Evidence on differential role for alpha 1 and alpha 2 subtypes of AP-2 adaptin in the central nervous system.

Two subtypes of alpha (α)subunits, α1and α2, belonging to AP-2 complex have been described in the central nervous system (CNS). The specific role of each subtype is still unclear. In this study, we evaluated the expression and interaction with cell membranes of both subtypes in the postnatal developing cerebral cortex and cerebellum in two rat strains that display distinct developmental features. We observed that α2 displays higher variations than α1 during development, and at lesser extent in the rats with delayed rate of development. Additionally, by in vitro binding assays we evaluated the interaction of α subunits with bovine brain membranes. Both subtypes displayed clear differences in their performance, maximum binding of α1 was higher and α2 reached it faster than α1. In addition, both subtypes displayed different binding to membranes when bivalent cations or nucleotides were added. We conclude that both subtypes interact differently with membranes and that they may play different roles in clathrin-mediated endocytosis in the CNS.

Relación entre el nivel de ansiedad y rendimiento académico en estudiantes de enfermería / Relationship between anxiety level and academic performance among nursing students / Relação entre o nível de ansiedade e desempenho acadêmico em estudantes de enfermagem

Resumen Introducción: La ansiedad ante exámenes es un tipo de ansiedad de ejecución y puede afectar el rendimiento académico, en especial en los estudiantes de enfermería que sufren altos niveles de estrés. Objetivo: Establecer la relación entre el nivel de ansiedad, el rendimiento académico y variables sociodemográficas en estudiantes de enfermería de la Universidad Católica del Maule. Metodología: Estudio cuantitativo, descriptivo y de corte transversal. La muestra fue censal, de 94 estudiantes. Para la recolección de los datos se utilizaron dos instrumentos: de antecedentes sociodemográficos (edad, género, colegio de procedencia, lugar de origen y ocupación del estudiante); y el Cuestionario de Ansiedad frente a los Exámenes (CAEX). El rendimiento académico se obtuvo del Examen Clínico Objetivo Estructurado (OSCE por sus siglas en inglés). Para el análisis de los datos se usó T-Student y Anova. Resultados: Se observó una relación significativa entre el rendimiento académico y el semestre que cursaban los estudiantes. Los estudiantes de los semestres más avanzados tuvieron mejor rendimiento (p= 0.015). El alumno que trabaja y estudia presentó mejor rendimiento en el examen OSCE con respecto al que sólo estudia (p= 0.027). El sexo femenino presentó diferencias significativas con el nivel ansiedad (p= 0.038). Conclusión: Los niveles de ansiedad se encontraron entre los rangos bajos y medios, se sugiere mantenerlos para promover aprendizajes significativos. Resulta necesario analizar la planificación curricular para reestructurar las mallas curriculares y así apoyar a los estudiantes trabajadores al hacer compatible el trabajo con el estudio, con la finalidad de mejorar su calidad de vida.

Abstract Introduction: Anxiety towards tests can impact academic performance, especially among nursing students with high levels of stress. Objective: To confirm the relationship between the level of anxiety, the academic performance, and some social and demographic variables among nursing students in the Universidad Católica del Maule. Methodology: This is a quantitative, descriptive, and transversal study. The sample was constituted by 94 students. Data were collected through 3 instruments: (a) a social and demographic data questionnaire (age, gender, school of precedence, place of origin, and occupation); (b) a Questionnaire of Anxiety Towards Exams (QAEX); c) the Objective School Clinical Exam (OSCE). Student´s t and ANOVA were calculated. Results: A significant relationship was observed between academic performance and the school semester, with students in their last semesters (senior) demonstrating better performances (p= 0.015). Students working and studying showed better results in the OSCE in comparison to those only studying (p= 0.027). Female students showed significant differences in terms of their levels of anxiety (p= 0.038). Conclusion: Anxiety was found to be in the low and middle levels. From the findings, it is suggested to avoid high levels of anxiety among students and to adjust, when necessary, the curriculum in order to support students who work and study at the same time.

Resumo Introdução: A ansiedade causada pelos testes é um tipo de ansiedade de execução e pode afetar o desempenho acadêmico, em especial nos estudantes de enfermagem que sofrem altos níveis de estresse. Objetivo: Estabelecer a relação entre o nível de ansiedade, o desempenho acadêmico e variáveis sociodemográficas em estudantes de enfermagem da "Universidad Católica del Maule". Metodologia: Estudo quantitativo, descritivo e de corte transversal. A amostra foi censo, de 94 estudantes. Para a coleta dos dados utilizaram-se dois instrumentos: de antecedentes sociodemográficos (idade, género, escola de procedência, local de origem e ocupação do estudante); e o Questionário de Ansiedade causada pelos testes (CAEX). O desempenho acadêmico foi obtido do Exame Clínico Objetivo Estruturado (OSCE por suas siglas em inglês). Para a análise dos dados foram usados T-Student e Anova. Resultados: Observou-se uma relação significativa entre o desempenho acadêmico e o semestre que cursavam os estudantes. Os estudantes dos semestres mais avançados tiveram melhor desempenho (p= 0.015). O aluno que trabalha e estuda apresentou melhor desempenho no exame OSCE em relação ao aluno que apenas estuda (p= 0.027). O sexo feminino apresentou diferenças significativas com o nível de ansiedade (p= 0.038). Conclusão: Os níveis de ansiedade encontraram-se entre as faixas baixas e médias, sugere-se mantê-los para promover aprendizagens significativas. Resulta necessário analisar o planejamento curricular para reestruturar as redes curriculares e assim apoiar os estudantes trabalhadores e fazer compatível o trabalho com o estudo, com a finalidade de melhorar sua qualidade de vida.

Sleep disordered breathing and nocturnal hypoxemia are very prevalent in a lung cancer screening population and may condition lung cancer screening findings: results of the prospective Sleep Apnea In Lung Cancer Screening (SAILS) study.

OBJECTIVE: Obstructive sleep apnea (OSA) can influence the appearance and proliferation of some tumors. The Sleep Apnea In Lung Cancer Screening (SAILS) study (NCT02764866) evaluated the prevalence of OSA and nocturnal hypoxemia in a high-risk population enrolled in a lung cancer screening program. METHODS: This was a prospective study of the prevalence of OSA in a lung cancer screening program. Subjects met the National Lung Screening Trial (NLST) age and smoking criteria (age 55-75 years; pack-years >30). Participants in the study were offered annual screening with low-dose computed tomography (LDCT) and pulmonary function testing, as well as home sleep apnea testing (HSAT) and a sleep-specific questionnaire. Sleep study-related variables, symptoms, and epidemiologic data were recorded. RESULTS: HSAT was offered to 279 subjects enrolled in our lung cancer screening program. HSAT results were available for 236 participants (mean age 63.6 years; mean tobacco exposure: 45 pack-years), of whom 59% were male and 53% were active smokers. Emphysema (74%) and chronic obstructive pulmonary disease (COPD) (62%) were common and in most cases mild in severity. OSA, including moderate to severe disease, was very common in this patient population. AHI distributions were as follows: AHI <5 (22.5%); 5-15 (36.4%); 15-30 (23.3%); and >30 (17.8%). Nocturnal hypoxemia (T90) (p = 0.003), diffusing capacity for carbon monoxide (DLCO) (p = 0.01), tobacco exposure (p = 0.024), and COPD (p = 0.023) were associated with OSA severity. Positive screening findings (nodules ≥6 mm) were associated with nocturnal hypoxemia on multivariate analysis adjusted for confounders (OR = 2.6, 95% CI = 1.12-6.09, p = 0.027). CONCLUSION: Moderate to severe OSA is very prevalent in patients enrolled in a lung cancer screening program. Nocturnal hypoxemia more than doubles the risk of positive screening findings.

Hypoxia-ischemia alters distribution of lysosomal proteins in rat cortex and hippocampus.

Neuronal excitotoxicity induced by glutamatergic receptor overstimulation contributes to brain damage. Recent studies have shown that lysosomal membrane permeabilization (LMP) is involved in ischemia-associated neuronal death. In this study we evaluated the effect of neonatal hypoxia-ischemia (HI), as a model of excitotoxicity, on the lysosomal integrity throughout the distribution of the lysosomal proteins cathepsin D and prosaposin. Rat pups (7 days old) of the Wistar Kyoto strain were submitted to HI and they were euthanized 4 days after treatment and the cerebral cortex (Cx) and hippocampus (HIP) were processed for immunohistochemistry or immunoblotting. Treatment induced an increase of gliosis and also a redistribution of both prosaposin and cathepsin D (as intermediate and mature forms), into the cytosol of the HIP and Cx. In addition, HI induced a decrease of LAMP-1 in the membranous fraction and the appearance of a reactive band to anti-LAMP-1 in the cytosolic fraction, suggesting a cleavage of this protein. From these results, we propose that the abnormal release of Cat D and PSAP to the cytosol is triggered as a result of LAMP-1 cleavage in HI animals, which leads to cell damage. This could be a common mechanism in pathological conditions that compromises neuronal survival and brain function.

Cation-dependent mannose-6-phosphate receptor expression and distribution are influenced by estradiol in MCF-7 breast cancer cells.

Cancer cells secrete procathepsin D, and its secretion is enhanced by estradiol. Although alterations in the pro-enzyme intracellular transport have been reported, the mechanism by which it is secreted remains poorly understood. In this work, we have studied the influence of estradiol on the expression and distribution of the cation-dependent mannose-6-phosphate receptor (CD-MPR), which would be a key molecule to ensure the proper localization of the enzyme to lysosomes in breast cancer cells. Immunoblotting studies demonstrated that the expression of CD-MPR is higher in MCF-7 cells, as compared to other breast cancer and non-tumorigenic cells. This expression correlated with high levels of cathepsin D (CatD) in these cells. By immunofluorescence, this receptor mostly co-localized with a Golgi marker in all cell types, exhibiting an additional peripheral labelling in MCF-7 cells. In addition, CD-MPR showed great differences regarding to cation-independent mannose-6-phosphate receptor. On the other hand, the treatment with estradiol induced an increase in CD-MPR and CatD expression and a re-distribution of both proteins towards the cell periphery. These effects were blocked by the anti-estrogen tamoxifen. Moreover, a re-distribution of CD-MPR to plasma membrane-enriched fractions, analyzed by gradient centrifugation, was observed after estradiol treatment. We conclude that, in hormone-responsive breast cancer cells, CD-MPR and CatD are distributed together, and that their expression and distribution are influenced by estradiol. These findings strongly support the involvement of the CD-MPR in the pro-enzyme transport in MCF-7 cells, suggesting the participation of this receptor in the procathepsin D secretion previously reported in breast cancer cells.

Neurotoxins from Clostridium botulinum (serotype A) isolated from the soil of Mendoza (Argentina) differ from the A-Hall archetype and from that causing infant botulism.

The type A of neurotoxin produced by Clostridium botulinum is the prevalent serotype in strains of Mendoza. The soil is the main reservoir for C.botulinum and is possibly one of the infection sources in infant botulism. In this study, we characterized and compared autochthonous C. botulinum strains and their neurotoxins. Bacterial samples were obtained from the soil and from fecal samples collected from children with infant botulism. We first observed differences in the appearance of the colonies between strains from each source and with the A Hall control strain. In addition, purified neurotoxins of both strains were found to be enriched in a band of 300 kDa, whereas the A-Hall strain was mainly made up of a band of ∼600 kDa. This finding is in line with the lack of hemagglutinating activity of the neurotoxins under study. Moreover, the proteolytic activity of C. botulinum neurotoxins was evaluated against SNARE (soluble N-ethylmaleimide-sensitive factor-attachment protein receptor) proteins from rat brain. It was observed that both, SNAP 25 (synaptosomal-associated protein 25) and VAMP 2 (vesicle-associated membrane protein) were cleaved by the neurotoxins isolated from the soil strains, whereas the neurotoxins from infant botulism strains only induced a partial cleavage of VAMP 2. On the other hand, the neurotoxin from the A-Hall strain was able to cleave both proteins, though at a lesser extent. Our data indicate that the C.botulinum strain isolated from the soil, and its BoNT, exhibit different properties compared to the strain obtained from infant botulism patients, and from the A-Hall archetype.

[Complex febrile Seizures or Dravet syndrome?: Description of 3 case reports]. / ¿Crisis febriles complejas o síndrome de Dravet?: Descripción de 3 casos clínicos.

INTRODUCTION: Dravet syndrome (DS) is one of the most intractable forms of epilepsy that begins in infancy. This syndrome is characterized by beginning with complex febrile seizures (FS) in a healthy infant and progresses to refractory epilepsy with psychomotor regression. The detection of a SCN1A mutation encoding the sodium channel can confirm the diagnosis. OBJECTIVE: To report 3 confirmed cases of genetically DS. CASE REPORTS: We describe 3 girls diagnosed with complex FS that started when they were between 2 and 7 months old. FS were frequent, hemi generalized and myoclonic associated with recurrent febrile status epilepticus (SE). Despite FS and SE recurrence, the psychomotor development, electrophysiological studies and magnetic resonance imaging (MRI) of the brain were normal. After a year, they developed afebrile seizures progressing to refractory epilepsy with developmental regression. A molecular study detected SCN1A mutation confirming DS. The specific antiepileptic treatment and prevention of febrile episodes allowed partial control of epilepsy with some recovery of psychomotor skills. CONCLUSIONS: The high frequency complex FS associated with recurrent SE in a previously healthy infant should alert about the possibility of DS. Molecular diagnostics helps us to establish a drugs and non-drug therapies treatment, as well as long-term prognosis and genetic counseling.

Sutura de B-Lynch: experiencia en el desarrollo de una nueva técnica quirúrgica / B-Lynch suture for postpartum hemorrhage: a new surgical technique

Antecedentes: La hemorragia postparto (HPP) continúa siendo una de las patologías más prevalentes en la morbimortalidad materna en todo el mundo, especialmente en los países subdesarrollados. Distintos protocolos de manejo y técnicas se han desarrollado en los últimos años para su control. La sutura de B-Lynch surge como una herramienta útil y reproducible. Objetivo: Demostrar los beneficios de la técnica para el control de la HPP. Método: Serie de 5 casos en los que se realizó la sutura de B-Lynch en el Servicio de Obstetricia y Ginecología del Hospital Carlos Van Buren. Se identifican 5 casos en los que se realizó la técnica. Resultados: En los 5 casos se logró exitosamente controlar la HPP y preservar el útero. Una de las pacientes logró un embarazo posterior exitoso. Conclusión: Nuestros resultados permiten afirmar que la técnica de B-Lynch es segura, útil y reproducible en el manejo de la HPP.

Background: The postpartum haemorrhage (PPH) continues to be a prevalent problem affecting maternal morbimortality all over the world, particularly in non-developed countries. Different protocols of management and new techniques have been developed through these last years to control and treat PPH. The B-Lynch suture appears to be a useful and reproductible tool. Objectives: To show the benefits of the technique in the management of PPH. Method: A retrospective review of five cases in which B-Lynch suture was made, with the postoperatory controls and histeroscopics evaluations. Results: In all cases, successfully PPH was controlled and the uterus preserved. In one patient a successfully pregnancy and delivery was achieved. Conclusion: The B-Lynch suture is secure, useful and reproducible technique in the management of PPH.

Galectins: matricellular glycan-binding proteins linking cell adhesion, migration, and survival.

Galectins are a taxonomically widespread family of glycan-binding proteins, defined by at least one conserved carbohydrate-recognition domain with a canonical amino acid sequence and affinity for beta-galactosides. Because of their anti-adhesive as well as pro-adhesive extracellular functions, galectins appear to be a novel class of adhesion-modulating proteins collectively known as matricellular proteins (which include thrombospondin, SPARC, tenascin, hevin, and disintegrins). Accordingly, galectins can display de-adhesive effects when presented as soluble proteins to cells in a strong adhesive state. In this context, the de-adhesive properties of galectins should be considered as physiologically relevant as the proadhesive effects of these glycan-binding proteins. This article focuses on the roles of mammalian galectins in cell adhesion, spreading, and migration, and the crossregulation of these functions. Although careful attention should be paid when examining individual galectin functions due to overlapping distributions, these intriguing glycan-binding proteins offer promising possibilities for the treatment and intervention of a wide variety of pathological processes, including cancer, inflammation, and autoimmunity.

The effect of genotype on the natural history of eIF2B-related leukodystrophies.

BACKGROUND: Recessive mutations in the five eucaryotic initiation factor 2B (eIF2B) subunits have been found in leukodystrophies of variable age at onset and severity. OBJECTIVES: To evaluate the clinical spectrum of eIF2B-related disorders and search for a phenotype-genotype correlation. METHODS: Ninety-three individuals (78 families) with an undetermined leukodystrophy were selected on MRI-based criteria of childhood ataxia with central hypomyelination/vanishing white matter (CACH/VWM) for EIF2B genes analysis. RESULTS: Eighty-nine percent of individuals with MRI criteria of CACH/VWM have a mutation in one of the eIF2B beta to epsilon subunits. For 83 individuals (68 families), 46 distinct mutations (90% missense) in four of the five eIF2B subunits (beta, gamma, delta, epsilon) were identified. Sixty-four percent were in the epsilon subunit, a R113H substitution was found in 71% of eIF2B epsilon-mutated families. A large clinical spectrum was observed from rapidly fatal infantile to asymptomatic adult forms. Disease severity was correlated with age at onset (p < 0.0001) but not with the type of the mutated subunit nor with the position of the mutation within the protein. Mutations R113H in the epsilon subunit and E213G in the beta subunit were significantly associated with milder forms. CONCLUSIONS: The degree of eIF2B dysfunction, which is involved in the regulation of protein synthesis during cellular stress, may play a role in the clinical expression of eIF2B-related disorders.

A novel trypsin inhibitor from Peltophorum dubium seeds, with lectin-like properties, triggers rat lymphoma cell apoptosis.

A trypsin inhibitor (PDTI) was isolated from Peltophorum dubium seeds by affinity chromatography on a thyroglobulin-agarose or a trypsin-agarose column. In both cases, SDS-PAGE showed two bands of M(r) 20,000 and 22,000, which could not be resolved. Their amino-terminal sequences were identical and similar to that of Kunitz-type soybean trypsin inhibitor (SBTI). Mass spectrometry analysis of tryptic digests of both bands showed 16 coincident peaks, suggesting that they are closely related proteins. The K(i)s for trypsin and chymotrypsin inhibitory activity of PDTI were 1.6 x 10(-7) and 1.3 x 10(-5)M, respectively. Lectin-like activity of PDTI and SBTI, detected by hemagglutination of rabbit erythrocytes, was inhibited by sialic acid-containing compounds. PDTI and SBTI caused apoptosis of Nb2 rat lymphoma cells, demonstrated by decrease of viability, DNA hypodiploidy, DNA fragmentation, and caspase-3-like activity. They had no effect on normal mouse splenocytes or lymphocytes, whereas they caused apoptosis of concanavalin A-stimulated mouse lymphocytes.

Immunoglobulin G antibody response to infection with coccoid forms of Helicobacter pylori.

An increasing number of studies support a potential role for coccoid forms in Helicobacter pylori infection. Evidence for this was obtained through scanning microscopy, genetic analysis for virulence traits, examination of the presence and activity of key enzymes, and other methods. We studied the serum immunoglobulin G responses to coccoid H. pylori forms by enzyme-linked immunosorbent assay (ELISA) and immunoblotting and compared them with those of bacillary cells. Sera from a total of 295 infected individuals were studied; these included sera from 100 patients with duodenal ulcers, 98 patients with nonulcer dyspepsia, 11 patients with gastroduodenal cancer, and 86 asymptomatic individuals. Initially, we characterized and selected coccoid and bacillary antigenic preparations by one-dimensional (1-D) and 2-D gel electrophoresis and immunoblotting. Data showed that coccoid and bacillary preparations with comparable protein contents have similar patterns in 1-D and 2-D electrophoresis gels and antigenic recognition at blotting. These results revealed that coccoid and spiral antigens in ELISA can equally recognize specific antibodies to H. pylori in sera from infected individuals. The analysis of the spiral and coccoid preparations by Western blotting showed no major differences in antigen recognition. No specific bands or profiles associated with a single gastric condition were identified.

Portación de Staphylococcus aureus enterotoxigénicos en manipuladores de alimentos / Carriage of enterotoxigenic Staphylococcus aureus in food handlers

BACKGROUND: One of the most common pathogens causing alimentary toxi-infections is Staphylococcus aureus (S aureus). The presence of S aureus in food, indicates flaws during food manipulations. For this reason most sanitary norms require the detection of S aureus carriers. AIM: To determine the carriage rate of enterotoxin producing S aureus strains in food handlers, and to evaluate the antibiotic susceptibility to six antimicrobial agents. MATERIALS AND METHODS: A total of 102 food handlers from 19 restaurants in Santiago, were analyzed. Samples for microbiological analysis were obtained with a swab from the retropharynx. RESULTS: S aureus grew in 35 out of the 102 samples obtained (34 per cent). Further analysis revealed that 19/35 (54 per cent) strains were able to produce enterotoxins. Therefore the corrected carriage rate was 19 per cent (19/102). The most frequently detected enterotoxin was the type A (12/19). All S aureus isolates were resistant to penicillin and susceptible to oxacillin, clindamycin, kanamycin, vancomycin and linezolid. CONCLUSIONS: The carriage rate of S aureus in food handlers in similar to the rate reported in the general population in our country. These results confirm the need for education and training programs in food safety, directed to food handlers.

Prevalence of serum antibodies to Helicobacter pylori VacA and CagA and gastric diseases in Chile.

The objective of this study was to evaluate the prevalence of antibodies to Helicobacter pylori CagA and VacA proteins and correlate this prevalence with gastric diseases in colonised Chileans. The study was performed in 418 adults colonised with H. pylori: 316 with gastroduodenal pathology (152 duodenal ulcer, 14 gastric cancer and 150 gastritis patients) and 102 asymptomatic subjects. Serum IgG antibodies to H. pylori were determined by enzyme immunoassay (EIA). Antibodies to VacA and CagA proteins were detected by Western blotting. In a subgroup of the patients, the vacuolating activity was determined by HeLa cell assay and the CagA product was confirmed by PCR assay. IgG antibodies to both VacA and CagA proteins of H. pylori were found in 270 (85%) of 316 colonised gastric patients and in 72 (71%) of 102 asymptomatic subjects. Colonisation with virulent strains was significantly higher among duodenal ulcer and gastric cancer patients than in gastritis patients or asymptomatic subjects. Infections with VacA+/ CagA+ H. pylori strains is common in Chile but, in contrast to some Asian countries, this phenotype was more prevalent in isolates from patients with more severe gastric pathologies.

Infantile Alexander disease: spectrum of GFAP mutations and genotype-phenotype correlation.

Heterozygous, de novo mutations in the glial fibrillary acidic protein (GFAP) gene have recently been reported in 12 patients affected by neuropathologically proved Alexander disease. We searched for GFAP mutations in a series of patients who had heterogeneous clinical symptoms but were candidates for Alexander disease on the basis of suggestive neuroimaging abnormalities. Missense, heterozygous, de novo GFAP mutations were found in exons 1 or 4 for 14 of the 15 patients analyzed, including patients without macrocephaly. Nine patients carried arginine mutations (four had R79H; four had R239C; and one had R239H) that have been described elsewhere, whereas the other five had one of four novel mutations, of which two affect arginine (2R88C and 1R88S) and two affect nonarginine residues (1L76F and 1N77Y). All mutations were located in the rod domain of GFAP, and there is a correlation between clinical severity and the affected amino acid. These results confirm that GFAP mutations are a reliable molecular marker for the diagnosis of infantile Alexander disease, and they also form a basis for the recommendation of GFAP analysis for prenatal diagnosis to detect potential cases of germinal mosaicism.

Coagulación intravascular diseminada secundaria a un aneurisma aortoilíaco / Disseminated intravascular coagulation secondary to an aortoiliac aneurysm

Introducción. La coagulación intravascular diseminada (CID) es un síndrome hematológico que se ha asociado a una gran variedad de cuadros clínicos, y de forma ocasional, se ha descrito en relación con determinados procesos vasculares. Caso clínico. Presentamos el caso clínico de un varón que consultaba por un cuadro de equimosis espontáneas de localización errática y que presentaba niveles anormalmente bajos de fibrinógeno plasmático, trombopenia y alteraciones del estudio de coagulación, todo ello compatible con un cuadro de CID. Durante el estudio para descartar neoplasia oculta, se descubrió un aneurisma aortobiilíaco como único factor etiológico. El trastorno hematológico se corrigió tras la reparación del aneurisma, realizando resección en interposición de injerto protésico bifurcado, y se empleó como terapia de soporte la administración de fibrinógeno preoperatorio, así como una adecuada reposición intraoperatoria con derivados hematológicos. Asimismo, realizamos también una revisión bibliográfica de dicho cuadro clínico con el objetivo de actualizar las diferentes posibilidades terapéuticas. Discusión. Los aneurismas arterioscleróticos son un factor etiológico a considerar en el diagnóstico diferencial de un cuadro de CID. Una vez descartadas otras causas, la reparación quirúrgica de estos aneurismas debe ser el objetivo principal del tratamiento. El resultado es la normalización de los parámetros de laboratorio y desaparición de la clínica asociada. Las terapias con diversos fármacos son controvertidas y siempre deben ser coadyuvantes, excepto en los casos en que otra patología asociada contraindique de forma absoluta la intervención (AU)

Evolución del tratamiento quirúrgico para la revascularización del territorio vertebrobasilar / Surgical treatment evolution for revascularization of vertebrobasilar territory

Objetivos. Estudiar los resultados a corto y largo plazo del tratamiento quirúrgico de la isquemia vertebrobasilar, así como su evolución a lo largo del tiempo, atendiendo a nuestra experiencia clínica. Pacientes y métodos. Entre 1978 y 1997 fueron realizadas 72 técnicas de revascularización del territorio vertebrobasilar en 72 pacientes. Dos eran mujeres y 70 hombres, con edad media de 58 años (intervalo de 38 a 71). Cuarenta y dos pacientes (58 por ciento) presentaban sintomatología vertebrobasilar, 16 (22 por ciento) sintomatología inespecífica y los 14 restantes (19 por ciento) estaban asintomáticos y presentaban robo de la vertebral. Las técnicas quirúrgicas fueron intratorácicas en el 25 por ciento de los casos y extratorácicas en el 75 por ciento (5 injertos a vertebral distal, 6 TEA subclaviovertebrales, 11 trasposiciones, 1 reimplantación y 31 injertos a eje subclaviovertebral). El seguimiento medio fue de 98 meses. Resultados. La permeabilidad a 10 años fue del 80 por ciento. Los injertos subclavio-subclavios presentaron una menor permeabilidad respecto al resto de técnicas, con diferencia estadísticamente significativa (p< 0,05). La probabilidad de permanecer libre de síntomas a 10 años fue del 70 por ciento. La morbilidad precoz por eventos neurológicos fue del 2,8 por ciento con una morbilidad global del 23,6 por ciento. La mortalidad precoz fue del 5,6 por ciento (4 pacientes), siendo la causa más frecuente la cardiopatía isquémica. No se produjeron muertes precoces de causa neurológica. La supervivencia a 10 años fue del 59 por ciento. Conclusión. Según nuestra experiencia, la permeabilidad en las técnicas directas supera la de las técnicas indirectas, por ello las consideramos de elección (AU)

Cirugía de la arteria renal asociada a cirugía de aorta infrarrenal / Renal artery surgery associated with infrarrenal aortic surgery

Objetivos: Revisión retrospectiva del manejo de las lesiones de la arteria renal asociadas a lesiones de la aorta infrarrenal. Material y Métodos: Desde enero de 1980 hasta diciembre de 1999 se han realizado 66 revascularizaciones de arteria renal asociadas a cirugía aórtica en 63 pacientes de un total de 1117 cirugías, de edad media 59ñ8,2 años (63/1117) (5,6 por ciento). La patología aórtica fue oclusiva en 45 pacientes y aneurismática en 16. Presentaban insuficiencia renal 13 pacientes (2I por ciento), 8 de los cuales tenían nefropatía isquémica, e hipertensión arterial 40 pacientes (63 por ciento) en los cuales se demostró hipertensión vasculorenal en 17. Las técnicas quirúrgicas fueron 54 injertos aortorenales, 7 endarterectomías renales transaórticas, 3 reimplantaciones y una angioplastia. Todos los pacientes fueron sometidos a cirugía aórtica directa. El control de la revascularización renal se realizó con gammagrafía, arteriografiá y duplex. Resultados: Fallecieron tres pacientes en el postoperatorio inmediato (mortalidad 4,8 por ciento); 12 pacientes sufrieron complicaciones postoperatorias (morbilidad 19 por ciento). La respuesta de la tensión arterial fue favorable en el 65 por ciento. La función renal mejoró en los pacientes con nefropatía isquémica, aunque no llegó a ser estadísticamente significativa. Las causas de muerte en el seguimiento fueron por enfermedad cardiológica y neoplasia, principalmente. Conclusión: En nuestra experiencia la cirugía renal asociada a cirugía aórtica no aumenta significativamente la mortalidad de estos enfermos y ofrece buenos resultados a largo plazo. La gammagrafía renal es un excelente método para el control tardío de estos pacientes (AU)

[Application of serology to confirm the eradication of Helicobacter pylori in peptic ulcer patients]. / Aplicación de la serología para confirmar la erradicación de Helicobacter pylori en pacientes con úlcera péptica.

BACKGROUND: Measurement of changes in serum antibodies is an excellent predictor of Helicobacter pylori eradication after antibiotic treatment. AIM: To measure the changes in serum antibody titers to Helicobacter pylori, before and after treatment. MATERIAL AND METHODS: IgG antibodies to H. pylori were prospectively evaluated in 107 duodenal ulcer patients treated either with antibiotics (amoxicillin, metronidazole and bismuth subsalicylate) plus omeprazole or omeprazole alone. IgG antibody levels were determined using an "in house" ELISA in sera from 49 eradicated patients that received quadruple therapy and 58 non-eradicated patients (12 in whom antibiotic therapy failed and 46 that received omeprazole alone). Endoscopy, urease test, microscopy, and culture of gastric biopsies confirmed H. pylori eradication. RESULTS: Patients in whom H. pylori was eradicated, showed a maintained drop in serum antibody titers that ranged from 15%, 62%, 74% to 76% at 28 days, 4, 8 and 12 months respectively. Such reduction was not observed in patients treated with omeprazole. Patients, in whom quadruple therapy failed to eradicate H. pylori, showed a discrete and transient decrease in antibody titers. By the fourth month, patients in whom eradication with quadruple therapy was not achieved, irrespective of whether they received quadruple therapy or omeprazole alone. CONCLUSIONS: A 45% decrease in IgG titer after 4 months is indicative of therapeutic success in H. pylori eradication. Therefore, serology may be useful to monitor the outcome of antibiotic therapy (Rev Méd Chile 2000; 128: 1119-26).