Use of platelet-rich plasma in the healing of chronic ulcers of the lower extremity.

INTRODUCTION AND OBJECTIVES: Platelet-rich plasma (PRP) is used as an adjuvant in the treatment of chronic ulcers of the lower extremity and has shown particularly promising results in the case of neuropathic ulcers. There has been less research, however, into its use in venous and hypertensive ulcers. Our aim was to assess the safety and feasibility of using PRP in the treatment of chronic ulcers of the lower extremity and to evaluate its potential benefits in directed healing. MATERIAL AND METHODS: We prospectively selected 11 patients with nonischemic ulcers of the lower extremity that had been present for at least 6 weeks. PRP was injected subcutaneously into the perilesional tissue and applied topically in 4 sessions held at 1-week intervals. We assessed quality of life (SF-12 questionnaire), pain (visual analog scale), and the circumference of the ulcer before and after treatment. RESULTS: There was a predominance of women (8/11, 73%), and venous ulcers (7/11, 64%) were more common than hypertensive ulcers (4/11, 36%). The median age of the patients was 79 years and the median time since onset of the ulcer was 17 months (range, 6-108 months). We observed a significant reduction in pain (P<.05) and a significant improvement in the physical and mental components of the SF-12 (P<.05). The mean reduction in ulcer size was 60%, and complete healing was achieved in 5 cases. No adverse effects were observed. CONCLUSION: The local application of PRP is a valuable and practical procedure that promotes the healing of chronic ulcers of the lower extremity; it can improve patient quality of life and is particularly effective in local pain relief.

Oropharyngeal administration of colostrum to extremely low birth weight infants: theoretical perspectives.

Studies in adults have shown that the oropharyngeal route can be used to effectively and safely administer interferon-alpha, an immune cell-derived cytokine, to patients who are unable to tolerate its parenteral administration. The mechanism for this appears to be the stimulatory effects of the cytokine, on the oropharyngeal-associated lymphoid tissue system. Own mother's colostrum (OMC) is rich in cytokines and other immune agents that provide bacteriostatic, bacteriocidal, antiviral, anti-inflammatory and immunomodulatory protection against infection. OMC may be especially protective for the extremely low birth weight (ELBW) infant in the first days of life; however clinical instability typically precludes enteral feedings during this period. Oropharyngeal administration is a potential alternative method of providing OMC. Oropharyngeal administration of OMC may have immunomodulatory effects on the recipient infant, and would be especially beneficial to the ELBW infant who would otherwise remain nil per os during the first days of life.

[Ophthalmological manifestations of arterial hypertension]. / Manifestaciones oftalmológicas de la hipertensión arterial.

Systemic Arterial hypertension (AHT) is one of the most frequent diseases in the industrialised countries, with an incidence reaching 30%, a figure that is rising due to the greater life expectancy of the population. This rise in arterial tension causes, or accelerates, changes in the vascular wall of the target organs such as the kidney, brain, heart and eye. At the ocular level, AHT produces lesions in the retina, the choroids and optic nerve head; this can include a wide range of lesions, from slight vascular narrowing to severe visual loss due to ischaemic optical neuropathy. The primary response of the retinal arteries to systemic arterial hypertension is vascular narrowing and the manifestations that appear at the back of the eye in hypertensive retinopathy are diffuse or focal vasoconstriction, extravasation due to increased vascular permeability and arteriosclerosis with swelling of the wall of the vessels. These three entities are responsible for the appearance of different lesions that characterise the stages of the retinal disease, which are: arteriovenous crossings, hard and cotton-like exudates, thrombosis, embolisms, haemorrhages in the retinal parenchyma, vitreous detachment from the retina, papilla edema and ischaemic optical neuropathy in the more severe cases, such as in case malign arterial hypertension.

[Eyelid contact allergic eczema caused by topical ketorolac tromethamine 0.5%]. / Eccema alérgico de contacto palpebral por ketorolaco trometamol 0,5% tópico.

CLINICAL CASE: A 65-year-old man had been treated with eye-drops containing NSAIDs (Ketorolac). He developed conjunctival injection, edematous swelling of the eyelids and periorbital dermatitis due to a contact allergy. Allergy to NSAIDs is uncommon. DISCUSSION: This is an unusual case because topical application of ketorolac is safe in the vast majority of ophthalmologic patients. However adverse events associated with Ketorolac are similar to that of other NSAIDs.

Evaluation of alternatives to RFLP for the analysis of clustered cases of tuberculosis.

BACKGROUND: Mycobacterial interspersed repetitive unit-variable number tandem repeat (MIRU-VNTR) analysis is a recently developed method which could be suitable as a 'real-time' genotyping tool for Mycobacterium tuberculosis. METHODS: One hundred and thirty-four M. tuberculosis isolates were analysed using the reference method, IS6110-restriction fragment length polymorphism (RFLP), and by MIRU, alone and together with spoligotyping. RESULTS: MIRU reduced the genotyping turnaround time by 21 days. The discriminatory power (HGDI) for MIRU and RFLP was 0.978 and 0.989, respectively. RFLP clustered 41.8% of the isolates (17 clusters; 2-9 representatives), whereas MIRU increased the number and size of the clusters (57.5% of the isolates in 20 clusters; 2-14 representatives). With respect to the RFLP clusters, MIRU data showed full correlation in only 7/ 17 (41%) clusters and low correlation in 8/17 (47%) clusters. When MIRU and spoligotyping were considered together, the analysis fitted better with RFLP data: 1) 42.5% of the isolates were grouped in 20 clusters of 2-6 representatives, and 2) the number of clusters with full correlation with RFLP data increased to 11/17 and those with low correlation decreased to 2/17. CONCLUSION: MIRU-VNTR analysis showed low correlation with RFLP. The addition of spoligotyping to MIRU analysis fitted much better with RFLP analysis, although full correlation was still not achieved.

Eccema alérgico de contacto palpebral por ketorolaco trometamol 0.5% tópico / Eyelid contact allergic eczema caused by topical ketorolac tromethamine 0.5%

Caso clínico: Hombre de 65 años que había sidotratado con AINE tópico (Ketorolaco). El pacientepresentó inyección conjuntival, edema de párpados,y dermatitis periorbitaria por eccema alérgico decontacto secundario a AINE, un hecho raro en estetipo de tratamiento.Discusión: Este es un caso raro, ya que la aplicaciónde Ketorolaco tópico es seguro en la mayoríade los pacientes oftalmológicos. Además, las reaccionesadversas asociadas con el Ketorolaco sonsimilares a otros AINES

Clinical case: A 65-year-old man had been treated with eye-drops containing NSAIDs (Ketorolac). He developed conjunctival injection, edematous swelling of the eyelids and periorbital dermatitis due to a contact allergy. Allergy to NSAIDs is uncommon. Discussion: This is an unusual case because topical application of ketorolac is safe in the vast majority of ophthalmologic patients. However adverse events associated with Ketorolac are similar to that of other NSAIDs

Extramedullary plasmacytoma of the salivary gland in two Syrian hamsters (Mesocricetus auratus).

Two Syrian hamsters developed marked swelling of the ventral neck. Histologic examination of both masses revealed that the submaxillary salivary glands were effaced by large numbers of neoplastic plasma cells. In one hamster, neoplastic cells had infiltrated the adjacent lymph node. The neoplastic cells expressed CD79a antigen and were negative for CD3, lambda, and kappa light chains. Ultrastructural features of neoplastic cells in the salivary gland of one hamster included abundant cytoplasmic rough endoplasmic reticulum profiles, and peripherally displaced nuclei that contained marginated heterochromatin, consistent with plasma cells. Salivary gland plasmacytomas are extremely rare in humans and have not previously been reported in nonhuman species. The occurrence of such neoplasms in two hamsters suggests that this species may be predisposed to developing tumors of this type.

[Intraocular lenses with blue light filter]. / Lentes intraoculares con filtros para luz azul.

PURPOSE: To evaluate if a SN60AT <> IOL (Alcon) with IMPRUV filter (Alcon) offers any advantage in patients having cataract surgery, as compared with Acrysof SA60 IOL (Alcon). METHODS: This was a prospective analytical study. We studied sixty-four eyes from 32 patients with cataracts. After a random assignment, phacoemulsification with the implant was performed using the Acrysof SN60AT tinted lens in one eye and Acrysof SA60 in the other. A variety of variables was subsequently assessed: contrast sensitivity with a CSV 1000E test, colour perception through a Farnsworth 25 test and subjective measures by a patient survey. Differences between the groups were assessed statistically. RESULTS: The contrast sensitivity results were obtained for 3, 6, 12 and 18 cycles per degree (cpd) frequencies under scotopic conditions, with better results obtained following the use of SN60AT: 0.75 (CSV 1000E test units) for 3 cpd, 0.86 for 6 cpd, 0.54 for 12 cpd and 0.35 for 18 cpd. The differences were statistically significant between the two groups for 3 cpd and 6 cpd. A total of 62.5% of patients using a tinted lens and 50% with SA60 achieved good results in the Farnsworth test; 12.5% and 21% had fair results and 25% and 28.1% respectively had poor results. CONCLUSIONS: We obtained an improvement in favour of the tinted lens for all frequencies, with this being statistically significant at lower frequencies (3 and 6 cpd). No significant differences in the Farnsworth test performance or in the patient survey were found. The tinting provided by the IMPRUV filter brings an increase in contrast sensitivity without affecting colour perception.

Lentes intraoculares con filtros para luz azul / Intraocular lenses with blue light filter

Objetivo: Comparar si la lente intraocular SN60AT «Natural»® (Alcon), con filtro IMPRUV® (Alcon), aporta mejorías en la visión de los pacientes intervenidos de catarata con respecto a la Acrysof SA60® (Alcon).Métodos: Estudio prospectivo analítico, sobre treinta y dos pacientes (64 ojos) que presentaban catarata. Se realizó facoemulsificación con implante, tras un método de asignación aleatorio, de una lente Acrysof SN60AT (Natural) en un ojo y en el ojo contralateral de una Acrysof SA60. Determinamos diferencias entre ambas lentes para las variables de sensibilidad al contraste (CSV 1000E®. Vistech), percepción de los colores (Farnsworth 25) y una valoración subjetiva por el paciente a través de una encuesta.Se realizó un estudio estadístico para comparación de ambas muestras.Resultados: Los resultados de sensibilidad al contraste se obtuvieron para las frecuencias de 3, 6, 12 y 18 ciclos por grado (cpd) en condiciones escotópicas obteniendo una diferencia a favor de SN60AT de 0,75 (unidades de test del CSV 1000E) para 3 cpd, 0,86 para 6 cpd, 0,54 para 12 cpd y 0,35 para 18 cpd, siendo estadísticamente significativa esta diferencia en el caso de las dos primeras.Un 62,5% de pacientes con lente tintada y un 50% de los pacientes con SA60 realizaron el test de Farnsworth 25 con buen resultado, un 12,5% y un 21% regular, y un 25% y un 28,1% mal.Conclusiones: Hemos obtenido una mejora para todas las frecuencias a favor de la lente tintada, siendo estadísticamente significativas para las frecuencias bajas (3 y 6 cpd.)No hemos apreciado diferencias significativas en la realización del test de Farnsworth, ni el paciente las refiere a través del test subjetivo.La tinción que supone la adición del filtro IMPRUV® (Alcon), conlleva un aumento en la sensibilidad al contraste sin consecuencias para la percepción de los colores

Purpose: To evaluate if a SN60AT «Natural»® IOL (Alcon) with IMPRUV filter ®(Alcon) offers any advantage in patients having cataract surgery, as compared with Acrysof SA60® IOL (Alcon).Methods: This was a prospective analytical study. We studied sixty-four eyes from 32 patients with cataracts. After a random assignment, phacoemulsification with the implant was performed using the Acrysof SN60AT tinted lens in one eye and Acrysof SA60 in the other. A variety of variables was subsequently assessed: contrast sensitivity with a CSV 1000E test, colour perception through a Farnsworth 25 test and subjective measures by a patient survey. Differences between the groups were assessed statistically.Results: The contrast sensitivity results were obtained for 3, 6, 12 and 18 cycles per degree (cpd) frequencies under scotopic conditions, with better results obtained following the use of SN60AT: 0.75 (CSV 1000E test units) for 3 cpd, 0.86 for 6 cpd, 0.54 for 12 cpd and 0.35 for 18 cpd. The differences were statistically significant between the two groups for 3 cpd and 6 cpd.A total of 62.5% of patients using a tinted lens and 50% with SA60 achieved good results in the Farnsworth test; 12.5% and 21% had fair results and 25% and 28.1% respectively had poor results.Conclusions: We obtained an improvement in favour of the tinted lens for all frequencies, with this being statistically significant at lower frequencies (3 and 6 cpd).No significant differences in the Farnsworth test performance or in the patient survey were found. The tinting provided by the IMPRUV filter brings an increase in contrast sensitivity without affecting colour perception

Assessment of the doses received by the Cuban population from 40K contained in the body: modelling based on a neural network.

Potassium-40 constitutes the main natural source of potassium present in the body, which influences the effective dose received by people. With the aim of assessing the contribution of this component to the doses received by the Cuban population, a study intended to assess the doses was developed. For this purpose, a representative sample of the Cuban population was selected according to age and sex. The measurements were made using the whole-body counter (WBC) of the Center for Radiation Protection and Hygiene (CPHR). For dose estimations, a uniform distribution of potassium for the whole body was assumed. The methodology used was the one recommended by the ICRP. The values of annual effective dose range between 93 and 209 microSv for females and between 123 and 212 microSv for males. The annual average effective dose for members of the public was estimated as 150 +/- 40 microSv, taking into account the experimental data and the specific features of the Cuban population. With the dose values obtained, it was possible to model dose estimates by means of a neural network, which was trained with the results obtained and using as starting data the sex, age, height and corporal weight of people studied. The modelobtained allows consideration of the anatomical features of each person in the estimation of doses.

Thrombin is present in the lungs of patients with primary extremity osteosarcoma and pulmonary metastases.

Osteosarcoma is a rare cancer, which metastasizes to the lung in up to 80% of cases. Thrombin is involved in metastasis and is present in the lungs of patients with pulmonary metastases (PM). To identify its role in PM and osteosarcoma, we measured thrombin levels in the bronchoalveolar lavage fluid (BALF) of 15 patients. BALF was collected at different stages of the disease and correlated with the diagnosis of PM. We also assessed fibrinogen overexpression in the tumors. We found that 11/15 (73%) patients with high thrombin levels in the lungs developed PM within the first 12 months from primary surgery. The median thrombin concentration in the BALF of these patients increased up to 8x10(-9) M (range, 3x10(-9)M-15x10(-9)M), which represents a more than 100-fold increase compared to patients without PM (p<0.0001). Eight of 15 (53%) primary and 11/15 (73%) metastatic samples showed fibrinogen overexpression. A significant difference between high thrombin levels, fibrinogen overexpression and PM was found compared to patients without PM (p=0.00073 and p=0.025). These results show that thrombin levels are increased in the lungs of patients with primary osteosarcoma and a high risk of developing PM. They suggest that thrombin may be involved in the development of PM.

Clinical and histopathological evaluation of 13 cases of adenocarcinoma in aged rhesus macaques (Macaca mulatta).

In recent years, the emphasis on aging research, has led to an increase in the number of aged macaques being maintained in some research facilities with a subsequent increase in the occurrence of age-related diseases. One of the most commonly reported age related diseases is intestinal adenocarcinoma. At the University of Illinois at Chicago (UIC), which maintains a colony of approximately 55 aged rhesus macaques 13 cases of intestinal adenocarcinoma were diagnosed within a 25-month period. This report provides a comprehensive description of the clinical findings for intestinal adenocarcinoma in aged rhesus macaques, including results from physical examinations, laboratory tests, radiographic evaluations, gross and histopathologic findings as well as a comparison with the disease condition in humans. The use of carcinoembryonic antigen as a potential tumor marker was evaluated by immunohistochemical analysis of tissue specimens in 10 cases. Intestinal adenocarcinoma is a disease condition that should be of concern to individuals responsible for the care of aged rhesus macaques.

Antinociceptive activity of and clinical experience with buprenorphine in swine.

We performed antinociceptive testing on swine receiving buprenorphine. Intravenous access was achieved, and animals were allowed to recover for 24 h. Baseline skin-twitch latency to a focused light source was determined for each animal. Animals received intravenous (i.v.) buprenorphine at 0.08 (n =1), 0.16 (n = 1), 0.005 (n = 5), 0.01 (n = 5), or 0.02 mg/kg (n = 6). Skin-twitch latency was determined 15, 30, 60, 120, 180, 240, 300, 360, 420, 480, 540, and 600 min after buprenorphine administration. Analgesic activity as measured by a significant increase in latency time over baseline values occurred at all time points except 480 min in animals that received 0.02 mg/kg buprenorphine i.v. Analgesic activity to 420 min was demonstrated in animals that received 0.01 mg/kg buprenorphine i.v. Analgesic activity was not demonstrated at any time point in animals that received 0.005 mg/kg buprenorphine i.v. A retrospective analysis of postoperative care records was performed to determine whether 0.01 mg/kg buprenorphine i.v. or intramuscularly (i.m.) postoperatively to swine provided clinically relevant analgesia. Records of swine receiving buprenorphine from 1997 to 2000 were reviewed for indications of treatment failure, such as pain or a change in analgesic regimen from that used routinely. Treatment failure occurred in 18 of 416 (4.3%) cases treated with buprenorphine. This failure occurred in 17% of cases with problems categorized as inflammatory in nature and in 15.5% of those with systemic problems or organ failure. We concluded that antinociceptive testing predicted that buprenorphine administered at 0.01 mg/kg i.v. in swine likely would provide analgesic efficacy for 6 h and when administered at 0.02 mg/kg i.v. likely would provide 10 h analgesia. Clinical signs of pain in animals recovering from surgery were not observed in the majority of cases when buprenorphine was administered twice or thrice daily at 0.01 mg/kg i.m. or i.v. However, buprenorphine was less effective at treating signs of pain associated with inflammation, organ failure, or systemic disease than at ameliorating pain associated with surgical incisions and orthopedic, dental, and ophthalmic procedures.

Ki-67: a proliferative marker that may predict pulmonary metastases and mortality of primary osteosarcoma.

Alterations in Ki-67 activity have been associated with tumor progression and poor outcome in cancer patients. This study was undertaken to identify the potential of this proliferative marker as a predictor of pulmonary metastases (PM) and mortality in osteosarcoma patients. In 38 patients with tissue available for immunohistochemical analysis, overexpression of Ki-67 was assessed. Chi-square and log rank tests were used to determine differences between proportions of the marker with PM and mortality and survival distributions respectively. P values equal or less than .05 were considered statistically significant. The median follow up of this case series was 28 months. Eighteen (47.4%) of 38 patients developed PM, and 17 (44%) overexpressed Ki-67. We found a high frequency of PM (15 of 17) among those cases that overexpressed Ki-67. This relationship was significant (P = .000006) when compared to the rest of the group. We also found a statistically significant correlation between patients with positive and negative Ki-67 scores and higher and lower mortality (P = .000962). These findings suggest that Ki-67 overexpression could be used as a prognostic molecular marker for the development of PM in osteosarcoma patients.

Cyclooxygenase-2 deficiency results in a loss of the anti-proliferative response to transforming growth factor-beta in human fibrotic lung fibroblasts and promotes bleomycin-induced pulmonary fibrosis in mice.

Prostaglandin E(2) (PGE(2)) inhibits fibroblast proliferation and collagen production. Its synthesis by fibroblasts is induced by profibrotic mediators including transforming growth factor (TGF)-beta(1). However, in patients with pulmonary fibrosis, PGE(2) levels are decreased. In this study we examined the effect of TGF-beta(1) on PGE(2) synthesis, proliferation, collagen production, and cyclooxygenase (COX) mRNA levels in fibroblasts derived from fibrotic and nonfibrotic human lung. In addition, we examined the effect of bleomycin-induced pulmonary fibrosis in COX-2-deficient mice. We demonstrate that basal and TGF-beta(1)-induced PGE(2) synthesis is limited in fibroblasts from fibrotic lung. Functionally, this correlates with a loss of the anti-proliferative response to TGF-beta(1). This failure to induce PGE(2) synthesis is because of an inability to up-regulate COX-2 mRNA levels in these fibroblasts. Furthermore, mice deficient in COX-2 exhibit an enhanced response to bleomycin. We conclude that a decreased capacity to up-regulate COX-2 expression and COX-2-derived PGE(2) synthesis in the presence of increasing levels of profibrotic mediators such as TGF-beta(1) may lead to unopposed fibroblast proliferation and collagen synthesis and contribute to the pathogenesis of pulmonary fibrosis.

Novel use of the Elizabethan collar as a "hoop-skirt" for protecting wounds and catheters in nonhuman primates.

This article describes the novel use of an Elizabethan collar, which is attached to a primate jacket to create a tamper-proof "hoop-skirt" for protecting wounds and catheters. We successfully have used this hoop-skirt to manage juvenile male rhesus monkeys with Foley catheters for 10 days post-prostatectomy. In addition, our hoop-skirt has been used to manage wounds on the hindlimbs of both macaques and baboons.

Evidence that thrombin present in lungs of patients with pulmonary metastasis may contribute to the development of the disease.

Early cellular events in the lung which may lead to the development of pulmonary metastases (PM) are still poorly understood. Thrombin, a key component of the coagulation cascade, may be involved in the development of PM as it has been shown to be an enhancer of platelet-tumor interaction in vitro and metastasis in vivo, and because it has been found in high levels in lungs from patients with PM. In this study, we assessed the potential role of thrombin in promoting PM by inducing an enhancement of tumor cell adhesion to platelets and tumor cell chemoinvasion and proliferation. We used bronchoalveolar lavage fluid (BALF) from 20 patients with PM. Results were compared with those from healthy controls. We found an enhancement of adhesion of PM-BALF-treated tumor cells to untreated platelets. BALF from patients with PM significantly increased chemoinvasion and proliferation in three human tumor cell lines. These activities were attenuated significantly by a thrombin inhibitor: hirudin. These results indicate that the thrombin present in the lungs of patients with PM is, at least in part, responsible for their adhesive, invasive and mitogenic activity on three different tumor cell lines. They also suggest that thrombin may be involved in the development of PM.

Frecuencia y distribución de metástasis pulmonar por sarcoma óseo en el Instituto Nacional de Cancerología: periodo 1986-1996 / Frequency and distribution of pulmonary metastases induced by bone sarcoma in the Instituto Nacional de Cancerologia: period 1986-1996

Antecedentes. Los sarcomas óseos son poco frecuentes, pero inducen hasta 80 por ciento de metástasis pulmonar. En población mexicana esta información se desconoce, por lo que describimos su frecuencia en el Instituto Nacional de Cancerología. Métodos. Se revisaron los expedientes de pacientes con sarcoma, registrados entre 1986-1996. Se recabo información demográfica, la histología del tumor y el tiempo de desarrollo de la metástasis. Resultados. Se incluyeron en el estudio 173 casos. De éstos, 74 (43 por ciento) desarrollaron metástasis pulmonar; 102 (60 por ciento) fueron hombres y 71 (40 por ciento) mujeres. Se observó una mediana de edad de 21 años. Se registraron 120 (70 por ciento) casos con diagnóstico de osteosarcoma, 54 (45 por ciento) de los cuales presentaron metástasis; 35 (20 por ciento) casos de condrosarcoma, en 10 (29 por ciento) de los cuales se confirmó metástasis a pulmón y 18 (10 por ciento) casos con sarcoma de Ewing, 10 (56 por ciento) de éstos con metástasis. Considerando la fecha de ingreso, se observaron medianas de tiempo de desarrollo de metástasis pulmonar de hasta 15 meses. A 50 meses, en los pacientes con sarcoma de Ewing, se calculó una supervivencia del 60 por ciento, significativamente menor a la observada en los otros grupos (p=0.0368). Los pacientes con osteosarcoma y metástasis presentaron una supervivencia del 70 por ciento a 50 meses, significativamente menor a la registrada de los osteosarcomas sin metástasis (p=0.0319). Conclusiones. Se encontró una frecuencia del 43 por ciento de metástasis pulmonar. El osteosarcoma y el sarcoma de Ewing fueron los principales inductores de este tipo de metástasis y los grupos en los que se registraron los menores tiempos de supervivencia en presencia o no de metástasis, respectivamente