Two metallocarboxypeptidase inhibitors are implicated in tomato fruit development and regulated by the Inner No Outer transcription factor.

The TCMP-1 and TCMP-2 genes of tomato code for metallocarboxypeptidase inhibitors and show sequential, tightly regulated expression patterns during flower and fruit development. In particular, TCMP-1 is highly expressed in flower buds before anthesis, while TCMP-2 in ripe fruits. Their expression pattern suggests that they might play a role in fruit development. Here, to investigate their function, we altered their endogenous levels by generating transgenic plants harbouring a chimeric gene expressing the TCMP-1 coding sequence under the control of the TCMP-2 promoter. The expression of the transgene caused an earlier fruit setting with no visible phenotypic effects on plant and fruit growth. The altered TCMP-1 regulation determines an increased level of TCMP-1 in the fruit and unexpected changes in the levels of both TCMPs in flower buds before anthesis, suggesting a mechanism of transcriptional cross-regulation. We in silico analysed TCMPs promoter regions for the presence of common cis acting elements related to ovary/fruit development and we found that both promoters contain putative binding sites for INNER NO OUTER (INO), a transcription factor implicated in ovule development. By chromatin immunoprecipitation, we proved that INO binds to TCMP-1 and TCMP-2 promoters, thereby representing a candidate regulatory factor for coordinated control of TCMPs.

Analysis of the feed-forward method for the referencing of a CW laser to a frequency comb.

We report on a comprehensive theoretical and experimental analysis of the feed-forward method for external frequency stabilization of a continuous wave laser against a frequency comb. Application of the method to a distributed feedback diode laser at 1.55 µm allows line narrowing from 800 to 10 kHz, with frequency noise reduction by more than 2 decades up to a Fourier frequency of 100 kHz and a maximum control bandwidth of 0.8 MHz. The results are consistent with a relative phase fluctuation of 1.4 rad rms, as limited by uncompensated high-frequency noise of the slave laser.

Wide-bandwidth phase lock between a CW laser and a frequency comb based on a feed-forward configuration.

Wide-bandwidth phase lock between the tooth of a frequency comb and a CW extended-cavity diode laser at 1.55 µm is achieved by the use of an acousto-optical frequency shifter in a feed-forward configuration. The coherence properties of the comb are efficiently transferred to the CW laser, whose linewidth is narrowed down to the ∼10 KHz comb level. A maximum control bandwidth of ∼0.6 MHz has been experimentally achieved, limited by the transit time of the acoustic wave inside the frequency shifter.

¿Cómo se drena un pseudoquiste pancreático? Aspectos técnicos / No disponible

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Variation among endoscopy units in the achievement of the standards of colonoscopic performance indicators.

BACKGROUND/AIMS: To assess the achievement of quality standards of colonoscopy at six endoscopy units. METHODOLOGY: Three indicators were used to assess the quality of 1056 colonoscopies performed at six hospitals: cecal intubation; adequate colon cleansing; and removal and recovery of all detected polyps. Analyses were performed on the total number of colonoscopies and on colonoscopies in which polyps were actually detected. The accomplishment of each indicator and a global compound index of all three indicators, named the Problem Rate, were analyzed. Results from each endoscopy unit were compared to previously established standards. RESULTS: Adequate colon cleansing was the most frequent problem for quality in all centers; adequate colon preparation was 67% (range 50 to 84%). The cecum was reached in 84% of all colonoscopies (range 76 to 90%). 75% of all patients (range 28. 79%) had all polyps excised and recovered. All centers had rates below standard for one or several indicators (p<0.01, all cases). Two of the participant hospitals had an overall problem rate above the estimated standard (p<0.01). CONCLUSIONS: There is a significant variation in the achievement of quality standards of colonoscopy between endoscopy units. Colon cleansing is the most frequent quality problem for colonoscopy.

[Revision of obstructive sleep apnea syndrome in the child]. / Revision del síndrome de apnea obstructiva del sueño en el niño.

The obstructive sleep apnea syndrome (OSAS) is frequent in infancy and childhood. It is caused by a prolonged upper respiratory airway obstructioon during sleep, and adenotonsillar hypertrophy is the most important cause. OSAS may have an impact on physical and cognitive development, but syntoms in children are subtle and may pass unrecognised. Polysomnography is the gold standard technique for OSAS diagnosis and surgical approach with adenotonsillectomy is the most frequently treatment indicated. Early diagnosis and treatment and adequate follow up are important to prevent physical disturbances secondary to chronic hypoxemia and to avoid cognitive deficits associated with disrupted sleep architecture.

Revisión del síndrome de apnea obstructiva del sueño en el niño / Revision of obstructive sleep apnea syndrome in the child

El síndrome de apnea obstructiva del sueño (SAOS) esun problema prevalente en la infancia. Se produce como consecuencia de una obstrucción de la vía áerea superior, siendo su principal causa la hipertrofia adenoamigdalar. Da lugar al desarrollo de alteraciones fisicasy cognitivas, aunque sus manifestaciones clínicas sonsutiles en la niñez. La polisomnografia nocturna es la técnica recomendada para su diagnóstico y el tratamiento de elección es la adenoamigdalectomía.Un diagnóstico y un tratamiento precoz será importantepara prevenir trastornos secundarios a la hipoxemia crónica y déficits cognitivos asociados a la fragmentación del sueño

The obstructive sleep apnea syndrome (OSAS) is frequent in infancy and childhood. lt is caused by a prolonged upper respiratory airway obstructioon during sleep, and adenotonsillar hypertrophy is the most important cause. OSAS may have an impact on physical and cognitive development, but syntoms in children are subtle and may pass unrecognised. Polysomnography is the gold standard technique for OSAS diagnosis and surgical approach with adenotonsillectomy is the most frequently treatment indicated. Early diagnosis and treatment and adequate follow up are important to prevent physical disturbances secondary to chronic hypoxemia and to avoid cognitive deficits associated with disrupted sleep architecture

Menière's disease and gentamicin: preliminary results using the minimum effective dose and integrated therapy.

Treatment of Menière's disease is aimed at restoring a normal quality of life and preserving residual hearing, in view of the increasing frequency with which the contralateral ear is affected. Conventional medical treatment (diuretics + vasoactive drugs) leads to cure in a large percentage of patients (75-95%). In intractable cases, transtympanic (intratympanic) aminoglycoside therapy, associated with various techniques, is becoming widespread as an alternative to surgery. Progressive reduction of the dose introduced into the middle ear did not prevent the onset of anacusis in several patients; the variable, unpredictable permeability of the round window membrane, the object of fundamental studies in the past, explains this complication. The Author has used gentamicin transtympanically in Menierians since 1978, and has treated a total of 105 patients. He first prescribed transtympanic gentamicin therapy that did not follow, but was integrated with conventional medical treatment in 22 intractable Menierians, by instilling the minimum effective dose, to reduce the risk of hearing impairment. Preliminary results, related to stage of disease, may be summarised as follows: improvement in the quality of life, as evaluated by the American Academy of Ophthalmology & Otolaryngology Committee on Hearing and Equilibrium questionnaire (14 patients--63.63%--at point 1 and 8-36.36%--at point 2); disappearance of vertigo in 15 patients (68.18%); a minor vertigo attack in 3 and two minor attacks in 3 others not affecting quality of life; persistence of occasional unsteadiness in one patient. Hearing remained unchanged in 15 patients, improved slightly in 3 cases and worsened slightly in 2; decreased sensitivity to high tones was observed in 2 patients at the first insertion of gentamicin. According to the Author, employing integrated therapy and using the minimum effective dose of gentamicin, the risk of damage to the cochlear structures may be reduced, although not excluded, while restoring a good quality of life, even when repeat instillation is necessary.

Diagnostic value of symptoms in patients with suspected upper digestive tract disease.

OBJECTIVE: to develop a predictive model based on clinical data for patients with suspected upper digestive tract disease. PATIENTS AND METHODS: forty-seven clinical data were obtained before endoscopy from 283 patients with suspected upper digestive disease (153 men; mean age 55 years, limits 17-92 years). A clinical prediction of diagnosis was made before endoscopy. On the basis of the endoscopic findings, the patients were divided into three diagnostic groups: absence of significant disease (group I), significant benign disease (group II) and malignant disease (group III). The probability rate of belonging to each one of the three groups was obtained for each patient by using Bayes' theorem. RESULTS: the endoscopic findings were classified according to their clinical importance: 121 patients (43%) belonged to group I, 137 (48%) were included in group II; and 25 (9%) in group III. The clinical prediction correctly classified 61% of the patients (group I: 56%, group II: 62% and group III: 76%) The coincidence between prediction obtained using Bayes' theorem and the actual diagnosis was 61% (group I: 65%, group II: 51%, group III: 92%). The predictive model was useful to confirm or not the clinical prediction. CONCLUSION: objective analysis of clinical data can be useful to support clinical judgment, mainly in patients with neoplasia. However, the model is not adequate to improve indication of upper endoscopy since many patients are misclassified.

Valor diagnóstico de los síntomas en pacientes con sospecha de enfermedad del tracto digestivo superior / Diagnoctic value of symptoms in patients with suspected upper digestive tract disease

Objetivo: desarrollar un modelo objetivo, predictivo del diagnóstico endoscópico a partir del análisis de los síntomas en pacientes con sospecha de enfermedad del tracto digestivo superior. Pacientes y métodos: se recogieron prospectivamente 47 variables en cada uno de los 283 pacientes estudiados (153 hombres; media de edad 55 años, límites 17-92 años) a los que se había indicado una endoscopia digestiva alta. Previamente se emitió un juicio predictivo clínico sobre cuál era el diagnóstico más probable. Los hallazgos endoscópicos se agruparon en función de su trascendencia clínica en tres categorías diagnósticas que fueron: ausencia de enfermedad trascendente (grupo I), enfermedad trascendente benigna (grupo II) y enfermedad maligna (grupo III). A partir de las 23 variables más discriminativas se obtuvo en cada paciente la probabilidad de que perteneciera a cada uno de los tres grupos diagnósticos, mediante el teorema de Bayes. Resultados: pertenecieron al grupo I, 121 pacientes (43 por ciento), 137 (48 por ciento) al grupo II; y 25 (9 por ciento) al grupo III. El juicio clínico clasificó correctamente al 61 por ciento de los pacientes (grupo I: 56 por ciento, grupo II: 62 por ciento y grupo III: 76 por ciento). La coincidencia entre el modelo objetivo y el diagnóstico real fue del 61 por ciento (grupo I: 65 por ciento, grupo II: 51 por ciento, grupo III: 92 por ciento). El modelo predictivo se demostró útil para confirmar o no el juicio predictivo clínico, previamente emitido por el médico. Conclusión: el análisis objetivo de los datos clínicos puede servir de apoyo al juicio clínico, emitido por el médico, especialmente en pacientes con neoplasia. Sin embargo, muchos pacientes son clasificados erróneamente con este análisis lo que le resta utilidad para mejorar la indicación de una endoscopia digestiva alta (AU)

[Endoscopic treatment of pancreatitis and its complications]. / Tratamiento endoscópico de la pancreatitis y sus complicaciones.

OBJECTIVES: To study the long- and short-term safety and efficacy of endoscopic treatment of pancreatitis and its complications in our environment. PATIENTS AND METHODS: We performed a retrospective analysis of 43 patients with chronic pancreatitis, acute pancreatitis complicated with pseudocyst, and pancreatic fistula diagnosed by endoscopic retrograde cholangiopancreatography who were suitable for endoscopic treatment. RESULTS: Endoscopic treatment was attempted in 35 patients. The indication for treatment was pain in 17 patients (48.5%), jaundice in 7 (20%), pseudocyst in 10 (28.5%) and suspected external fistula in 1 (3%). The technique was successfully performed in 28 (80%). Of the patients with pain, pancreatic prosthesis was inserted in 13 and extracorporeal lithotripsy was applied in 6. Sixty-five percent of the patients improved. Of the 7 patients with jaundice, all had secondary stenosis of the biliary tract. Treatment was applied in 2, who showed partial improvement. Of the 15 patients with pseudocyst, endoscopic treatment was indicated in 10; the technique was successfully performed in 8 and complete resolution was achieved in 7 (87.5%). The patient with external fistula was treated with transpapillary prosthesis and complete resolution of disruption of Wirsung's duct was achieved. Overall improvement in successfully treated patients was: complete in 19 (68%), partial in 3 (18%), no improvement in 4 (14%) and 2 patients were lost to treatment. There were 4 short-term complications. There were 4 deaths and one was related to the technique. CONCLUSIONS: Endoscopic treatment of chronic pain in chronic pancreatitis, pseudocysts and fistulas was effective in our environment with a low rate of complications.

[Endoscopic treatment combined with extracorporeal shock wave lithotripsy of difficult bile duct stones]. / Tratamiento endoscópico combinado con litotricia extracorpórea con ondas de choque de la coledocolitiasis de difícil manejo.

OBJECTIVES: The aim of this study was to determine the safety and effectiveness of extracorporeal shock wave lithotripsy (ESWL) in difficult bile duct stones resistant to endoscopic extraction. PATIENTS AND METHOD: From January 1997 to February 2002, combined treatment with endoscopy and ESWL was used in 19 patients who had undergone unsuccessful endoscopic bile duct stone extraction after sphincterotomy. The procedure was carried out using analgesic and sedative drugs or deep sedation, prophylactic antibiotic therapy, and monitoring of vital signs. Bile duct stone localization was performed by contrast injection through nasobiliary drainage and fluoroscopy. After each ESWL session, lavage was performed through drainage and stone fragments were extracted endoscopically. RESULTS: The 19 patients presented high surgical risk due to advanced aged and/or concomitant diseases. All presented jaundice and pain and nine (47.3%) presented associated cholangitis. Thirty ESWL sessions were performed (1.57 sessions per patient), with a mean of 2,120 shock waves per session. In 16 of the 19 patients (84.2%), combined treatment with ESWL and subsequent instrumental endoscopic extraction achieved complete clearance of the biliary tract. The treatment failed in 3 patients who were referred for surgical treatment. No early or late complications were observed, except in one patient who presented a self-limiting febrile syndrome. CONCLUSIONS: Therapeutic endoscopy combined with ESWL is safe and effective in patients with difficult bile duct stones. It represents a therapeutic alternative in patients at high surgical risk.

A randomized comparison of low-dose ketamine and lignocaine infiltration with ketamine-diazepam anaesthesia for post partum tubal ligation in Vanuatu.

Ketamine remains one of the most commonly used anaesthetic agents around the world. Despite it being the anaesthetic agent of choice in many developing nations, there is a paucity of literature describing ketamine in the developing world. In what we believe is the first randomized controlled trial to be performed in Vanuatu (formerly the New Hebrides) we compared the use of ketamine 0.9 mg/kg and diazepam 0.07 mg/kg with ketamine 0.3 mg/kg and 2% lignocaine infiltration in 50 Melanesian women undergoing post partum tubal ligation. All women received 0.5 mg/kg intramuscular pethidine. Visual analog pain scores and verbal numeric satisfaction scores were similar between the groups. However the time to obeyed command was significantly faster in the 0.3 mg/kg ketamine group (7.0+/-4.9 vs 13.0+/-9.2 min). The incidence of dreaming was similar and the content rated as pleasant by both groups. In institutions where post-anaesthesia care resources are limited, 0.3 mg/kg ketamine with local anaesthesia provides for earlier self-care of patients after tubal ligation, without compromise of analgesia, emergence or satisfaction. The implications of these findings extend to other procedures that require short general anaesthesia, which can be adequately performed with low-dose ketamine and local anaesthesia. The latter technique allows more rapid awakening.

[Comparison of the efficacy of cleaning and disinfection of videoscopes: mechanized versus manual]. / Comparación de la eficacia en la limpieza y desinfección de videoendoscopios: mecanizada frente a manual.

AIM: a) To analyze the effectiveness of the automated cleaning and disinfection of endoscopies (Olympus miniETD, not previously tested) versus the manual method; b) To evaluate the drying and storage procedures used in our unit. MATERIAL AND METHODS: Prospective 10-day study. The endoscopies were randomized for automated or manual cleaning and disinfection. Endoscopic samples were collected for microbiology studies at three points during the process: a) after endoscopy (after manual cleaning with water), b) after cleaning with enzymatic detergent and disinfection (automated or manual) and c) at the first hour in the morning. RESULTS: Sixty-five samples were collected after endoscopy: 26 from gastroscopy, 26 from colonoscopy and 13 from duodenoscopy (positive cultures were found in 22, 25 and 10, respectively). The 35 samples collected after automated disinfection were negative, as were 29 of the 30 collected after manual disinfection (p = 0.46). Sixty-four of the 65 samples were negative for hepatitis B and hepatitis C. The only sample positive for hepatitis C became negative after manual disinfection. Positive culture was found in 15% of the samples collected before beginning the session. CONCLUSIONS: a) Automated cleaning and disinfection (Olympus miniETD) are as effective as manual cleaning. b) Drying and storage procedures should be improved and/or disinfection should be carried out again before the first endoscopy of each session.

[A reliability study of pediatric somatometric determinations and the level of agreement between 4 observers]. / Estudio de la fiabilidad de las determinaciones somatométricas infantiles, nivel de coincidencia entre 4 observadores.

OBJECTIVES: Given the great importance given at present to determining anthropometric measurements as an indicator of child health, and its general use in primary care, this study aimed to find how reliable the measurements by four nurses at a health centre were. The measurements' internal concordance, and thus the weight of the observer on the values found, was studied. DESIGN: Analytical study of validation of infants' anthropometric measurements. SETTING: Urban Health Centre, Valencia. PARTICIPANTS: 37 children, selected at random by a draw from those attending the programme for overseeing child development. MEASUREMENTS AND RESULTS: Four nurses, using the methods of measurement normally followed at the Virgen de la Fuensanta Health Centre, consecutively determined weight, height and cephalic perimeter of the children. The analyses of variance of the anthropometric measurements for the observer showed no statistically significant differences. The calculation of the greatest discrepancy between observers regarding the mean of the values displayed no quantitatively important discrepancies, either. CONCLUSIONS: High consistency was found in the concordance of the somatometric measurements, as far as technique goes. This means that trained staff can find good indicators of child development and health, even when the staff taking the measurements alternate.

Transtympanic gentamicin in the treatment of Meniére's disease.

Aminoglycosides enable a pharmacological approach, before resorting to surgery, to the treatment of Menière's disease (MD) proving unamenable to routine medical treatment. The staging of MD is an essential preliminary step in the implementation of a specific and personalized treatment with transtympanic gentamicin. The ideal condition is the presence of endolymphatic hydrops with little or no damage to the cochlear and vestibular hair cells. The technical aspects of the method are discussed. In 21 patients with unilateral Menière's disease in various stages, this treatment achieved the regression of vertigo in 86% of cases; hearing was better in 19% of cases, preserved in 62% and worse in 19%; tinnitus regressed totally or partially in 62% of cases; aural fullness also regressed totally or partially in 57% of cases.

[Hepatoporto-appendicostomy. Our experience in 3 cases of biliary cystic disease]. / Hepaticoporto-apendicostomía. Nuestra experiencia en 3 casos de enfermedad quística biliar.

This report details our preliminary experience with hepaticoporto-appendicostomy in three patients with biliary cystic disease. The surgical procedure was total resection of choledochal cyst and vascularized appendix interposition between biliary tree and duodenum. The children have been followed by clinical, ultrasonography and endoscopic (ECPR) during a period between 1-4 years. There was no episodes of ascending colangitis. All the patients remain free of jaundice and the biochemical abnormalities have become normal three months after interposition. Our results suggest that this procedure is more physiologic than the standard bilioenteric derivation Roux-in-Y, because allow bile to enter freely to duodenum and prevent reflux, stasis and ascending cholangitis. This procedure allows postoperative endoscopic valoration, not possible in another kind of bilioenteric derivations.

Individual prediction of response to pneumatic dilation in patients with achalasia.

During nine years, 157 consecutive patients with achalasia have been dilated in our unit. First, the long-term effect of dilation on clinical status was evaluated. The probability of being in clinical remission eight years after first dilation was 51%. The pressure of the LES measured after dilation was highly predictive of the long-term clinical evolution. Second, a predictive model of the individual response to pneumatic dilation was developed and simplified. Therapy was effective in 80% of the patients, after one to four dilations. Younger age was the only factor significantly associated with ineffective therapy. Depending on the prognosis of the outcome calculated with the predictive model, patients were classified in groups of risk that showed a different rate of ineffective, therapy. In the simplified model, age < or = 20 years, male gender, esophageal body diameter < or = 3 cm, esophageal body basal pressure > 15 mm Hg, and pressure of the lower esophageal sphincter > 30 mm Hg were predictors of a poor response to dilation. We conclude that pneumatic dilation is an effective therapy for achalasia. A predictive model was useful to classify the patients in groups with a different risk for ineffective dilation. A simplification of this model could be used to predict the response to dilation.

[Primary carcinoma of the thyroglossal duct. 2 case reports]. / Il carcinoma primitivo del dotto tireoglosso. Due casi clinici.

AA. present two cases of carcinoma arising on thyroglossal duct's cystic. Those carcinomas are a rare event and will be suspected in the patients that present an irregular tumefaction of medial neck's district. Etiology is unknown; is possible that a preceding irradiation on the neck will represent a factor risk. AA. retained that in case of medial neck's district tumefactions is necessary executed a total examination of neck's and head's district, an echography, a thyroid scintigraphy, a thoracic radiography, a panendoscopy and a FNAB. When we found a squamous carcinoma on residual thyroglossal duct the therapy is chirurgical in function of dimension of T and N with following radiotherapy in function of stage (possible lymph node metastasis). When we found a different adenoma is necessary chirurgical removal of tumefactions with hyoid bone's a body resection (Sistrunk's operation) with total thyroidectomy and following Pochin's test for seeking eventual residual with radiometabolic and suppressive therapy.