Clinical and histopathological features of bladder cancer following radiotherapy for prostate cancer: A comparative study.

INTRODUCTION: Low certainty exists on how bladder cancer (BCa) after pelvic radiotherapy (RT) differs from BCa in radiation-naive patients from a histopathological and clinical perspective. This study aims to compare histopathological features of bladder tumors between patients with previous RT for prostate cancer (PCa) and radiation-naive patients using single-institutional data and to estimate relapse-free survival (eRFS) and cystectomy-free survival (eCFS) in both groups. MATERIALS AND METHODS: Comparative study in adult men diagnosed with BCa in Hospital Italiano de Buenos Aires, Argentina, between January 2015 and December 2020. Included patients were categorized as previously irradiated for PCa or radiation-naive. PRIMARY OUTCOME: differences in prevalence of aggressiveness features of bladder tumors (variant histology; high-grade tumors; muscle-invasive disease; criteria compliance for high or very-high risk of progression) between irradiated and radiation-naive patients at diagnosis of BCa. SECONDARY OUTCOMES: differences in eRFS and eCFS between groups. RESULTS: In total, 34 and 291 patients were included in the Irradiated and Radiation-naive groups, respectively. Mean age at the time of diagnosis of BCa was 72.7 years (CI 95% 71.6-73.8). Median follow-up of the overall cohort was 25 months (IQR 11-45.5). Concerning primary outcomes, no statistical differences were found except for a higher prevalence of low-grade tumors between irradiated patients and high-grade tumors between radiation-naive patients (P 0.018). Regarding secondary outcomes, prior RT did not increase neither eRFS nor eCFS in both univariate and multivariate analysis. CONCLUSIONS: BCa after RT for PCa has similar histological features and cystectomy free-survival compared to BCa in a radiation-naive population. For patients with non-muscle invasive BCa arising after prostate RT, the risk of recurrences appears to be similar to non-irradiated patients.

A systematic review and meta-analysis of the cyclic alternating pattern across the lifespan.

BACKGROUND: Cyclic alternating pattern (CAP) is the electroencephalogram (EEG) pattern described as a marker of sleep instability and assessed by NREM transient episodes in sleep EEG. It has been associated with brain maturation. The aim of this review was to evaluate the normative data of CAP parameters according to the aging process in healthy subjects through a systematic review and meta-analysis. METHODS: Two authors independently searched databases using PRISMA guidelines. Discrepancies were reconciled by a third reviewer. Subgroup analysis and tests for heterogeneity were conducted. RESULTS: Of 286 studies, 10 submitted a total of 168 healthy individuals to CAP analysis. Scoring of CAP can begin at 3 months of life, when K-complexes, delta bursts, or spindles can be recognized. Rate of CAP increased with age, mainly during the first 2 years of life, then decreased in adolescence, and increased in the elderly. The A1 CAP subtype and CAP rate were high in school-aged children during slow-wave sleep (SWS). A1 CAP subtypes were significantly more numerous in adolescents compared with other groups, while the elderly showed the highest amounts of A2 and A3 CAP subtypes. Our meta-analysis registered the lowest CAP rate in infants younger than 2 years old and the highest in the elderly. CONCLUSIONS: This review summarized the normative data of CAP in NREM sleep during the aging process. The CAP rate increased with age and sleep depth, especially during SWS. Parameters of CAP may reflect gender hormonal effects and neuroplasticity. More reports on CAP subtypes are needed for their reference values establishment.

Characteristics and Surgical Outcomes in Very Elderly Patients (≥75 years) with Renal Cell Carcinoma: Data from the Latin American Renal Cancer Group.

BACKGROUND: The incidence of renal cell carcinoma (RCC) is increasing globally due to an aging population and widespread use of imaging studies. OBJECTIVE: The aim of this study was to describe the characteristics and perioperative outcomes of RCC surgery in very elderly patients (VEP), ≥ 75 years of age. METHODS: This is a retrospective comparative study of 3656 patients who underwent the treatment for RCC from 1990 to 2015 in 28 centers from eight Latin American countries. We compared baseline characteristics as well as clinical and perioperative outcomes according to age groups (less than 75 vs. ≥75 years). Surgical complications were classified with the Clavien-Dindo score. We performed logistic regression analysis to identify factors associated with perioperative complications. RESULTS: There were 410 VEP patients (11.2%). On bivariate analysis, VEP had a lower body mass index (p less than 0.01) and higher ASA score (ASA > 2 in 26.3% vs. 12.4%, p < 0.01). There was no difference in performance status and clinical stage between the study groups. There were no differences in surgical margins, estimated blood loss (EBL), complication, and mortality rates (1.3% vs. 0.4%, p = 0.17). On multivariate regression analysis, age ≥75 years (odds ratio [OR] 2.33, p less than 0.01), EBL ≥ 500 cc (OR 3.34, p less than 0.01), and > pT2 stage (OR 1.63, p = 0.04) were independently associated with perioperative complications. CONCLUSIONS: Surgical resection of RCC was safe and successful in VEP. Age ≥75 years was independently associated with 30-day perioperative complications. However, the vast majority were low-grade complications. Age alone should not guide decision-making in these patients, and treatment must be tailored according to performance status and severity of comorbidities.

Characteristics and Surgical Outcomes in Very Elderly Patients (≥75 years) with Renal Cell Carcinoma: Data from the Latin American Renal Cancer Group

Background: The incidence of renal cell carcinoma (RCC) is increasing globally due to an aging population and widespread use of imaging studies. Objective: The aim of this study was to describe the characteristics and perioperative outcomes of RCC surgery in very elderly patients (VEP), ≥75 years of age. Methods: This is a retrospective comparative study of 3656 patients who underwent the treatment for RCC from 1990 to 2015 in 28 centers from eight Latin American countries. We compared baseline characteristics as well as clinical and perioperative outcomes according to age groups (<75 vs.≥ 75 years). Surgical complications were classified with the Clavien-Dindo score. We performed logistic regression analysis to identify factors associated with perioperative complications. Results: There were 410 VEP patients (11.2%). On bivariate analysis, VEP had a lower body mass index (p < 0.01) and higher ASA score (ASA >2 in 26.3% vs. 12.4%, p < 0.01). There was no difference in performance status and clinical stage between the study groups. There were no differences in surgical margins, estimated blood loss (EBL), complication, and mortality rates (1.3% vs. 0.4%, p = 0.17). On multivariate regression analysis, age ≥75 years (odds ratio [OR] 2.33, p < 0.01), EBL ≥ 500 cc (OR 3.34, p < 0.01), and > pT2 stage (OR 1.63, p = 0.04) were independently associated with perioperative complications. Conclusions: Surgical resection of RCC was safe and successful in VEP. Age ≥75 years was independently associated with 30-day perioperative complications. However, the vast majority were low-grade complications. Age alone should not guide decision-making in these patients, and treatment must be tailored according to performance status and severity of comorbidities. (REV INVEST CLIN. 2020;72(5):308-15)

El conocimiento botánico local en áreas urbanas del norte de Uruguay / Local botanical knowledge in urban areas of northern Uruguay

Este trabajo rescata el acervo etnobotánico de la región más septentrional de Uruguay. En este país la etnobotánica, ha tenido poco desarrollo, siendo escasos los estudios y publicaciones científicas. El área de estudio comprende los departamentos de: Artigas, Rivera, Tacuarembó y Cerro Largo. Por medio de un muestreo aleatorio fueron entrevistadas 315 personas. Entre otras variables, los datos obtenidos se refieren a los usos especiales de las plantas. La información fue procesada en planilla de cálculo y listada por medio de técnicas de estadística descriptiva. Se identificaron 134 especies utilizadas, distribuidas en 57 familias botánicas. Las familias de mayor frecuencia fueron: Lamiaceae, Asteraceae, Apiaceae y Fabaceae. La medicina convencional es complementada con plantas cultivadas que presentan aplicaciones medicinales. Fueron reportadas nueve formas de usos, la infusión mostró ser la práctica más utilizada. El conocimiento relativo a las propiedades de las plantas proviene de personas de mayor edad y se trasmite por tradición oral. La metodología puede ser replicada a otras zonas del país.

This work rescues the ethnobotanical heritage of the northernmost region of Uruguay. In this country, ethnobotany has had little development, with scarce studies and scientific publications. The study area includes the departments of: Artigas, Rivera, Tacuarembó and Cerro Largo. Through random sampling, 315 people were interviewed. Among other variables, the data obtained refer to the special uses of the plants. The information was processed in the spreadsheet and listed by means of descriptive statistics techniques. 134 species used were identified, distributed in 57 botanical families. The most frequent families were: Lamiaceae, Asteraceae, Apiaceae and Fabaceae. Conventional medicine is complemented with cultivated plants that have medicinal applications. Nine forms of uses were reported, the infusion proved to be the most used practice. The knowledge related to the properties of plants comes from older people and is transmitted by oral tradition. The methodology can be replicated to other areas of the country.

Adrenalectomía laparoscópica: ¿abordaje retroperitoneal posterior o transperitoneal lateral? / Laparoscopic Adrenalectomy: posterior retroperitoneoscopic or lateral transperitoneal approach?

Objetivo: comparar los resultados obtenidos en adrenalectomía retroperitoneoscópica posterior (ARP) con los obtenidos por vía transperitoneal lateral (ATL) a corto y mediano plazo. Material y métodos: estudio de cohortes prospectivo. Se incluyeron 22 pacientes a quienes se les realizaron 24 adrenalectomías (12 ARP y 12 ATL) entre los meses de enero de 2015 y mayo de 2016. En el grupo ARP se realizó a 1 paciente adrenalectomía bilateral simultánea y a 1 paciente, bilateral sincrónica. Fueron comparados datos basales, clínicos, quirúrgicos y evolutivos. Resultados: la mediana de tiempo de seguimiento fue de 6,5 meses (r 1-16). Los grupos ARP y ATL fueron comparables en edad, sexo, BMI y presencia de cirugías previas. Los adenomas fueron las lesiones predominantes (41,7% en cada grupo). El promedio de tiempo operatorio en ART y ATL fue 104,3 ± 21,2 y 146 ± 32,9 minutos, respectivamente (p 0,05). No hallamos diferencias en tiempo de internación, sangrado y complicaciones. Todos los pacientes lograron curación clínica. Conclusiones: la técnica ARP es una vía segura, con resultados comparables a ATL y menor tiempo operatorio. También permite intervenir de manera simultánea y sincrónica ambas glándulas adrenales sin necesidad de reposicionar al paciente.

Objetive: to compare the results of posterior retroperitoneoscopic (PRA) or lateral transperitoneal approach (LTA) in laparoscopic adrenalectomy in the short and medium term. Material y methods: prospective cohort study. We included 22 patients who underwent 24 adrenalectomies (12 PRA and 12 LTA) between January 2015 and May 2016. In the PRA group, two simultaneous bilateral laparoscopic adrenalectomies were performed (1 synchronous bilateral adrenalectomy). Baseline, clinical and surgical outcome were compared. Results: the median follow-up time was 6.5 months (range: 1-16). The PRA and LTA groups were comparable in age, gender, BMI and presence of previous surgeries. Adenomas were the predominant lesions (41.7% in each group). The average operating time in PRA and LTA was 104.3 ± 21.2 and 146 ± 32.9 minutes, respectively (p=0.05). We found no differences in length of hospital stay, bleeding and complications. All patients achieved clinical cure. Conclusions: the PRA technique is a safe approach, with results comparable to LTA and shorter operating time. It also allows to intervene simultaneously and synchronously both adrenal glands without the need of repositioning the patient.

Feasibility of endoscopic endonasal approach for clip application of cerebral aneurysms: a systematic review.

INTRODUCTION: While open, microsurgical clipping and endovascular coiling remain the gold standards for treatment of cerebral aneurysms, a growing number of aneurysms treated via endoscopic endonasal methods have been reported in the literature. The aim of this study was to conduct a systematic review of the literature to gain a more thorough appreciation of the potential benefits and drawbacks of the endoscopic endonasal strategy in this setting. EVIDENCE ACQUISITION: We performed a detailed systematic review of the medical literature on endoscopic endonasal skull base surgery for treatment of cerebral aneurysms utilizing the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) guidelines. We identified 9 clinical studies describing treatment of 23 aneurysms utilizing the EEA. Eleven additional cadaveric studies investigating aspects of operative exposure and/or technique in this setting were identified. The full text of these articles was reviewed. EVIDENCE SYNTHESIS: In the 9 clinical studies that met inclusion criteria, 23 aneurysms were treated in 21 patients. The mean patient age was 52.6 years. 15 aneurysms were unruptured and 8 were ruptured. Fourteen aneurysms involved the anterior circulation and 9 involved the posterior circulation. In 21 of 23 aneurysms, complete occlusion was achieved with endonasal clipping. Two aneurysms required additional treatment that included a takeback for clip repositioning and staged endovascular coiling. Complications included post-operative CSF leak (23.8%), stroke (19%), and meningitis (14.3%). Analysis of the combined literature revealed a significantly higher rate of CSF leak with endonasal clipping of posterior circulation aneurysms compared to anterior circulation aneurysms (P=0.047, Fisher's Exact Test). While there was a trend towards increased post-operative neurologic deficit following EEA for posterior circulation aneurysms, this did not reach statistical significance (P=0.063). The majority of post-operative complications in posterior circulation aneurysms occurred during clip application of aneurysms at the level of the basilar apex. In addition to the aforementioned clinical reports, 11 cadaveric studies were identified. 4 of these reports investigated approaches for individual anterior circulation aneurysms, 5 investigated approaches for posterior circulations aneurysms, and 2 involved both anterior and posterior circulation aneurysms. CONCLUSIONS: Despite a moderate increase in utilization, caution should be exercised when choosing an endonasal strategy for treatment of aneurysmal pathology over more traditional and established methods such as microsurgical clip application and endovascular methods. Anecdotal evidence suggests that inferior and/or medial projecting aneurysms involving the paraclinoid ICA not amenable to traditional open/endovascular strategies may be reasonable to consider for EEA clip application. Wide-necked, midline, ventrolaterally-projecting aneurysms involving the vertebrobasilar system may represent an additional exception, as long as the location along the rostrocaudal axis is low enough so as not to compromise visualization. Future improvements in operative technology, including anticipated advances in endoscopic 3-D visualization, may further alter the landscape of treatment involving this complex pathology.

Medical students career choices and perceptions in family medicine and primary care

Background@#Maldistribution and dearth of primary care practitioners is a continuing health human resource problem of many countries particularly in developing countries like the Philippines. The call to strengthen primary care for better health outcomes is a battle-cry that has never been resolved due to lack of physicians, trained and untrained, serving the rural areas. Family physicians are primarily the workforce in primary care settings but few medical graduates pursue this kind of career track. This study aimed to describe the career choices of medical students and factors that influenced them including their perspectives of family medicine as career choice.@*Methods@#On-line survey using google form was used to reach a total of 1800 medical students from 41 medical schools across the country in November 2016. Purposive sampling was done to allocate at least 40 students per school coordinated through the APMC Student Network representatives. They were sent with a link of the pre-validated questionnaire on career choices after medical school and reasons influencing their career choices based from prior studies. @*Results@#Of the 1,800 students, 1010 (81%) completed the questionnaire. Majority opted residency training (92%) after graduation and few pursue rural health practice (14%). Family medicine ranked 10th as first choice for training with IM and surgery consistently the top choices regardless if it is the first, second or third choice. Family medical needs influenced these choices. Family medicine was considered by majority as the primary care providers (94.1%) but lack of emphasis on it in their curriculum was experienced by most. @*Conclusion@#Most of the medical students want to pursue residency training in internal medicine and surgery while few in family medicine. Their choice of training is influenced by medical needs of the family. Family medicine as primary care provider was recognized but most experienced of lack emphasis in their medical curriculum.

Prochlorococcus as a Possible Source for Transparent Exopolymer Particles (TEP).

Transparent exopolymer particles (TEP), usually associated with phytoplankton blooms, promote the formation of marine aggregates. Their exportation to deep waters is considered a key component of the biological carbon pump. Here, we explored the role of solar radiation and picocyanobacteria in the formation of TEP in oligotrophic surface waters of the Atlantic and Pacific Oceans in ten on-deck incubation experiments during the Malaspina 2010 Expedition. TEP concentrations were low on the ocean's surface although these concentrations were significantly higher on the surface of the Pacific (24.45 ± 2.3 µg XG Eq. L-1) than on the surface of the Atlantic Ocean (8.18 ± 4.56 µg XG Eq. L-1). Solar radiation induced a significant production of TEP in the on-deck experiments from the surface water of the Pacific Ocean, reaching values up to 187.3 µg XG Eq. L-1 compared with the low production observed in the dark controls. By contrast, TEP production in the Atlantic Ocean experiments was lower, and its formation was not related to the light treatments. Prochlorococcus sp. from the surface ocean was very sensitive to solar radiation and experienced a high cell decay in the Pacific Ocean experiments. TEP production in the on-deck incubation experiments was closely related to the observed cell decay rates of Prochlorococcus sp., suggesting that this picocyanobacteria genus is a potential source of TEP. The evidence to propose such potential role was derived experimentally, using natural communities including the presence of several species and a variety of processes. Laboratory experiments with cultures of a non-axenic strain of Prochlorococcus marinus were then used to test TEP production by this genus. TEP concentrations in the culture increased with increasing cell abundance during the exponential phase, reaching the highest TEP concentration at the beginning of the stationary phase. The average TEP concentration of 1474 ± 226 µg XG Eq. L-1 (mean ± SE) observed at the stationary phase of P. marinus cultures is comparable with the values reported in the literature for diatom cultures, also growing in non-axenic as well as axenic cultures. Our results identify Prochlorococcus sp. as a possible relevant source of TEP in the oligotrophic ocean.

Troponin levels within the normal range and probability of inducible myocardial ischemia and coronary events in patients with acute chest pain.

BACKGROUND/OBJECTIVES: Patients with suspected acute coronary syndromes and negative cardiac troponin (cTn) levels are deemed at low risk. Our aim was to assess the effect of cTn levels on the frequency of inducible myocardial ischemia and subsequent coronary events in patients with acute chest pain and cTn levels within the normal range. METHODS: We evaluated 4474 patients with suspected acute coronary syndromes, nondiagnostic electrocardiograms and serial cTnI levels below the diagnostic threshold for myocardial necrosis using a conventional or a sensitive cTnI assay. The end points were the probability of inducible myocardial ischemia and coronary events (i.e., coronary death, myocardial infarction or coronary revascularization within 3 months). RESULTS: The probability of inducible myocardial ischemia was significantly higher in patients with detectable peak cTnI levels (25%) than in those with undetectable concentrations (14.6%, p<0.001). These results were consistent regardless of the type of cTnI assay, the type of stress testing modality, or the timing for cTnI measurement, and remained significant after multivariate adjustment (odds ratio [OR] 1.47, 95% confidence interval [CI] 1.21-1.79, p<0.001). The rate of coronary events at 3 months was also significantly higher in patients with detectable cTnI levels (adjusted OR 2.08, 95% CI 1.64-2.64, p<0.001). CONCLUSIONS: Higher cTnI levels within the normal range were associated with a significantly increased probability of inducible myocardial ischemia and coronary events in patients with suspected acute coronary syndromes and seemingly negative cTnI.

Nueva escala de severidad del daño hepático por sepsis / New injury severity scale liver sepsis

La sepsis tiene elevada mortalidad, el hígado se afecta tempranamente, los Especialistas en Medicina Intensiva y Emergencia utilizan herramientas para predecir la evolución de los pacientes. Objetivo: diseñar una escala para unificar criterios en el diagnóstico de la severidad del daño hepático por sepsis. Material y método: estudio retrospectivo, observacional, descriptivo a 200 fallecidos por sepsis; se determinaron patrones histológicos del hígado y variables epidemiológicas y clínicas y se diseñó una escala para evaluar la severidad del daño hepático en la sepsis, la que fue validada internamente. Resultados: el daño hepático se clasificó como severo y no severo, el severo resultó tres veces mayor en enfermos de color de piel no blanca y 17 veces mayor en pacientes con APACHE II (riesgo de mortalidad) mayor que 76 por ciento e infección abdominal; el modelo identificó mejor el daño hepático severo con exactitud de 89.5 por ciento, sensibilidad de 97.6 por ciento y especificidad de 52.8 por ciento y el área bajo la curva de receiver operating characteristics fue de 0.78, con una significación asociada al estadígrafo calculado menor que 0.01 y predijo mejor que el azar, con intervalo de confianza de 0.71 a 0.85. Conclusiones: el modelo tuvo alta sensibilidad, identificó mejor el daño hepático severo y predijo mejor que el azar (AU)

Observations on the biology and distribution of Uresiphita reversalis (Lepidoptera, Crambidae), a defoliator of the native tree Calia secundiflora in México

Observations on the biology and distribution of Uresiphita reversalis (Lepidoptera, Crambidae), a defoliator of the native tree Calia secundiflora in México. Uresiphita reversalis (Guenée, 1854) feeding on Calia secundiflora (Ortega) Yakovlev is recorded for the first time in the state of Hidalgo, Mexico. New aspects regarding the life cycle, feeding behaviour, geographical distribution and host plant damage by U. reversalis on C. secundiflora are here presented and discussed.

CEP41 is mutated in Joubert syndrome and is required for tubulin glutamylation at the cilium.

Tubulin glutamylation is a post-translational modification that occurs predominantly in the ciliary axoneme and has been suggested to be important for ciliary function. However, its relationship to disorders of the primary cilium, termed ciliopathies, has not been explored. Here we mapped a new locus for Joubert syndrome (JBTS), which we have designated as JBTS15, and identified causative mutations in CEP41, which encodes a 41-kDa centrosomal protein. We show that CEP41 is localized to the basal body and primary cilia, and regulates ciliary entry of TTLL6, an evolutionarily conserved polyglutamylase enzyme. Depletion of CEP41 causes ciliopathy-related phenotypes in zebrafish and mice and results in glutamylation defects in the ciliary axoneme. Our data identify CEP41 mutations as a cause of JBTS and implicate tubulin post-translational modification in the pathogenesis of human ciliary dysfunction.

Cardiac rehabilitation programs improve metabolic parameters in patients with the metabolic syndrome and coronary heart disease.

This study was performed to determine the effectiveness of a cardiac rehabilitation and exercise training program on metabolic parameters and coronary risk factors in patients with the metabolic syndrome and coronary heart disease. The study involved 642 patients with coronary heart disease. Of them, 171 (26.7%) fulfilled criteria for the metabolic syndrome. Clinical data, laboratory tests, and exercise testing were performed before and after the program, which lasted 2 to 3 months. Except for waist circumference, there were no significant differences between groups; blood pressure, high-density lipoprotein cholesterol, triglycerides, and fasting glucose improvements during the follow-up were higher in patients with the metabolic syndrome (all P<.001). At study end, in patients with the metabolic syndrome, functional capacity increased by 26.45% ( P<.001), as measured by metabolic equivalents, with a slight increase of 1.25% ( P=not significant) in the double product. Patients with the metabolic syndrome who took part in this secondary prevention program reported improvements in cardiovascular risk profile and functional capacity.

Blood bilirubin determinations as an aid in the differentiations between peptic ulcer and portal cirrhosis in gastric hemorrhage

1. Seven cases with massive gastric hemorrhage resulting in profuse hematemesis form the basis of this report. Four of these were admitted in the Medical Wards of the Philippine General Hospital, two were patients admitted in the Pay Section of the same Hospital, and the sixth was an American internee admitted in a special ward for internees of the same hospital2. Four of these patients died, and a complete pathologic report for each was available. Two were operated on and accurate operative findings were also available for these patients. One had no operative or autopsy verification of the clinical impression. But this appears well supported by clinical laboratory and X-ray findings3. Four of these patients were found suffering from peptic ulcer and the other three from portal chirrhosis. The patients with peptic ulcer showed practically no bilirubin in the blood (Whether B-I or B-II) while those with portal cirrhosis showed significant amounts of B-I4. When clinical, laboratory , or x-ray findings are not sufficiently distinct for the differentiation of these two conditions in cases of massive gastric hemorrhage, the bilirubin (B-I) content of the blood may help in the differentiation. Peptic ulcer is not accompanied by B-I in the blood, while portal cirrhosis is always accompanied by functional disturbances of the liver. This is shown by the constant presence of B-I in the blood. (Conclusion)

Studies on peptic ulcer

We collected for study 100 cases of peptic ulcer the diagnosis of which was verified by x-ray in seventy-two cases, by operation in twenty-one, and by autopsy in sevene have prepared seven tablesTable 1 shows that peptic ulcer is a disease that frequently occurs among persons in the active period of their lifeTable 2 indicates that peptic ulcer affects chiefly persons who are hard workers. It is also frequent among the jobless, in whom the neurogenic factor may play a role in the causation of peptic ulcerTable 3 demonstrates the presence of abdominal pain in every case of peptic ulcer in our series. It has been noted that more frequently than not, epigastric pain had relation to meals. The other symptoms in the order of Frequency are: vomiting, sour eructations, nausea, constipation, etcTable 4 shows that normal total acidity, free HCl and combined HCl values may be obtained in an empty or fasting stomach and also one hour after Ewalds test meal. In our series we have noted more cases of peptic ulcer with normal acid values than with hyperacidity. In many cases the acid values are higher in an empty or fasting stomach than one hour after the test meal. This may be due to hypersecretion and retention of the gastric contents due to partial pyloric obstructionTable 5 indicates the more frequent occurrence of ulcers in the stomach than in the duodenum, the proportion being two to one. Gastric ulcers are found more frequently in the lesser curvature, and in the antrumTable 6 shows that hemorrhages in the form o melena or hematemesis occured in about one half of the total number of cases. Perforations occured in both gastric and duodenal ulcers, and recoveries were due to timely surgical intervention. Malignant degenrations occured in a few cases of gastric ulcer, but none occured in duodenal lesionsTable 7 demonstrates that with our cases of peptic ulcer, ascariasis has frequently been found associated, but probably there is no causal relationshipWe have briefly enumerated the different therories regarding the genesis of peptic ulcer. The neurogenic factor is probably fundamentally essential, operating in conjunction with some other predisposing or provocative factorsWe hve outlined an opinion on the proper diagnosis of peptic ulcer with special emphasis on x-ray pictures and gastroscopy.(Summary)

Highlights of the weekly staff clinical conferences in 1940

We have tried, although in a brief way, to summarize the interesting and instructive features of the Weekly Staff Clinical Conferences in 1940A. The Department of Medicine presented a total of 41 cases for clinical study and discussion1. Eight cases were blood diseases. The etiology of the aplastic anemia in 3 cases is still obscure, hence they are considered idiopathic, but ankylostomiasis was found to have something to do with the production.(Summary)

Comportamiento epidemiológico de la mortalidad materna en el Hospital Maternidad Nuestra Señora de la Altagracia, 1992-1996 / Epidemiological behaviour of maternal mortality at \"Nuestra Señora de la Altagracia\" Maternity Hospital, 1992-1996

Con la finalidad de conocer la posible causa de muerte directa o asociada al embarazo, realizamos un estudio descriptivo transversal con la recolección retrospectiva de la información en el Hospital Maternidad Nuestra Señora de la Altagracia, durante el período 1992-1996. Del total de 121.197 pacientes admitidas 169 fueron defunciones, lo que representa una tasa de mortalidad materna de 156.5/100,000 NV., y se realizaron 95.007 partos y 12,492 cesáreas de las cuales se representaron (0.07//) defunciones vía parto vaginal y 0.41// mediante operación cesárea (9.75//) correspondieron a pacientes que fallecieron embarazadas y 10.97// por aborto, (1.21//) a las que se les practicó laparotomía; (32.92//) eran primigesta, (42//) las multíparas, (11.9//) adolescentes, (73.8// entre 20 y 30 años; (14.3//) eran mayores de 30 años, (16.45//) eran gran multíparas. La causa de muerte fue (43.29//) por hemorragias, donde el DPPNT ocupó el primer lugar (10.5//), (ver cuadro 12); (27.4//) debido a trastornos hipertensivos; (5.24//) muertes por sepsis, (2.4//) por accidente anestésico, (4.3//) por causa desconocida. Consideramos que las principales causas de mortalidad materna son hemorragias, trastornos hipertensivos y sepsis