Fabrication of Silver Nanoparticles Using a Gas Phase Nanocluster Device and Preliminary Biological Uses.

Nanoparticles can be used in a large variety of applications, including magnetic sensing, biological, superconductivity, tissue engineering, and other fields. In this study, we explore the fabrication of gas phase silver nanoparticles using a sputtering evaporation source. This setup composed of a dual magnetron cluster source holds several advantages over other techniques. The system has independent control over the cluster concentration and a wide range of cluster size and materials that can be used for the clusters and for the matrix where it can be embedded. Characterization of these silver nanoparticles was done using transmission electron microscopy (TEM). We obtain a lateral width of 10.6 nm with a dispersion of 0.24 nm. With atomic force microscopy (AFM) a Gaussian fit of this distribution yields and average height of 6.3 nm with a standard deviation of 1.4 nm. We confirm that the deposited silver nanoparticles have a homogenous area distribution, that they have a defined shape and size distribution, and that they are single standing nanoparticles. Given that the scientific literature is not precise regarding the toxic concentration of the nanoparticles, devices such as ours can help clarify these questions. In order to explore further biological applications, we have done preliminary experiments of cell spreading (myoblast adhesion), obtaining interesting morphological changes correlated with the silver concentration on the surface. With a deposited silver concentration ranging from 100⁻620 ng/cm², the cells showed morphological changes in a short time of 2 h. We conclude that this high precision nanoparticle fabrication technique is adequate for further biological research.

Resultados oncológicos y funcionales en prostatectomía radical laparoscópica en grupo de bajo riesgo vs riesgo intermedio y alto / Oncological and functional results OF radical laparoscopic prostatectomy in low-risk group vs intermediate and high risk

INTRODUCCIÓN: La prostatectomía radical (PR) es el tratamiento de elección en pacientes con cáncer de próstata organoconfinado y esperanza de vida mayor a 10 años. Dentro de este grupo se pueden distinguir pacientes de riesgo bajo, intermedio y alto según D'Amico. Parámetros oncológicos y funcionales, como la continencia inmediata o precoz y potencia sexual sirven para evaluar el resultado de este procedimiento. OBJETIVO: Evaluar parámetros oncológicos y funcionales entre el grupo de riesgo bajo Vs Intermedio alto. PACIENTES Y MÉTODOS: Estudio prospectivo de carácter descriptivo. 132 Pacientes sometidos aprostatectomía radical laparoscópica entre 2003-2013 por un único cirujano. Datos recopilados en el momento de la cirugía y controles postoperatorios. Se agruparon según edad, Score de Gleason, PSA y estadio clínico en pacientes de riesgo bajo e intermedio-alto. En controles se realizó encuesta de continencia, potencia sexual y evaluación de biopsia. Los datos se analizaron considerando p<0,05 estadísticamente significativo según prueba Xi Square. RESULTADOS: Se incluyeron en total 132 pacientes, edad promedio 64,2(±7)años (48-75). PSA promedio 8,4(±6)ng/dl (1,5-37). El grupo de riesgo bajo(G1) corresponde a 92 pacientes (70 %), Promedio 64 años, PSA 6, 83 por ciento T1c. El grupo de riesgo intermedio-alto (G2) 40 pacientes (30 %), Promedio 64,9 años, PSA 13,7; 86 por ciento T1c. Márgenes positivos en G1 13(14 por ciento )pacientes Vs 11(26 por ciento) pacientes en G2. En G1 41 (45 por ciento ) están continentes al mes, 73 por ciento al tercer mes y 92 por ciento al año Vs 35 (41 por ciento ) están continentes al mes, 65 por ciento al tercer mes y 825 al año en G2. De los pacientes con seguimiento mayor a un año y erección satisfactoria previa, en G1 un 53 por ciento logró erección de igual calidad al octavo mes Vs G2 un (53 por ciento ) lo logró al mes 11. No hubo diferencia significativa en márgenes (+), continencia y potencia postoperatoria entre ambos grupos con (P>0.05). CONCLUSIONES: Los resultados oncológicos y funcionales no difieren en pacientes de bajo riesgo VS riesgo mayor. No hubo diferencias significativas en los parámetros estudiados, aunque se necesitan estudios de mayor cantidad de pacientes y revisiones sistemáticas para comparar series de distintos centros.(AU)

INTRODUCTION: Radical prostatectomy is the treatment of choice for patients with localized prostate cancer and life expectancy over 10 years. Within this group we can distinguish patients with low, intermediate and high risk according to D'Amico. Oncological and functional parameters, such as immediate or early continence and sexual potency are useful to evaluate the outcome of this procedure. OBJECTIVE: To evaluate oncological and functional parameters among low-risk group vs. intermediate. PATIENTS AND METHODS: Prospective descriptive clinical study. 132 patients underwent laparoscopic radical prostatectomy between the years 2003-2013 performed by a single surgeon. Data collected that at the time of surgery and postoperative controls. They were grouped according to age, Gleason Score, PSA and clinical stage in patients with risk low- and intermediate-high. During controls, a survey was performed in relation to continence, sexual potency and evaluation of biopsy. Data were analyzed considering p <0.05 statistically significant according Xi Square test. RESULTS: 132 patients participated, with an average age of 64.2 (± 7) years (48-75). PSA average 8.4 (± 6) ng / dl (1.5 to 37). The low risk group (G1) corresponds to 92 patients (70 pertrcent), average 64 years, PSA 6.83 pertcent T1c. The intermediate-high risk group G2) consisted of 40 patients (30 pertcent), average 64.9 years, PSA 13.7; 86 pertcent T1c. G1 positive margins in 13 (14 percent) patients vs 11 (26 pertcent) patients in G2. In G1 41 (45 pertcent) are continent in a month, 73 pertcent in the third month and 92 pertcent in one year vs 35 (41 pertcent)are continent in a month, 65 pertcent in the third month and 825 in a year in G2. Of patients with follow-up longer than a year and satisfactory prior erection in G1, a 53 pertcent achieved erection of equal quality in eighth month vs. G2 one (53 pertcent) did it achieved it in month 11. There was no significant difference in margins (+), postoperative continence or potency between the two groups (P> 0.05). CONCLUSIONS: oncological and functional results do not differ in low-risk patients vs. higher risk. There were no significant differences in the parameters studied, althoug. (AU)

Consideraciones clínicas de la expresión de P504S y metaloproteinasa de matriz 2 en células prostáticas circulantes en sangre diseminadas como resultado de una biopsia prostática trans-rectal guiada por ecografía / Expression of P504S and matrix metalloproteinase-2 in circulating prostate cells disseminated as a result of transrectal ultrasound guided biopsy as determined by immunocytochemistry: Clinical implications

OBJETIVO: la manipulación quirúrgica del cáncer tiene la potencialidad de aumentar la diseminación de células cancerosas al torrente sanguíneo y con esto el riesgo de metástasis. Presentamos el efecto de la biopsia prostática en la diseminación de estas células así como sus características fenotípicas. MÉTODOS: Se incluyeron cincuenta hombres que fueron sometidos a una biopsia prostática trans rectal como sospecha de cáncer de próstata en nuestro estudio. Se recolectaron muestras sanguíneas inmediatamente antes de la biopsia, una hora y 24 horas posterior a la misma, para detección de células prostáticas en sangre (CPC) así como para determinar sus características fenotípicas utilizando inmunocitoquímica estándar con anti PSA y luego caracterizarlas utilizando anti P504S y anti matriz de metaloproteinasa 2 (MMP-2). RESULTADOS: Catorce hombres (28%) tuvieron cáncer de próstata en la biopsia, 13 de estos fueron P504S + y MMP-2 + previo a la biopsia. Una hora posterior a la biopsia existió una mezcla de P504S + y P504S - así como de MMP2 + y MMP2 - en pacientes con biopsia positiva para cáncer, niveles que se igualaron a los pre biopsia luego de 24 horas. En pacientes negativos para cáncer, se detectaron células circulantes P504S - y MMP-2 -, algunas de ellas se mantuvieron por más de 24 horas. CONCLUSIONES: La biopsia prostática puede causar diseminación de células prostáticas malignas y benignas a la circulación y la mayoría son eliminadas dentro de las primeras 24 horas. No existió conversión de pacientes con cáncer de CPCs negativos a positivos lo que sugiere que la capacidad inherente de las células prostáticas de diseminar es más importante que el efecto de la biopsia prostática

OBJECTIVES: Surgical manipulation of cancer has been shown to increase blood borne cancer cell dissemination and increase the risk of metastasis. We present the effect of prostate biopsy on prostate cell dissemination and the phenotypic characteristics of these cells. METHODS: 50 men undergoing initial prostate biopsy for suspicion of prostate cancer were studied. Blood samples were taken immediately before, and 1 and 24 hours after biopsy for circulating prostate cells (CPC) determination and phenotypic characterization. CPCs were detected and counted using standard immunocytochemistry using anti-PSA and then characterized using anti-P504S and anti-matrix metalloproteinase-2 (MMP-2). RESULTS: 14 (28%) men had cancer detected on biopsy. 13/14 had P504S (+) and MMP-2 (+) cells detected prior to biopsy. One hour after biopsy there was a mixture of P504S (+) and P504S (-) cells detected, as well as MMP-2 (+) and MMP-2 (-) cells detected. 24 hours after biopsy the same 13/14 men remained positive, although the number of CPCs increased 1 hour after biopsy and then the numbers decreased to prebiopsy levels after 24 hours. In cancer negative men, P504S (-) and MMP-2 (-) cells were detected, some of these cells persisted 24 hours after biopsy. CONCLUSIONS: Prostate biopsy causes dissemination of prostate cells into the circulation, both malignant and benign; the majority of them are cleared within 24 hours. There was no conversion of negative to positive result in men with cancer, this suggests that the inherent capacity of malignant CPCs to disseminate is more important than the effect of dissemination caused by prostate biopsy

Effect of androgen blockade on HER-2 and matrix metalloproteinase-2 expression on bone marrow micrometastasis and stromal cells in men with prostate cancer.

INTRODUCTION: HER-2 has been associated with castrate resistant prostate cancer and matrix metalloproteinase-2 (MMP-2) in the dissemination and invasion of tumor cells as well as activating angiogenesis. We present an immunocytochemical study of the effect of androgen blockade on the expression of HER-2 and MMP-2 in bone marrow micrometastasis and the surrounding stromal cells in men with prostate cancer. METHODS AND PATIENTS: A cross-sectional study of men with prostate cancer. Touch preps were obtained from bone marrow biopsies of men with prostate cancer, before and after radical prostatectomy and during androgen blockade. Micrometastasis detected with anti-PSA immunocytochemistry underwent processing with anti-HER-2 and anti-MMP-2 immunocytochemistry. Patients were defined as HER-2 positive or negative, MMP-2 negative or an MMP-2 pattern described as border or central and stromal MMP-2 defined as positive or negative. The expression of the biomarkers was compared before and after primary treatment and during androgen blockade in relation to the serum PSA at the time of sampling and duration of androgen blockade. RESULTS: 191 men participated, 35 men before surgery and 43 after surgery; there were no significant differences in HER-2 expression between groups, there was no MMP-2 expression centrally or stromal expression of MMP-2. In men with androgen blockade, HER-2 expression was significantly higher; there was a trend for increasing HER-2 expression up to 5 years; central MMP-2 expression significantly increased after 3 years, while stromal MMP-2 significantly increased after 6 years. MMP-2 expression both in micrometastasis and stroma was significantly associated with HER-2 expression. Expression of MMP-2 at the border of the micrometastasis was not associated with HER-2 expression and occurred in the absence of androgen blockade. CONCLUSIONS: Androgen blockade decreases serum PSA by eliminating HER-2 negative prostate cancer cells. However, there is early selection of HER-2 positive cancer cells which leads to androgen independence and to increased expression of MMP-2 activity in the micrometastasis. The increased MMP-2 activity in the micrometastasis increases the expression of MMP-2 in the surrounding stromal cells and thus could promote angiogenesis and tumor growth resulting in macrometastatic androgen independent disease.

A performance analysis of the presence of malignant circulating prostate cells as a predictive factor for the detection of prostate cancer in the first, second and third prostate biopsy.

OBJECTIVES: Serum prostate specific antigen and digital rectal examination are the tests used as screening tests to detect prostate cancer. However, only approximately 30% of men with suspicion of cancer have it confirmed on prostate biopsy, and not all of these need treatment. Detection of circulating tumor cells in localized prostate cancer has given variable results, but it could be a useful complementary screening tool to detect prostate cancer in men with abnormal screening tests before the evaluation with prostate biopsy. This may be more so in subsequent biopsies where serum PSA has a decreased diagnostic yield. To evaluate the diagnostic yield of the detection of CPCs as a complementary PC screening test in a population fulfilling criteria for an initial, second and third prostate biopsy for suspicion of PC. METHODS: A prospective screening study of consecutive patients aged 45-80 years presenting to the urologist for PC screening. Inclusion criteria were PSA >4.0 ng/ml, PSA velocity >0.35 ng/ml/year and/or DRE suspicious for cancer. Patients fulfilling inclusion criteria had blood taken for CPC detection and then underwent 12-core transrectal prostate biopsy. Double immune-his-tochemical staining with anti-PSA and anti-P504S was used to detect CPCs. Both cytologist and pathologist were blinded to the results of the biopsy, CPC results and clinical details. The diagnostic yield of the presence or absence of CPC was evaluated; the prostate biopsy was classified as cancer or no-cancer. RESULTS: 282 men participated, 83 undergoing of these undergoing a second and 38 a third biopsy, with a mean age of 66.2 ± 8.9 years and a median serum PSA of 5.10 ng/ml, 5.45 ng/ml and 6.45 ng/ml for first, second and third biopsies. Cancer was detected in 33,6%, 10.8% and 29.0% of first, second and third biopsies respectively, CPCs were detected in 36.9%, 21.7% and 36.8% of the patients. Sensibility, specificity and negative predictive value were 86% ,91% and 94% for the first biopsy, 89%, 87% and 99% for the second and 100% , 89% and 100% for third biopsy respectively. All the CPC determinations were interpretable. There were 11 false negative cases, all with small low grade tumors. Of the 29 men with a false positive CPC, 8/10 had cancer detected in the subsequent biopsy. CONCLUSIONS: The use of CPC detection could be useful as a complementary prostate cancer screening test, especially for excluding cancer, and including patients with indications for repeat biopsies. Men with a false positive CPC detection had a high risk of detecting cancer in the succeeding biopsy.

Análisis del desempeño de la presencia de células prostáticas malignas circulantes como factor predictivo para la detección de cáncer de próstata en la primera, segunda y tercera biopsia prostática / A performance analysis of the presence of malignant circulating prostate cells as a predictive factor for the detection of prostate cancer in the first, second and third prostate biopsy

OBJETIVO: El PSA en conjunto con el tacto rectal son los exámenes más utilizados para el cribado de cáncer de próstata (CP), sin embargo, en solo el 30% de estos pacientes se confirma el diagnóstico. En el presente estudio evaluamos el rendimiento diagnóstico de la detección de células prostáticas circulantes malignas (mCPC) para la detección precoz del CP en pacientes que cumplen con los criterios para realización de una o más biopsias prostáticas. MÉTODO: Estudio prospectivo, ciego, con reclutamiento consecutivo de pacientes entre 45-80 años, con sospecha de CP. Criterios de inclusión: PSA sérico >4,0 ng/ml, elevación >0,75 ng/ml/año, tacto rectal sospechoso de cáncer. La detección de mCPC fue realizada por inmunohistoquímica con doble marcación hacia el PSA y P504S. Se evalúo el rendimiento diagnóstico de la presencia o ausencia de mCPC comparándolos con los resultados de la biopsia prostática, la cual se clasificó como cáncer o no cáncer. RESULTADOS: Participaron 282 hombres; 83 de los cuales fueron sometidos a una segunda biopsia y 38 a una tercera. La edad media fue 66.2 ± 8.9 años; una media de PSA de 5,10, 5,45 y 6,45 ng/dl para la primera, segunda y tercera biopsia respectivamente. Se diagnosticó CP en 33.6%, 10,8% y 29,0% y las mCPC se detectaron en 36,9%, 21,7% y 36,8% de la primera, segunda y tercera biopsia respectivamente. Con una sensibilidad, especificidad y valor predictivo negativo de 86.2%, 90.8% y 94.3% para la primera biopsia; 89%, 87% y 99% para la segunda y 100%, 89% y 100% para la tercera biopsia respectivamente. Ocurrieron 11 casos de falsos negativos, con un CP pequeño y de bajo grado. De los 29 pacientes con un falso positivo para CPC, 8/10 tuvieron un cáncer detectado en la siguiente biopsia. CONCLUSIÓN: El uso de la detección de mCPC puede ser un método útil como examen complementario a los actualmente en uso para la detección de cáncer prostático, y durante el seguimiento de pacientes con PSA persistentemente elevado para determinar la necesidad de una re biopsia. Las mCPCs tienen un especial valor por su alto valor predictivo negativo en pacientes con un PSA ≥4.0ng/ml (AU)

OBJECTIVES: Serum prostate specific antigen and digital rectal examination are the tests used as screening tests to detect prostate cancer. However, only approximately 30% of men with suspicion of cancer have it confirmed on prostate biopsy, and not all of these need treatment. Detection of circulating tumor cells in localized prostate cancer has given variable results, but it could be a useful complementary screening tool to detect prostate cancer in men with abnormal screening tests before the evaluation with prostate biopsy. This may be more so in subsequent biopsies where serum PSA has a decreased diagnostic yield. To evaluate the diagnostic yield of the detection of CPCs as a complementary PC screening test in a population fulfilling criteria for an initial, second and third prostate biopsy for suspicion of PC. METHODS: A prospective screening study of consecutive patients aged 45-80 years presenting to the urologist for PC screening. Inclusion criteria were PSA >4.0ng/ml, PSA velocity >0.35ng/ml/year and/or DRE suspicious for cancer. Patients fulfilling inclusion criteria had blood taken for CPC detection and then underwent 12-core transrectal prostate biopsy. Double immune-his-to chemical staining with anti-PSA and anti-P504S was used to detect CPCs. Both cytologist and pathologist were blinded to the results of the biopsy, CPC results and clinical details. The diagnostic yield of the presence or absence of CPC was evaluated; the prostate biopsy was classified as cancer or no-cancer. RESULTS: 282 men participated, 83 undergoing of these undergoing a second and 38 a third biopsy, with a mean age of 66.2 ± 8.9 years and a median serum PSA of 5.10ng/ml, 5.45ng/ml and 6.45ng/ml for first, second and third biopsies. Cancer was detected in 33,6%, 10.8% and 29.0% of first, second and third biopsies respectively, CPCs were detected in 36.9%, 21.7% and 36.8% of the patients. Sensibility, specificity and negative predictive value were 86%, 91% and 94% for the first biopsy, 89%, 87% and 99% for the second and 100%, 89% and 100% for third biopsy respectively. All the CPC determinations were interpretable. There were 11 false negative cases, all with small low grade tumors. Of the 29 men with a false positive CPC, 8/10 had cancer detected in the subsequent biopsy. CONCLUSIONS: The use of CPC detection could be useful as a complementary prostate cancer screening test, especially for excluding cancer, and including patients with indications for repeat biopsies. Men with a false positive CPC detection had a high risk of detecting cancer in the succeeding biopsy (AU)

Influencia del método de remoción de caries en la fuerza de adhesión a dentina afectada / Influence of caries removal method on bond strength to dentin affected

La técnica de adhesión en dentina es una técnica poco predecible y se agudiza aun más cuando la dentina ha sido afectada por caries ya que las alteraciones histológicas disminuyen la posibilidad de esta unión; no obstante la variación en la técnica de remoción del tejido cariado pudiera influir de manera independiente en la unión. El objetivo de esta investigación es determinar la influencia del método de remoción del tejido cariado en la resistencia adhesiva en micro tracción (µTBS) de resina compuesta unida a dentina humana afectada por caries. Se utilizaron 15 molares humanos afectados por caries y de manera aleatoria simple se dividieron en tres grupos (G1,G2,G3), luego se realizó un corte con disco de diamante (KG Sorensen® /Brasil) perpendicular al eje mayor del diente exponiendo la mayor cantidad de dentina afectada, el G1 fue sometido a remoción con Aire abrasivo de oxido de aluminio de 50 µm a una presión de 40 PSI (Microjato®, Bio-art /Brasil), al G2 se le eliminó la caries con fresa redonda de carburo N° 6 a baja velocidad (KG Sorensen® /Brasil)y al G3 se le eliminó con el método Químico/Mecánico (PAPACARIE ® /Brasil y Cucharita para dentina), la eliminación fue corroborada con fluorescencia laser (DIAGNOdent®, Kavo /Germany), posteriormente se aplicó la técnica de grabado total siguiendo las indicaciones del fabricante para adhesivo Excite ®( Ivoclar Vivadent Inc. /USA), y se restauraron 6 mm oclusales con resina compuesta Brilliant Enamel New Line® (Coltène-Whaledent /Germany.), luego se seccionaron con una sierra de precisión ISOMET 1000® (Buehler /USA) y se obtuvieron muestras de 1x1x10 mm , a continuación las muestras se prepararon para la prueba de micro tracción en la máquina de prueba universales AGS-J (Shimadzu /Japan) a una velocidad de desplazamiento de 0,5mm por min. Los datos fueron recolectados en hoja de cálculo Excel y analizados con un ANOVA de 1 Vía, en un nivel (µBts), el valor de p quedo preestablecido en p?0,05

The dentin adhesion technique is a quite unpredictable one and it is enhanced when the dentin has been affected because histological alterations reduce the chance for this union; however, the variation in the removal technique of caries-affected tissue could have an independent influence on the union. Aim: to determine the influence of the method of caries-affected tissue removal on the adhesive resistance in micro-tensile (µTBS) of composite bonded to human dentin affected by caries. Methods: 15 human molars affected by caries were randomly assigned into three groups (G1, G2, and G3). Then, one cut with a diamond disc (KG Sorensen® /Brasil) was performed perpendicular to the major axis of the teeth exposing the larger amount on affected dentin. G1 condition was removal with abrasive air of aluminum oxide of 50 µm at a 40 PSI (Microjato®, Bio-art /Brasil) pressure. G2 had caries removal with carbide round drill N° 6 at a low speed (KG Sorensen® /Brasil). Finally, for G3 caries was removed with the Chemical/Mechanical method (PAPACARIE ® /Brasil and spoon excavator). The elimination was corroborated by laser fluorescence (DIAGNODENT®, Kavo /Germany); later, the total etching technique was performed by following the manufacturer instructions for Excite ® (Ivoclar Vivadent Inc. /USA) and 6 oclusal mm were restored with composite Brilliant Enamel New Line® (Coltène-Whaledent /Germany.), then they were cut with a precision saw ISOMET 1000® (Buehler /USA) and 1x1x10 mm samples were obtained. The samples were prepared for the micro traction test in the universal testing machine AGS-J (Shimadzu /Japan) a speed of 0,5mm per minute. Data were recorded in Microsoft Excel and a one way ANOVA was performed for one level (µBts), the p value was established at p?0,05. Results: the mean µBts in MPa for each group and the standard deviation (±SD) was as follows: G1= 21,7 (8,6) G2=19,70 (10,5) G3=22,2 (9,7)

Redefining micrometastasis in prostate cancer - a comparison of circulating prostate cells, bone marrow disseminated tumor cells and micrometastasis: Implications in determining local or systemic treatment for biochemical failure after radical prostatectomy.

The presence of cells positive for cytokeratins or prostate-specific antigen (PSA) in bone marrow aspirates (BMAs) has been used to indicate the presence of micrometastasis. The aim of this prospective study of prostate cancer patients was to determine the presence of prostate cells in blood and BMAs and to compare them with bone marrow biopsy touch prep samples. The results indicated that there was a satisfactory concordance between circulating prostate cells (CPCs) in blood and disseminated tumor cells (DTCs) in BMAs for all Gleason scores (κ>0.50). However, neither were concordant with the presence of prostate cells in bone marrow biopsies except for high-grade tumors, Gleason 8 and 9. Phenotypic characteristics of CPCs and DTCs were identical (κ>0.9) but were different than cells detected in bone marrow biopsies (κ<0.2). The expression of matrix metalloproteinase-2 (MMP-2) in bone marrow biopsies was positively associated with the Gleason score (trend Chi-squared <0.05) and may explain the differences between the presence of DTCs and the presence of prostate cells in bone marrow biopsies. If the presence of DTCs was used to indicate micrometastatic disease, 20% of patients would be misclassified compared to micrometastasis defined as patients with a positive biopsy. This may have clinical implications for patients with low-grade tumors.

Rendimiento diagnóstico de la detección de células prostáticas malignas en la circulación sanguínea para la detección précoz del cáncer prostático: una comparación con la biopsia prostática / Diagnostic performance of malignant prostatic cells detection in blood for early detection of prostate cancer: comparison to prostatic biopsy

OBJETIVO: El PSA y el tacto rectal son los exámenes utilizados para el tamizaje de cáncer prostático (CP), pero solo en el 30% de los pacientes con sospecha de cáncer prostático se confirma el diagnóstico. La detección de células prostáticas circulantes en sangre puede ser una herramienta útil para la detección de cáncer prostático en estos pacientes.Evaluar el rendimiento diagnóstico de la detección de CPCm para la detección precoz del CP, en una población que cumple los criterios para la realización de una biopsia prostática por sospecha de CP.MÉTODO: Estudio prospectivo, con reclutamiento consecutivo de pacientes entre 45-80 años, con sospecho de CP. Criterios de inclusión: PSA sérico >4,0 ng/ml, elevación >0,35 ng/ml/año, tacto rectal sospechoso de cáncer. Pacientes con alguno de estos criterios fue sometido a una biopsia prostática transrectal y a la determinación de CPCm en sangre. La detección de CPCm fue realizada por inmunohistoquímica con doble marcación hacia el PSA y P504S. Tanto el citólogo como el patólogo fueron ciegos al resultado de las CPCm y la BP, así como a los datos clínicos. Se evalúo el rendimiento diagnóstico de la presencia o ausencia de CPCm. La biopsia se clasificó como cáncer o no cáncer. Los pacientes fueron divididos entre 1) PSA ≥4,0ng/ml y 2) PSA <4,0ng/ml y cumple con otro criterio para una BP.RESULTADOS: Participaron 228 hombres; edad media de 66.8 ± 8.8 años; PSA mediana de 5.15 ng/dl. Se diagnosticó CP en 28.6% de los casos mediante la BP y las CPCm se detectaron en 31% de todos los pacientes. Con una sensibilidad, especificidad y valor predictivo negativo de 86.2%, 90.8% y 94.3%, respectivamente. Razón de verosimilitud negativa y positiva de 0,15 y 9,36. En hombres con un PSA <4,0ng/ml, hubo 13,3% con CP, una sensibilidad y especificidad de 83,3% y 84,6% y valor predictivo negativo de 97,1%. Ocurrieron 9 casos de falsos negativos, con un CP pequeño y de bajo grado(AU)

CONCLUSIÓN: La detección de CPCm podría ser útil como examen complementario en la detección de cáncer prostático, en especial para su exclusión, incluido pacientes con PSA < de 4 ng/ml(AU)

OBJECTIVES: Serum prostate specific an-tigen and digital rectal examination are the tests used as screening tests to detect prostate cancer. However, only approximately 30% of men with suspicion of can-cer have it confirmed on prostate biopsy, and not all of these need treatment. Detection of circulating tumor cells in localized prostate cancer has given variable re-sults, but it could be a useful complementa-ry screening tool to detect prostate cancer in men with abnormal screening tests before the evaluation with prostate biopsy.To evaluate the diagnostic yield of the detection of mCPC as a complementary PC screening test in a po-pulation fulfilling criteria for a prostate biopsy for sus-picion of PC.METHODS: A prospective screening study of consecuti-ve patients aged 45-80 years presenting to the urologist for PC screening. Inclusion criteria were PSA >4.0ng/ml, PSA velocity >0.35ng/ml/year and/or DRE suspi-cious for cancer. Patients fulfilling inclusion criteria had blood taken for mCPC detection and then underwent 12-core transrectal prostate biopsy. Double immune-histochemical staining with anti-PSA and anti-P504S was used to detect mCPC. Both cytologist and pathologist were blinded to the results of the biopsy, mCPC results and clinical de-tails. The diagnostic yield of the presence or absence of mCPC was evaluated; the prostate biopsy was classi-fied as cancer or no-cancer(AU)

RESULTS: 228 men participated, with a mean age of 66.8 ± 8.8 years and a median serum PSA of 5.15ng/ml. 28.6% of the biopsies were positive for PC, and mCPC were detected in 31.0% of all cases. Sensibility, specifici-ty and negative predictive value were 86.2%, 90.8% and 94.3% respectively. The negative and positive like-lihood ratios were 9.36 and 0.15. In men with a PSA <4.0ngml, 13.3% had cancer detected on biopsy, with a sensibility and specificity for mCPC detection of 83.3% and 84.6% and negative predictive value of 97.1%. All the mCPC determinations were interpretable. There were 9 false negative cases, all with small low grade tumors.CONCLUSIONS: The use of mCPC detection could be useful as a complementary prostate cancer screening test, especially for excluding cancer, including patients with a serum PSA <4.0ng/ml(AU)

Diagnostic performance of malignant prostatic cells detection in blood for early detection of prostate cancer: comparison to prostatic biopsy.

OBJECTIVES: Serum prostate specific antigen and digital rectal examination are the tests used as screening tests to detect prostate cancer. However, only approximately 30% of men with suspicion of cancer have it confirmed on prostate biopsy, and not all of these need treatment. Detection of circulating tumor cells in localized prostate cancer has given variable results, but it could be a useful complementary screening tool to detect prostate cancer in men with abnormal screening tests before the evaluation with prostate biopsy. To evaluate the diagnostic yield of the detection of mCPC as a complementary PC screening test in a population fulfilling criteria for a prostate biopsy for suspicion of PC. METHODS: A prospective screening study of consecutive patients aged 45-80 years presenting to the urologist for PC screening. Inclusion criteria were PSA >4.0 ng/ml, PSA velocity >0.35 ng/ml/year and/or DRE suspicious for cancer. Patients fulfilling inclusion criteria had blood taken for mCPC detection and then underwent 12-core transrectal prostate biopsy. Double immune-histochemical staining with anti-PSA and anti-P504S was used to detect mCPC. Both cytologist and pathologist were blinded to the results of the biopsy, mCPC results and clinical details. The diagnostic yield of the presence or absence of mCPC was evaluated; the prostate biopsy was classified as cancer or no -cancer. RESULTS: 228 men participated, with a mean age of 66.8 ± 8.8 years and a median serum PSA of 5.15 ng/ml. 28.6% of the biopsies were positive for PC, and mCPC were detected in 31.0%of all cases. Sensibility, specificity and negative predictive value were 86.2%, 90.8% and 94.3% respectively. The negative and positive like-lihood ratios were 9.36 and 0.15. In men with a PSA <4.0ngml, 13.3% had cancer detected on biopsy, with a sensibility and specificity for mCPC detection of 83.3% and 84.6% and negative predictive value of 97.1%. All the mCPC determinations were interpretable. There were 9 false negative cases, all with small low grade tumors. CONCLUSIONS: The use of mCPC detection could be useful as a complementary prostate cancer screening test, especially for excluding cancer, including patients with a serum PSA <4.0 ng/ml.

Programa de comunicación a distancia. Elaboración de indicadores cuali-cuantitativos para su evaluación / Outreach education program. Development of qualitative and quantitative assessment markers.

La Oficina de Comunicación a distancia (OCD) es una estructura creada en 1997 en el Hospital de Pediatría Juan P. Garrahan, con el objetivo de responder consultas a distancia y facilitar el seguimiento de pacientes, con la intención de evitar los traslados innecesarios. Ha dado respuesta a más de 25000 consultas. Actualmente, en el marco del Programa de Comunicación a Distancia (PCD), funcionan 88 OCD distribuidas en 12 de las 23 provincias argentinas. Se presentan resultados sobre una muestra de 148 consultas realizadas al Hospital Garrahan desde 6 provincias, que participaron de un estudio de tipo descriptivo, retrospectivo, cuali-cuantitativo. Éste permitió formular nuevas formas de registro de la tarea y elaborar indicadores cualicuantitativos para evaluar el PCD: consultas, motivo de consulta, tipo de paciente consultado, necesidad de la consulta, duración de la enfermedad al momento de la consulta, derivación sugerida, tiempo de respuesta. Se analizó el número de consultas y las sugerencias de derivación, mostrando las primeras un progresivo y significativo incremento desde la implementación del PCD. Con relación a los motivos de consulta, 84% correspondió a definición de diagnóstico y tratamiento, 16% a motivos de seguimiento e intercurrencias. 62% presentaba patologías crónicas. 95% de los pacientes fueron definidos como complejos. 79% correspondió a consultas definidas como imprescindibles. La derivación fue sugerida en el 54% de las consultas. La mediana del tiempo de respuesta fue de 48 horas. El bajo porcentaje atribuido a "motivos de seguimiento" evidencia la necesidad de profundizar estrategias para promoverlo. El PCD oficializó una modalidad de comunicación que canaliza prácticas anteriormente realizadas a través de vías informales, resignificando la gestión como acto asistencial. Contribuyó a la implementación de metodologías de evaluación conjunta de los indicadores considerados, que contemplan el contexto de la población con la que se trabaja (AU)

In 1997, the Outreach Communication Office (OCO) was created at the Pediatric Hospital Juan P. Garrahan with the aim of responding to consultations from remote places and facilitating follow-up of patients while avoiding unnecessary patient transportations. More than 25,000 consultations have been responded. Currently, within the framework of the Program of Outreach Communication (POC), 88 OCO's are operating distributed over 12 of the 23 Argentine provinces. Here we present the results of a sample of 148 consultations made at the Garrahan Hospital from six provinces that participated in a descriptive, retrospective, qualitative and quantitative study. The study allowed formulation of new methods of task registration and the development of qualitative and quantitative indicators to evaluate the POC: consultations, reason for consultation, type of patient, urgency of the consultation, disease duration until the moment of consultation, suggested referral, and time to response. The number of consultations and suggestions for referral were analyzed showing a progressive and significant increase of the former since the implementation of the POC. Of the reasons for consultation, 84% was related to definition of diagnosis and treatment, 16% to follow-up and intercurrencies. Of all patients, 62% had chronic diseases and 95% were considered complex patients. Of the consultations, 79% were defined as essential and 54% of the patients were referred to specialists. Mean time to response was 48 hours. The low percentage of consultations for "reasons of follow-up" reveals the need to develop strategies to encourage this modality. The POC has officialized a means of communication channeling practices that previously were informal giving a new meaning to the concept management in health care. The POC has contributed to the implementation of methodologies for the assessment of global markers taking into account the context of the population in question (AU)

Evaluación de las propiedades flexurales y reológicas de cinco resinas compuestas formuladas para restauraciones anteriores / Evaluation of flexural and rheological properties of five resin composites formulated for anterior restorations

El objetivo de esta investigación fue evaluar las propiedades flexurales y reológicas de cinco resinas compuestas formuladas para restauraciones anteriores. Materiales y métodos: Se realizaron 17 muestras de resinas compuestas para cada grupo: G1 Ice® esmalte A2, G2 Ice® dentina OA2 (SDI), G3 Tetric N- Ceram® A2, G4 InTen-S® A3, G5 Tetric - Ceram® A2 (Ivoclar/Vivadent), G6 Filtek Z350® A2 (3M/ESPE); 10 muestras de cada grupo se confeccionaron con dimensiones de 25 mm de largo x 2 mm de alto x 2 mm de ancho para ser sometidas test de flexión de tres puntos, en una máquina de pruebas universales (Shimadzu AGS-J) a una velocidad de 1 mm/min. Para la prueba de escurrimiento se confeccionaron 7 muestras por cada grupo, de 5mm de diámetro x 3 mm de alto sin polimerizar entre 2 láminas de policarbonato con una carga de 20 Newtons x 60 segundos. Los datos fueron analizados con un ANOVA de 1 Vía para cada variable, utilizando el Software estadístico SPSS 15.0 ®. Resultados: La variable resistencia flexural obtuvo una p= 0,000; lo que indica diferencia estadística significativa, los grupos se ubicaron: G6? G2, G3= G1, G5> G4. La variable módulo flexural obtuvo un p= 0,000 lo que indica diferencia estadística significativa, los grupos se ubicaron: G6? G2, G3= G5, G1> G4. La variable escurrimiento obtuvo un p= 0,000 lo que indica diferencia estadística significativa, los grupos se ubicaron: G2> G3, G4? G6, G5, G1. Conclusiones: En las condiciones en que se realizó esta investigación las propiedades flexurales de las resinas compuestas de nanorrelleno G6 fueron superiores a las híbridas G5, G4; las microhíbridas G2, G1 y la nanohíbrida G3. La capacidad de escurrimiento no parece estar influenciada por el porcentaje de relleno proporcionado por el fabricante, la clase y la marca comercial, ya que casi todos los grupos presentaron un escurrimiento homogéneo; sin embargo el G2 parece tener una viscosidad reducida lo cual se relaciona con una difícil manipulación

The aim of this study was to evaluate flexural and rheological properties of five resin composites formulated for anterior restorations. Materials and methods: 17 samples of resin composite were made for each group: G1 Ice® enamel A2, G2 Ice® dentine OA2 (SDI), G3 Tetric N- Ceram® A2, G4 InTen-S® A3, G5 Tetric - Ceram® A2 (Ivoclar/Vivadent), G6 Filtek Z350® A2 (3M/ESPE); 10 samples of each group were made with a 25 x 2 x2 mm dimension and submitted at the three-point flexural test, in a universal testing machine (Shimadzu AGS-J) at a speed of 1 mm/min. For the flow test a load of 20 Newtons during 60 seconds, were applied at 7 samples of each group made of 5mm of diameter and 3 mm of thickness without photocuring between the two polycarbonate laminate. The data were analyzed whit a one way ANOVA for each variable, using statistical Software SPSS 15.0 ®. Results: The flexural strength variable obtained a p= 0,000 value indicating a strong and significant statistical difference, the ranks groups were: G6? G2, G3= G1, G5> G4. The elastic module variable obtained a p= 0.000 value; indicating significant statistical difference, the ranks groups were: G6? G2, G3= G5, G1> G4. The slumping resistance variable obtained a p= 0.000 value indicating significant statistical difference, the ranks groups were: G2> G3, G4? G6, G5, G1. Conclusions: In the conditions in which this research was made the flexural properties of nanofilled composite resin G6 were superior to the G5, G4 hybrids; the G2, G1 micro-hybrids and the nano-hybrid G3. The flow capacity seems not to be influenced by the percentage of filling referred by the manufacturer, the class and the trade name since almost all the groups presented a homogenous flow; nevertheless the G2 seems to have a reduced viscosity which is related to a difficult manipulation

Microfiltración en cavidades clase II restauradas con resinas compuestas de baja contracción

El objetivo: El propósito de esta investigación es comparar la capacidad de sellando marginal en el margen gingival de tres sistemas de resina compuesta en premolares humanos. Los tres sistemas usados fueron: Resina Grupo 1 ORMOCERAMICA (Admira Bond, Admira Flow A2, Admira A2 - Voco), Resina Grupo 2 NANOHIBRIDA (Solobond M, Grandio Flow A2, Grandio A2 - Voco), Resina Grupo 3 HIBRIDA (Excite, Tetric Flow A2, el Tetric Ceram A2 - Ivoclar / Vivadent). Materiales y Métodos: se prepararon 30 premolares humanos con dos cavidades clase II y asignados al azar en tres grupos (G1, G2, y G3) con 20 restauraciones para cada grupo, se realizaron las restauraciones siguiendo las instrucciones de la casa fabricante. Después de restaurados las muestras se termociclaron (500 ciclos entre 5-55°C) y se almacenaron en agua durante 90 días. Luego se sumergieron en una solución de 50% de nitrato de plata durante dos horas, se fijaron, se seccionaron y se analizaron con imágenes digitales. La prueba no paramétrica (Kruskal-Wallis) fue usada para observar las diferencias estadísticas. Resultados: Se observaron diferencias significativas en la microfiltración (p = 0,002) entre los materiales restaurativos usados. Los sistemas quedaron ordenados de la siguiente manera 20.98 G3, 31.65 G1, y 38.88 G2. Conclusión: Bajo las condiciones en las que se realizo este estudio, los bajos valores de contracción de polimerización reportados para ORMOCERAMICA G1 (1,97vol%) o NANOHIBRIDA G2 (1,57vol%) no muestran mayor capacidad de sellar los márgenes gingivales de restauraciones clase II después del termociclado y el almacenamiento en agua por 90 días, cuando se compararon con una resina compuesta de contracción convencional G3 HÍBRIDA (2,32vol%).

Objective: The purpose of this research was to compare the sealing capability of three all-composite system Class II (human premolars) restorations at the gingival margin. The three systems used were: group 1 ORMOCER (Admira Bond, Admira Flow A2, Admira A2 -Voco), group 2 NANOHYBRID (Solobond M, Grandio FlowA2, GrandioA2 - Voco), group 3 HYBRID (Excite, Tetric Flow A2, Tetric Ceram A2 - Ivoclar /Vivadent). Methods and Materials: 30 human premolars were prepared with 2 single classes II and randomly assigned to three groups (G1, G2, and G3) with 20 restorations for each one following the manufacturer's instructions. After restored, samples were thermocycled (500 cycles between 5-55◦C) and stored in water for 90 days. Then, they were immersed in a 50% of Ag ion solution for two hours, sectioned and analyzed by digital imaging. No-parametric test (Kruskal-Wallis) was used to detect statistical differences. Results: Significant differences in microleakage were observed (p = 0,002) among the restorative materials used. Respect to the manufacturer's system the mean ranks were 20.98 G3, 31.65 G1, and 38.88 G2. Conclusion: Under the conditions of this study, the reduced polymerization shrinkages reported for ORMOCER G1 (1,97vol %) or NANOHYBRID G2 (1,57vol %) don't show better capacity of sealing in gingival margins of class II after thermo - cycling and water storage when compared to HYBRID G3 (2,32vol %).

Cambios en la sensibilidad antibiótica de E. Coli en mujeres con infección urinaria baja ambulatoria en un período de 10 años / Change in E. Coli antibiotic therapy resistance in female urinary tract infections in the last 10 years

La infección urinaria constituye la infección bacteriana más común, siendo los bacilos gram negativos(E. coli, P. mirabilis, Klebsiella) los patógenos más frecuentes. Esta enfermedad pese a los nuevos conocimientos tanto en factores relacionados con el huésped cómo en los relacionados con la biología de las bacterias, aún nos enfrenta a numerosos problemas no resueltos, cómo son la resistencia a los antibióticos y la recurrencia. La resistencia, de los patógenos, a los agentes antimicrobianos es un problema muy importante para la elección deun tratamiento de primera línea, por lo que nos parece necesario conocer sus cambios. El objetivo de este estudio es evaluar los cambios experimentados por la susceptibilidad de la E. Coli a los antibióticos de uso frecuente, en pacientes de consulta ambulatoria con ITU baja no complicada, en un período de 10 años. Realizamos unarevisión retrospectiva de los antecedentes, urocultivos y antibiograma de pacientes de sexo femenino que consultaron en nuestro centro en los años 1996 y 2005. Se registró la edad, bacteria y antibiograma de aquellas con urocultivos positivos, comparando las variaciones producidas en este período de tiempo. Se utilizó la prueba de Chi cuadrado para comparar la sensibilidad antibiótica. En el año 1996, durante el período enero a septiembre, se registraron 242 pacientes con urocultivos positivos, con una edad promedio de 46 años. En el 91,3 por ciento la bacteria responsable fue Escherichia coli. Durante el mismo período en el año 2005 registramos 296 pacientes con urocultivos positivos, con edad promedio de 52 años y Escherichia coli en el 88,5 por ciento. La resistencia de E. Coli a cotrimoxazol, sulbactam-ampicilina, Ac. Pipemídico, cefotaxima y cefradina aumentó significativamente. Por el contrario la resistencia a gentamicina disminuyó significativamente. El ciprofloxacino, norfloxacino, nitrofurantoina y amikacinano presentaron cambios significativos. Conclusiones: Los cambios en la...

The urinary tract infection (UTI) is the most common bacterial infection, caused by several germs like gramnegative bacillus ( E. Coli, P. Mirabilis, Klebsiella). This disease has a lot of non-resolved problems like resistance to the antibiotics and recurrence. The germ resistance is important at the moment to choose a first line antibiotic.The aim of the study was evaluate the evolution of E. Coli resistance to the frequent used antibiotics in female outpatients of our center with no complicate UTI in a 10 years period. We assessed retrospectively our database ofurine culture (UC) and antibiogram the years 1996 and 2005 from January to September using the Chi square test to compare the antibiotic sensitivity. In 1996 we found 242 patients with positive UC, the mean age was 46 years and E. Coli was responsible in 91,3 percent. In 2005 we had 296 patients with positive UC, the mean age was 52 years and E. Coli was responsible in 88,5 percent. We found a rise E. Coli resistance (statistically significant) to cotrimoxazol, sulbactam-ampicilin, pipemidic acid, cefotaxim and cefradin. Ciprofloxacin, norfloxacin, nitrofuranto in and amikacin present no significant changes. Gentamicin has an important increase of sensitivity.

[Pancreatic exocrine function in diabetes mellitus. Determination of fecal elastase]. / Función pancreática exocrina en diabetes mellitus. Determinación de elastasa fecal.

BACKGROUND: One of the complications of diabetes mellitus is the development of pancreatic exocrine insufficiency. AIM: To study pancreatic exocrine function in diabetics patients. MATERIAL AND METHODS: Seventy two diabetic patients were included in the protocol, but two were withdrawn because an abdominal CAT scan showed a chronic calcified pancreatitis, previously undiagnosed. Fecal elastase was measured by ELISA and the presence of fat in feces was assessed using the steatocrit. RESULTS: Mean age was 60+/-12 years and 67 (96%) patients had a type 2 diabetes. Fecal elastase was normal (elastase >200 microg/g) in 47 (67%) patients, mildly decreased (100-200 microg/g) in 10 (14%) and severely decreased in 13 (19%). There was a significant association between elastase levels and time of evolution of diabetes (p=0.049) and between lower elastase levels and the presence of a positive steatocrit (p=0.042). No significant association was found between elastase levels and other chronic complications of diabetes such as retinopathy, nephropathy, neuropathy, microangiopathy or with insulin requirement. CONCLUSIONS: One third of this group of diabetic patients had decreased levels of fecal elastase, that was associated with the time of evolution of diabetes. Patients with lower levels of elastase have significantly more steatorrhea. Among diabetics it is possible to find a group of patients with non diagnosed chronic pancreatitis.

Función pancreática exocrina en diabetes mellitus: Determinación de elastasa fecal / Pancreatic exocrine function in diabetes mellitus: Determination of fecal elastase

Background: One of the complications of diabetes mellitus is the development of pancreatic exocrine insufficiency. Aim: To study pancreatic exocrine function in diabetics patients. Material and methods: Seventy two diabetic patients were included in the protocol, but two were withdrawn because an abdominal CAT scan showed a chronic calcified pancreatitis, previously undiagnosed. Fecal elastase was measured by ELISA and the presence of fat in feces was assessed using the steatocrit. Results: Mean age was 60±12 years and 67 (96%) patients had a type 2 diabetes. Fecal elastase was normal (elastase >200 µg/g) in 47 (67%) patients, mildly decreased (100-200 µg/g) in 10 (14%) and severely decreased in 13 (19%). There was a significant association between elastase levels and time of evolution of diabetes (p=0.049) and between lower elastase levels and the presence of a positive steatocrit (p=0.042). No significant association was found between elastase levels and other chronic complications of diabetes such as retinopathy, nephropathy, neuropathy, microangiopathy or with insulin requirement. Conclusions: One third of this group of diabetic patients had decreased levels of fecal elastase, that was associated with the time of evolution of diabetes. Patients with lower levels of elastase have significantly more steatorrhea. Among diabetics it is possible to find a group of patients with non diagnosed chronic pancreatitis.

Hepatitis crónica por virus C: factores asociados a la severidad del daño histológico / Factors associated with the severity of liver damage in chronic hepatitis C

Background: Twenty percent of patients with chronic hepatitis C evolve to cirrhosis in 10 to 20 years. The degree of steatosis and hepatic iron stores in liver biopsy increase the risk. Age, high body mass index, diabetes mellitus and alcohol consumption are factors associated to the severity of liver damage. Aim: To study the association of steatosis and increased iron stores in the liver biopsy and age, overweight, alcohol consumption and diabetes with the severity of liver damage in patients with hepatitis C virus infection. Patients and methods: Retrospective study of 84 liver biopsies of patients with chronic infection with hepatitis C virus were studied. The pathological appearance was classified as stage I when chronic hepatitis with mild activity without fibrosis was observed; as stage II when moderate chronic hepatitis with mild fibrosis was observed and as stage III when there was a moderate chronic hepatitis with fibrosis or cirrhosis. The amount of steatosis and iron deposition in the biopsy were also assessed. Results: Forty one percent of patients were in stage I, 32% in stage II and 27% in stage III. Patients in stage I were younger than those in stages II and III (40.7 and 52.2 years respectively, p <0,001). No association between the severity of liver damage and the degree of steatosis, hemosiderosis, body mass index or alcohol intake, was observed. The frecuency of diabetes mellitus increased along with pathological staging (3, 15 and 30% in stages I, II and III, respectively, p <0,05). Conclusions: This study confirms that severity of chronic hepatitis C is associated with age and the presence of diabetes mellitus.

Colangitis esclerosante primaria: revisión de 12 años en dos centros de referencia / Primary sclerosing cholangitis: A twelve-year experience

Background:Primary sclerosing cholangitis (PSC) is a chronic cholestatic disorder characterized by progressive inflammation and fibrosis of the biliary tract, evolving to cirrhosis. It is commonly associated with inflammatory bowel disease (IBD). Aim: To communicate the clinical characteristics of patient with PSC seen in two reference centers. Patients and methods: Review of medical records of patients with PSC confirmed by liver biopsies. The clinical picture, laboratory abnormalities, imaging studies and treatment were recorded. Results: Thirty three patients (aged 16 to 73 years, 64% female) were identified. They corresponded to 1.7% of liver biopsies done between 1991-2003. Clinical presentation was a cholestatic picture in 40%, right upper abdominal pain in 36%, a dysenteric syndrome in 9% and varied symptoms in 15%. Laboratory tests showed cholestasis in 94% and positive anti ANCA, SMA, ANA and AMA antibodies in 28, 18, 15 and 9% of cases, respectively. Endoscopic retrograde cholangiopancreatography and magnetic resonance cholangiography were diagnostic in 43 and 58% of patients, respectively. There was an association with ulcerative colitis in 12% of cases. Liver biopsies showed grade I PSC in 76% and grade II-III in 6% of patients. It also showed a concomitant chronic hepatitis and primary biliary cirrhosis in 12 and 6% of cases, respectively. Treatment consisted on ursodeoxycholic acid (UDCA) in 45%, UDCA plus 5-aminosalicylic acid derivatives in 12% and UDCA plus immunosuppresors in 12% of patients. Two patients had to be transplanted. Conclusions: PSC is an uncommon cause of chronic liver disease. It is suspected in cholestatic patients and confirmed with a liver biopsy. It can be associated with other autoimmune hepatic and extrahepatic diseases.

[Factors associated with the severity of liver damage in chronic hepatitis C]. / Hepatitis crónica por virus C: factores asociados a la severidad del daño histológico.

BACKGROUND: Twenty percent of patients with chronic hepatitis C evolve to cirrhosis in 10 to 20 years. The degree of steatosis and hepatic iron stores in liver biopsy increase the risk. Age, high body mass index, diabetes mellitus and alcohol consumption are factors associated to the severity of liver damage. AIM: To study the association of steatosis and increased iron stores in the liver biopsy and age, overweight, alcohol consumption and diabetes with the severity of liver damage in patients with hepatitis C virus infection. PATIENTS AND METHODS: Retrospective study of 84 liver biopsies of patients with chronic infection with hepatitis C virus were studied. The pathological appearance was classified as stage I when chronic hepatitis with mild activity without fibrosis was observed; as stage II when moderate chronic hepatitis with mild fibrosis was observed and as stage III when there was a moderate chronic hepatitis with fibrosis or cirrhosis. The amount of steatosis and iron deposition in the biopsy were also assessed. RESULTS: Forty one percent of patients were in stage I, 32% in stage II and 27% in stage III. Patients in stage I were younger than those in stages II and III (40.7 and 52.2 years respectively, p <0,001). No association between the severity of liver damage and the degree of steatosis, hemosiderosis, body mass index or alcohol intake, was observed. The frequency of diabetes mellitus increased along with pathological staging (3, 15 and 30% in stages I, II and III, respectively, p <0,05). CONCLUSIONS: This study confirms that severity of chronic hepatitis C is associated with age and the presence of diabetes mellitus.

Uso, abuso y dependencia de sustancias psicoactivas legales e ilegales en adolescentes de bachillerato y su relación con la funcionalidad familiar en el cantón Ambato-Tungurahua / Uso, abuse and dependency of legal and illegal psychoactive substances in adolescents of baccalaureate and their relation with the familiar functionality in the Ambato-Tungurahua corner

Objetivo: La frecuencia del uso, abuso y dependnecia de sustancias psicoactivas en población adolescente fue investigado con el propósito de determinar su relación con la percepción de la funcionalidad familiar por parte de el/la adolescente, así como la relación con su madre o padre, en colegios matutinos del cantón Ambato, Tungurahua. Métodos: En un total de 28 colegios. Se escogieron de manera aleatoria y sistemática un total de 552 alumnos. La información fue recolectada mediante respuestas anónimas en tres cuestionarios validados intenrnacionalemte y uno desarrollado por los autores. Resultados: El 75,2 por ciento de las y los encuestados han usado alguna vez sustancias psicoactivas, el 19,9 por ciento abusan...