Determination of herbicides, including thermally labile phenylureas, by solid-phase microextraction and gas chromatography-mass spectrometry.

A method for the determination of 10 herbicides, including thermally unstable compounds, has been developed. The method uses solid-phase microextraction (SPME) with a polyacrylate fibre. Separation, identification and quantification were accomplished with gas chromatography-mass spectrometry. The herbicides chosen belong to different chemical groups and were alachlor, atrazine, chlorotoluron, diclofop, diflufenicam, ethofumesate, isoproturon, linuron, terbutryn and trifluralin. In the present work we studied the chromatographic behaviour of three phenylureas as a function of the medium and injection mode employed. The compounds generated as a function of the solvent used in direct injection of the phenylureas (ethyl acetate, methanol and methanol-water) and those obtained when injection was accomplished using the polyacrylate fibre were determined. The results allow us to propose a method for the determination of stable and thermally unstable herbicides as long as a preconcentration step involving SPME is carried out. In the proposed method, the limits of detection varied between 0.02 microg/l for ethofumesate and 0.11 microg/l for chlorotoluron. The method was applied to the determination of these herbicides in surface and ground water samples, performing quantification by standard addition calibration. The contents of chlorotoluron and atrazine found were significantly equal to those obtained using HPLC after a preconcentration stepwith styrene-divinylbenzene sorbents.

Hemangiopericitoma nasosinusal / Sinonasal hemangiopericytoma

El hemangiopericitoma es un tumor vascular infrecuente a nivel nasal, que produce epistaxis y clínica obstructiva respiratoria como principales síntomas. Tiene a nivel nasal características clínicas especiales que lo diferencian de los de otras localizaciones. Presentamos un caso de hemangiopericitoma nasosinusal con apariencia polipoidea y tratado mediante cirugía endoscópica nasosinusal, con remisión completa y controles continuos sin observar recidiva. Revisamos la bibliografía y comentamos sus principales características (AU)

The hemangiopericytoma is an infrequent vascular tumour in the nose, that produces epistaxis and obstructive respiratory clinical like principal symptoms. It has, in the nose, special clinical characteristics that makes it different of the others localitations. We report a case of nasosinusal hemangiopericytoma with appearance of polyposis and treated with nasosinusal endoscopic surgery; after that, the patient had a complete remission and subsequent follow-up without recurrence. We review the literature and study the most important characteristics (AU)

Are twelve days of omeprazole, amoxicillin and clarithromycin better than six days for treating H. pylori infection in peptic ulcer and in non-ulcer dyspepsia?

BACKGROUND/AIMS: To evaluate whether omeprazole, amoxicillin and clarithromycin for 12 days is more effective for Helicobacter pylori eradication than the same regimen for only 6 days; and to verify whether these eradication regimens are more effective in peptic ulcer disease than in non-ulcer dyspepsia. METHODOLOGY: We studied 411 patients in whom a gastroscopy was carried out due to symptoms related to the upper gastrointestinal tract and who were diagnosed with duodenal ulcer (175 patients, 43%), gastric ulcer (42 patients, 10%), or non-ulcer dyspepsia (194 patients, 47%), and concomitant infection by H. pylori. At endoscopy, biopsies were obtained for rapid urease test, and a 13C-urea breath test was carried out. Urea breath test was repeated four weeks after completing eradication treatment with 1) omeprazole (20 mg b.i.d.), amoxicillin (1 g b.i.d.) and clarithromycin (500 mg b.i.d.) for six days (239 patients), or 2) the same regimen for 12 days (172 patients). RESULTS: H. pylori eradication was achieved in 73.6% (95% CI, 68-79%) of the patients treated during 6 days, and in 84.3% (79-90%) of those receiving 12 days of therapy (P < 0.01). The overall eradication rate with both regimens (6 plus 12 days), respectively in patients with duodenal ulcer, gastric ulcer and non-ulcer dyspepsia, was 84.6% (79-90%), 75.6% (61-86%), and 72.8% (67-79%) (P < 0.01 when comparing duodenal ulcer vs. non-ulcer dyspepsia). Twelve-day regimen was more effective than 6-day regimen only in non-ulcer dyspepsia (62% vs. 83%, P < 0.01), but not in duodenal or gastric ulcer. In the multivariate analysis the duration (6 vs. 12 days) of eradication therapy (odds ratio: 2.2; 1.3-3.7) and the type of disease (duodenal ulcer vs. non-ulcer dyspepsia; odds ratio: 2.3; 1.3-3.8) were the only variables which influenced on H. pylori eradication efficacy (chi 2 model, 17; P < 0.001). CONCLUSIONS: Efficacy with omeprazole-amoxicillin-clarithromycin regimen in patients with duodenal ulcer is higher than in those patients with non-ulcer dyspepsia. The increase of H. pylori eradication rate by 21% in our non-ulcer dyspepsia patients justifies the prolongation from 6 to 12 days of omeprazole-amoxicillin-clarithromycin therapy, whilst the increase of cure rates in duodenal or gastric ulcer patients with a 12-day therapy would not be cost-effective.

[Sinonasal hemangiopericytoma]. / Hemangiopericitoma nasosinusal.

The hemangiopericytoma is an infrequent vascular tumour in the nose, that produces epistaxis and obstructive respiratory clinical like principal symptoms. It has, in the nose, special clinical characteristics that makes it different of the others localitations. We report a case of nasosinusal hemangiopericytoma with appearance of polyposis and treated with nasosinusal endoscopic surgery; after that, the patient had a complete remission and subsequent follow-up without recurrence. We review the literature and study the most important characteristics.

6-mercaptopurine or methotrexate added to prednisone induces and maintains remission in steroid-dependent inflammatory bowel disease.

BACKGROUND: As treatment of steroid-dependent patients with inflammatory bowel disease (IBD) is controversial, we analysed the efficacy and tolerance of 6-mercaptopurine (6-MP) and methotrexate (MTX) added to prednisone in increasing and maintaining the disease remission rate. METHODS: Seventy-two steroid-dependent IBD patients, 34 with ulcerative colitis (UC) and 38 with Crohn's disease (CD), receiving treatment with prednisone were randomly assigned in a 2:2:1 ratio to additionally receive, orally, over a period of 30 weeks 1.5 mg/kg/day of 6-MP (group A) or 15 mg/week of MTX (group B), or 3 g/day of 5-aminosalicylic acid (5-ASA) (group C). All patients who achieved remission were included in a maintaining remission study for 76 weeks. Remission was defined after stopping prednisone as a CD activity index of <150 and normal serum orosomucoid concentration for CD patients and a Mayo Clinic score <7 for UC patients. RESULTS: With regard to achieved remission, a significantly higher (P< 0.05) rate existed for UC patients in group A (78.6%) than in group C (25%), with no statistical differences in group B (58.3%) versus C. For CD patients, the rates were significantly higher (P< 0.001 and 0.01, respectively) in groups A (93.7%) and B (80%) versus C (14%). With regard to maintaining remission, UC patients in group A (63.6%) presented significantly higher rates (P < 0.0015 and P < 0.001, respectively) versus 14.3% in group B and none in group C. For CD patients, statistical differences (P < 0.001) existed when comparing rates in groups A (53.3%) and B (66.6%) versus none in group C. Noticeable side effects appeared in 13.3% of patients from group A and 11.5% from group B. CONCLUSIONS: These results suggest that 6-MP or MTX added to prednisone could be effective in steroid sparing, as well as in achieving and maintaining remission in steroid-dependent IBD patients. MTX was less effective in maintaining remission in UC patients.

[Antibodies against Helicobacter pylori in saliva. Study of their validity versus breath test and its agreement with serology]. / Anticuerpos frente a Helicobacter pylori en saliva. Estudio de su validez frente a la prueba del aliento y de su concordancia con la serología.

OBJECTIVES: To evaluate prospectively the validity of a new diagnostic method based on a saliva sample, taking as reference the breath test with 13C-marked urea, and to compare the results of this technique with another indirect method based on the detection of antibodies, "classical" serology using venous blood. METHODS: 48 individuals, 24 healthy volunteers and 24 consecutive patients with gastro-duodenal ulcer disease, were studied prospectively. Treatment during the previous month with gastro-erosive medication, antibiotics, proton-pump inhibitors or bismuth-derived drugs, prior treatment to eradicate H. pylori, gastric surgery and the presence of linked illnesses, were all considered criteria of exclusion from the study. For the diagnostic test in saliva a commercial enzyme-linked immunosorbent assay (ELISA, trademark Helisal) was used; and for blood serology, another commercial ELISA (Helico-G). The staff responsible for reading the saliva, serology and breath tests did not know the result of the other diagnostic methods. The result of the breath test with 13C-urea (TAU-kit) was taken as the reference standard for H. pylori infection. RESULTS: The mean age of the healthy volunteers was 23 +/- 0.7 years; and of ulcer patients, 55 +/- 18. The prevalence of H. pylori infection, valued by the gold standard, was 79.2% in the ulcer patients and 54% in the volunteers. The sensitivity, specificity, positive predictive value, negative predictive value and diagnostic accuracy of the saliva test in the ulcer patients were, respectively: 100% (95% CI, 79-99), 60% (17-93), 90% (68-98), 100% (31-97) and 92% (71-98). In the volunteers these figures were: 46% (20-74), 73% (39-93), 67% (31-91), 53% (27-78) and 58% (37-77). The serology results were better, with 100% sensitivity in both groups and outstanding diagnostic accuracy (92% and 96% for ulcer patients and volunteers, respectively). Concordance between serology and the saliva test in ulcer patients was perfect (kappa, 1). However, in asymptomatic individuals concordance was deficient (kappa, 0.28), and the prevalence of infection diagnosed with the two tests was not homogeneous (McNemar, 2.8; p < 0.05). CONCLUSION: The diagnostic test for H. pylori infection in saliva is lacking in diagnostic accuracy in healthy individuals, which indicates that it cannot be used for screening infection in the asymptomatic population. The technique is more valuable in ulcer patients, although it does not reach the specificity desirable. For these reasons, the saliva test evaluated in this study cannot be recommended for diagnosis of H. pylori infection.

Anticuerpos frente a helicobacter pylori en saliva. Estudio de su validez frente a la prueba del aliento y de su concordancia con la serología / Helicobacter pylori antibodies in saliva. Study of their validity versus the breath test and their concordance with serology

Objetivo. Evaluar prospectivamente la validez de un nuevo método diagnóstico a partir de una muestra de saliva, tomando como referencia la prueba del aliento con urea marcada con 13C, así como comparar los resultados de esta técnica con otro método indirecto basado en la detección de anticuerpos, la serología 'clásica' realizada a partir de sangre venosa. Métodos. Se estudiaron prospectivamente 48 individuos, 24 voluntarios sanos y 24 pacientes consecutivos con enfermedad ulcerosa gastroduodenal. Se consideró criterio de exclusión el tratamiento durante el último mes con fármacos gastroerosivos, antibióticos, inhibidores de la bomba de protones y derivados del bismuto, la administración previa de tratamiento erradicador de H. pylori, la cirugía gástrica y la presencia de enfermedades asociadas. Para la realización del test diagnóstico en saliva se empleó un enzimoinmunoanálisis (ELISA) comercial (Helisal®). Para la serología en sangre se empleó un ELISA comercial (Helico-G®). El personal responsable de la lectura del test en saliva, de la serología y de la prueba del aliento desconocían el resultado de los demás métodos diagnósticos. Como patrón de referencia de infección por H. pylori se consideró el resultado de la prueba del aliento con 13C-urea (TAU-kit®). Resultados. La edad media de los voluntarios sanos fue de 23 ñ 0,7 años y de 55 ñ 18 en los ulcerosos. La prevalencia de infección por H. pylori, valorada por el 'patrón oro', fue del 79,2 por ciento en los ulcerosos y del 54 por ciento en los voluntarios. La sensibilidad, especificidad, valor predictivo positivo, valor predictivo negativo y exactitud diagnóstica del test en saliva en los ulcerosos fue, respectivamente: 100 por ciento (IC del 95 por ciento, 79-99), 60 por ciento (17-93), 90 por ciento (68-98), 100 por ciento (31-97) y 92 por ciento (71-98). Por su parte, dichos valores en los voluntarios fueron: 46 por ciento (20-74), 73 por ciento (39-93), 67 por ciento (31-91), 53 por ciento (27-78) y 58 por ciento (37-77).Los resultados de la serología fueron mejores, destacando una sensibilidad del 100 por ciento en ambos grupos, con una notable exactitud diagnóstica (92 por ciento y 96 por ciento, respectivamente para los ulcerosos y los voluntarios). La concordancia entre la serología y el test en saliva en los enfermos ulcerosos fue perfecta (kappa, 1), mientras que en los individuos asintomáticos fue deficiente (kappa, 0,28) y las prevalencias de infección diagnosticadas con ambas pruebas en este último grupo no fueron homogéneas (McNemar, 2,8; p < 0,05). Conclusión. El test diagnóstico de infección por H. pylori en saliva posee una deficiente exactitud diagnóstica en los individuos sanos, lo que indica que no es útil para el cribado de la infección en la población asintomática. El valor de esta técnica en los pacientes ulcerosos es mayor, aunque no alcanza los valores de especificidad deseables. Por todo ello, el test en saliva evaluado en el presente estudio no puede ser recomendado para realizar el diagnóstico de la infección por H. pylori (AU)

Estimated incidence of inflammatory bowel disease in Argentina and Panama (1987-1993).

AIM: to estimate the incidence of inflammatory bowel disease (IBD) in two areas from Panama and Argentina. METHOD: during a 7-year period from 1987 to 1993 we surveyed IBD in two well-defined communities from Panama (District of Colón) and Argentina (Partido General Pueyrredón). The mean annual incidence of IBD was estimated from hospital-based registries. Records from the General Records Department and the endoscopy, radiology and pathology services were reviewed at the Hospital MA Guerrero in Colón and at two other hospitals in Partido General Pueyrredón to identify suspected cases of IBD. Cases were confirmed using standard criteria, and disease incidence rates were calculated by dividing the number of cases in which a positive diagnosis could be established by the population served by each hospital. RESULTS: mean annual incidence of ulcerative colitis in Panama was 1.2/100 000 inhabitants/year, and no cases of Crohn's disease (CD) could be diagnosed. Mean annual incidence of IBD in Partido General Pueyrredón was 2.2/100 000 inhabitants/year, with only a single case of CD being identified. We argue that such figures could represent a good estimate of the incidence of IBD in each area, given the wide coverage of the population by the hospitals surveyed in each region. CONCLUSION: according to these results, the incidence rates of IBD seem to be much lower than those published for other "Hispanic" communities outside Latin America. Factors such as population structure, environment or genetic determinants might account for these differences.

Significant increase in eradication rates of Helicobacter pylori infection with two consecutive dual therapies (omeprazole and amoxycillin or omeprazole and clarithromycin). A randomized study in 450 Spanish patients.

Helicobacter pylori infection is associated with peptic ulcer disease and chronic gastritis, and eradication of the microorganism markedly reduces the recurrence of peptic ulcer. However, a major problem is the choice of a treatment that is effective, has high eradication rate, and is well tolerated by patients. We evaluated the eradication of H. pylori infection in patients with chronic gastritis (CG), duodenal ulcer (DU), and gastric ulcer (GU) after two dual therapies (omeprazole with either amoxycillin or clarithromycin). Of 450 patients initially included in the study, 207 had CG, 187 DU and 56 GU, and all presented with H. pylori infection. Diagnosis was made from endoscope examination, biopsy samples, rapid urease test and 13C-urea breath test (UBT). H. pylori infection was considered to be present when two of the tests had positive results. All patients were randomized to one of two regimens: (A) omeprazole (20 mg b.i.d.) plus amoxycillin (750 mg t.i.d.) or (B) omeprazole (40 mg b.i.d.) plus clarithromycin (500 mg t.i.d.). The duration of each of the regimens was 2 weeks. Fifty-eight patients who showed H. pylori infection after the first treatment (27 with CG, 24 with DU, and 7 with GU) were allocated to a second therapy. H. pylori eradication was assessed by UBT, 6 weeks after the end of the therapies; positive values were those higher than 5 delta units. A second consecutive dual therapy of omeprazole plus an antibiotic (amoxycillin or clarithromycin) not used in the first therapy improved on the eradication rates obtained with the first regimen. The overall eradication rates were also higher, but no significant differences were found between amoxycillin and clarithromycin. The best results were obtained in those patients with GU.

Rheumatic manifestations in human immunodeficiency virus positive and negative individuals: a study of 2 populations with similar risk factors.

OBJECTIVE: Assess the impact of human immunodeficiency virus (HIV) infection on the onset of rheumatic manifestations in HIV+ patients, and to compare them with a control HIV- group with similar risk factors. METHODS: We prospectively studied 74 consecutive HIV+ patients, looking for clinical and laboratory findings of rheumatic manifestations and compared them with 72 control subjects with similar risk factors for HIV who tested negative for HIV. RESULTS: Rheumatic manifestations were more frequently observed in the HIV+ group than the HIV-group (p < 0.001): Arthralgias were found in 34 (45%), arthritis in 8 (10%), and Reiter's syndrome in 6 (8%). Laboratory findings revealed rheumatoid factor in 16 (21%) HIV+ vs 2 (2%) in HIV-, antinuclear antibodies in 13 (17%) HIV+ vs 0 in HIV-, IgG anticardiolipin antibodies in 70 (94%) HIV+ vs 7 (9%) in HIV- (p < 0.001). Hyperuricemia was found in 31 HIV+ patients (41%), and hypouricemia in 4 (5%), compared with none in the HIV- group (p < 0.0001). Neoplasia were identified in 13 HIV+ patients, in 7 associated with hyperuricemia and 3 with hypouricemia. Of interest, 2 patients had urate abnormalities before the diagnosis of neoplasia. CONCLUSIONS: Our study suggests that rheumatic manifestations are more prevalent in HIV+ patients. In advanced HIV infection, hypo and hyperuricemia may be considered markers of neoplasia.

PIP: This study was conducted to assess the impact of HIV infection on the onset of rheumatic manifestations in HIV+ patients and to compare them with a control HIV- group with similar risk factors. 74 consecutive HIV+ patients were therefore studied prospectively, with researchers looking for clinical and laboratory findings of rheumatic manifestations. These cases were compared against 72 control subjects with similar risk factors for HIV who tested negative for HIV. The results suggest that rheumatic manifestations are more prevalent in HIV+ patients. Further, in advanced HIV infection, hypo and hyperuricemia may be considered markers of neoplasia. Specifically, rheumatic manifestations were found more frequently in the HIV+ group than in the HIV- group: arthralgia were found in 45%, arthritis in 10%, and Reiter's syndrome in 8%. Rheumatoid factor was found in 21% of the HIV+ group and 2% in the HIV- group, antinuclear bodies in 17% of the HIV+ group versus none in the HIV- group, and IgG anticardiolipin antibodies in 94% of the HIV+ group and 9% of the HIV- group. Hyperuricemia was observed in 31 HIV+ patients and hypouricemia in 4, compared with none in the HIV- group. Neoplasia were observed in 13 HIV+ patients. Two patients had urate abnormalities before the diagnosis and neoplasia.

[Group health care]. / Atención de salud en grupo.

The transition from individual to group health care entails a response to multidisciplinary scientific systems, the enlistment of community participation, and an effort to make the professionals aware of the need to work as a team. The author points to the need to change the information system so that the professional-to-be will acquire a mentality and method of work appropriate for group care. In the architecture of service facilities structural changes must also be provided for the care of groups rather than individuals. In short, the change entails a review of all the elements of care.

Atención de salud en grupo / Group health care

The transition from individual to group health care entails a response to multidisciplinary scientific systems, the enlistment of community participation, and an effort to make the professionals aware of the need to work as a team. The author points to the need to change the information system so that the professional-to-be will acquire a mentality and method of work appropriate for group care. In the architecture of service facilities structural changes must also be provided for the care of groups rather than individuals. In short, the change entails a review of all the elements of care (Au)