 casos) y sin TIU (14 casos) entre los años 2004 y 2009. Resultados: Aunque la sobrevida a los 6 meses de los fetos con TIU fue alrededor de un 80 por ciento, solo una muerte puede atribuirse a la severidad de su condición de base. Los RN con TIU nacieron a una menor edad gestacional que los que no requirieron este tratamiento (34,4 +/- 2,2 sem vs. 37,4 +/- 0,6 sem; p=0,003). Al evaluar el manejo neonatal inmediato se observa que el 60 por ciento de los RN isoinmunizados sin TIU requirieron ser hospitalizados y requirieron fototerapia, mientras que todos los RN con antecedente de TIU fueron hospitalizados, recibieron fototerapia y 30 por ciento requirió una exanguineo transfusión. A los 6 meses de vida, 75 por ciento y 20 por ciento de los RN isoinmunizados, con y sin TIU, fueron hospitalizados para una nueva transfusión de GR y/o fototerapia, respectivamente. Conclusión: La isoinmunización Rh es una patología de alto riesgo, pero la terapia intrauterina, en los casos con anemia moderada y severa, permite llegar a edades gestacionales que dan una adecuada sobrevida.

Objective: To compare neonatal and six months of life morbidity of babies affected by Rh isoimmunization during pregnancy that required at least one intrauterine blood transfusion, with babies that did not required that procedure. Methods: Case control study of patients with diagnosis of Rh isoimmunization under control in the Fetal Medicine Unit at the University of Chile Hospital. Perinatal and until 6 months of life outcomes of isoimmunized newborns (NB) with (9 cases) and without intrauterine transfusion (IUT) (14 cases) between years 2004 and 2009 were compared. Results: Although six months of life survival of IUT babies was about 80 percent only one death was related to the severity of isoimmunization. Isoimmunized babies with IUT were delivered at a lower gestational age than those without IUT (34.4 +/- 2.2 vs. 37.4 +/- 0.6 weeks; p=0.003). At the immediate neonatal period only 60 percent of isoimmunized babies without IUT required hospitalization and phototherapy, in contrast to IUT babies where all of them were hospitalized and required phototherapy, and 30 percent required exchange transfusion. Until six months of life, 75 percent and 20 percent of NB with and without IUT required another hospitalization for a new transfusion and/or phototherapy respectively. Conclusion: Rh isoimmunization is a high risk disease, but intrauterine therapy in cases with moderate and severe fetal anemia increases gestational age at delivery with good survival rates.

Factores predictivos de éxito tras una sesión única de litotricia extracorpórea de cálculos urinarios a las tres semanas de seguimiento / Single-Session Extracorporeal Shock Wave Lithotripsy for Urinary Calculi: Factors Predicting Success after Three Weeks of Follow-Up

Objetivo: Identificar factores predictivos de éxito después de una sesión única de litotricia extracorpórea por ondas de choque (LEOC) a las tres semanas de seguimiento. Material y métodos: Se revisaron los registros clínicos de 116 pacientes con cálculos urinarios únicos sometidos a LEOC entre octubre 2007 y agosto 2009. Las tomografías axiales computarizadas preoperatorias de todos los pacientes fueron revisadas por dos radiólogos en desconocimiento del desenlace clínico. El éxito fue definido como la desaparición completa del cálculo o la persistencia de fragmentos ≤ 2mm en la radiografía simple realizada durante las tres primeras semanas de seguimiento. El impacto de factores clínicos y radiológicos fue evaluado utilizando regresión logística. Resultados: La tasa de éxito de LEOC a las tres semanas de seguimiento fue del 49,1%. Tamaño < 8mm, área del cálculo < 30mm2, localización en el uréter distal, densidad < 1.000 UH y fragmentación intraoperatoria demostraron una significativa asociación con éxito en el análisis univariado (p<0,05). Área del cálculo<30mm2 (OR: 2,9), localización en uréter distal (OR: 3,4) y fragmentación intraoperatoria (OR: 4,2) fueron factores predictivos de éxito en el análisis multivariado (p<0,05). Conclusiones: El área del cálculo y la localización en el uréter distal son útiles en el momento de decidir acerca de la realización de una LEOC. Sin embargo, la resolución exitosa de solamente la mitad de los casos bajo los criterios evaluados recalca la relevancia de informar al paciente de la eventual necesidad de tratamientos adicionales después de una sesión única de LEOC (AU)

Introduction: The aim of this study was to identify predictive factors of success following a single-session of shock wave lithotripsy (SWL) at 3 weeks of follow-up in our center. Material and methods: The medical records of 116 patients with solitary urinary calculi who underwent single-session SWL in our department between October 2007 and August 2009 were reviewed. All preoperative unenhanced computed axial tomographies were reviewed by two radiologists blinded to clinical outcome. Success was defined as complete clearance or the persistence of fragments ≤ 2mm on a plain film at 3 weeks of follow-up. The impact of clinical and radiological factors on success was assessed by univariate and multivariate analyses. Results: The single-session SWL success rate at 3 weeks was 49.1%. Stone size <8mm, stone area < 30mm2, stone location (mid- and distal ureter), stone density <1000 HU and intraoperative fragmentation showed a significant association with SWL success in the univariate analysis (p<0.05). Stone area (OR 2.9), ureteral stone location (OR 3.4) and intraoperative fragmentation (OR 4.2) were the only predictors of success in the multivariate analysis. Conclusions: Stone area and ureteral stone location provide important information when deciding about the indication of a SWL in a patient with stone disease. However, successful resolution of only half of the cases after a single session at 3 weeks in our series undermines the relevance of informing patients about the potential need for additional treatment (AU)

Poverty, folate deficiency, human immunodeficiency virus and ulcerated vulval sexually transmitted diseases in Jamaica.

Sexually transmitted genital ulcerative conditions are declining in Jamaica. The rates at present are far lower than that seen in the 1950s-1960s. Review of the records of the national Comprehensive Clinic has revealed that all of the major sexually transmitted conditions (Syphilis, Lymphogranuloma Venereum (LGV), Chancroid, Granuloma Inguinale and Herpes Simplex) have declined but have had three peaks between 1958 and 2000. Closer review seems to suggest that the peaks were associated firstly with poverty in the 1960s and 1970s and to the HIV epidemic in the 1980s and early 1990s. There are also smaller spikes which appear to be associated with periods of environmental disasters, with a possible association with folate deficiency. This is apparent for the bacterial and chlamydial conditions as well as viral conditions such as Herpes simplex.

[Single-session extracorporeal shock wave lithotripsy for urinary calculi: factors predicting success after three weeks of follow-up]. / Factores predictivos de éxito tras una sesión única de litotricia extracorpórea de cálculos urinarios a las tres semanas de seguimiento.

INTRODUCTION: The aim of this study was to identify predictive factors of success following a single-session of shock wave lithotripsy (SWL) at 3 weeks of follow-up in our center. MATERIAL AND METHODS: The medical records of 116 patients with solitary urinary calculi who underwent single-session SWL in our department between October 2007 and August 2009 were reviewed. All preoperative unenhanced computed axial tomographies were reviewed by two radiologists blinded to clinical outcome. Success was defined as complete clearance or the persistence of fragments ≤ 2 mm on a plain film at 3 weeks of follow-up. The impact of clinical and radiological factors on success was assessed by univariate and multivariate analyses. RESULTS: The single-session SWL success rate at 3 weeks was 49.1%. Stone size <8 mm, stone area < 30 mm(2), stone location (mid- and distal ureter), stone density <1000 HU and intraoperative fragmentation showed a significant association with SWL success in the univariate analysis (p<0.05). Stone area (OR 2.9), ureteral stone location (OR 3.4) and intraoperative fragmentation (OR 4.2) were the only predictors of success in the multivariate analysis. CONCLUSIONS: Stone area and ureteral stone location provide important information when deciding about the indication of a SWL in a patient with stone disease. However, successful resolution of only half of the cases after a single session at 3 weeks in our series undermines the relevance of informing patients about the potential need for additional treatment.

Poverty, folate deficiency, human immunodeficiency virus and ulcerated vulval sexually transmitted diseases in Jamaica / Pobreza, deficiencia de ácido fólico, virus de la inmunodeficiencia humana, y la ulceratión de la vulva por enfermedades de transmisión sexual, en Jamaica

Sexually transmitted genital ulcerative conditions are declining in Jamaica. The rates at present are far lower than that seen in the 1950s -1960s. Review of the records of the national Comprehensive Clinic has revealed that all of the major sexually transmitted conditions (Syphilis, Lymphogranuloma Venereum (LGV), Chancroid, Granuloma Inguinale and Herpes Simplex) have declined but have had three peaks between 1958 and 2000. Closer review seems to suggest that the peaks were associated firstly with poverty in the 1960s and 1970s and to the HIV epidemic in the 1980s and early 1990s. There are also smaller spikes which appear to be associated with periods of environmental disasters, with a possible association with folate deficiency. This is apparent for the bacterial and chlamydial conditions as well as viral conditions such as Herpes simplex.

Las condiciones ulcerativas genitales transmitidas sexualmente están disminuyendo en Jamaica. En el presente, los índices son muchos más bajos que los observados en la década de 1950 y 1960 respectivamente. La revisión de los archivos de la llamada Nacional Comprehensive Clinic ha revelado que todas las condiciones principales (sífilis, linfogranuloma venéreo, chancroide, granuloma inguinal, y el herpes simple) han disminuido. No obstante, ha habido tres puntos críticos entre 1958 y 2000. Un examen detallado sugiere que estos picos estaban asociados primeramente con la pobreza en los años 60 y 70, y la epidemia de VIH en la década de los 80 ochenta y principios de los 90. Hay también pequeñas alzas que parecen estar asociados con periodos de desastres medioambientales, así como con una posible asociación con la deficiencia de folato. Esto es evidente en el caso de las condiciones bacterianas y clamidiales, así como las condiciones virales tales como la que representa el herpes simple.

Apheresis days required for harvesting CD34+ cells predicts hematopoietic recovery and survival following autologous transplantation.

We sought to determine whether patients requiring more aphereses to obtain adequate numbers of CD34+ cells had delayed hematopoietic recovery following autologous transplantation. We identified 496 consecutive individuals with lymphoma who underwent hematopoietic stem cell mobilization using etoposide and G-CSF and first autologous transplantation. In multivariate analysis, increased apheresis days as a continuous and as a categorical variable at ≥5/<5 days significantly predicted neutrophil recovery. Apheresis days fell just short of significance (P=0.06) as a predictor of platelet recovery in multivariate analysis. Increased apheresis days (as both continuous and categorical variables) were also predictive of treatment-related myelodysplastic syndrome/AML. Patients who underwent ≥5 days of pheresis had significantly worse survival (P=0.001) than patients with less pheresis days owing to significantly higher relapse mortality (P=0.001).