Calidad de vida posterior a gastrectomía total laparoscópica versus abierta en cáncer gástrico / Quality of life after -laparoscopic versus open total gastrectomy in gastric cancer

Resumen Introducción: En los últimos años, la gastrectomía laparoscópica ha aparecido como una técnica quirúrgica con resultados oncológicos comparables a la técnica abierta, pero existe poca evidencia en cuanto a la calidad de vida posoperatoria de estos pacientes. Objetivo: Evaluar la calidad de vida posoperatoria de pacientes sometidos a gastrectomía total laparoscópica (GTL) en comparación a gastrectomia total abierta (GTA) en cáncer gástrico. Materiales y Método: Estudio retrospectivo, observacional en Hospital Militar de Santiago, entre enero de 2015 y junio de 2020. Se les aplicó 2 encuestas validadas para Chile: EORTC QLQ-30 y EORTC QLQ-OG25. Resultados: Se obtuvieron 60 pacientes; 30 sometidos a GTL y 30 a GTA. Promedio edad fue 66,3 ± 11 años para GTL y 68,2 ± 11 años en GTA (p = 0,5). Se obtuvo un score en GTL versus GTA: global 83,3 y 80,2 (p = 0,6), sintomático 17,1 y 25,5 (p = 0,2) y score funcional 87,9 y 70,9 (p = 0,03). Posterior a eso obtuvimos en funcionalidad GTL versus GTA; física 92,2 versus GTA 73,1 (p = 0,04), emocional 84,1 versus 78,5 (p = 0,6), cognitiva 84,9 versus 79,0 (p = 0,3) y social 80,9 versus 72,2 (p = 0,4). Al analizar síntomas destaco; fatiga 14,6 versus 33,1 (p = 0,04) y dolor 13,4 versus 24,3 (p = 0,05). Finalmente, en síntomas digestivos altos obtuvimos en disfagia 0,84 GTL versus 17,3 GTA (p = 0,04). Conclusión: La GTL logra resultados comparables a GTA en calidad de vida e incluso ofrece ventajas significativas en funcionalidad física como también en síntomas como dolor, fatiga y disfagia.

Introduction: In recent years, laparoscopic gastrectomy has appeared as a surgical technique with oncological results comparable to the open technique, but there is little evidence regarding the postoperative quality of life of these patients. Objective: To evaluate the postoperative quality of life of patients undergoing laparoscopic total gastrectomy (LTG) compared to open total gastrectomy (OTG) in gastric cancer. Materials and Method: Prospective, observational study at Hospital Militar of Santiago, between January 2015 and June 2020. Two surveys validated for Chile were applied: EORTC QLQ-30 and EORTC QLQ-OG25. Results: 60 patients were obtained; 30 subjected to LTG and 30 to OTG. Average age was 66.3 ± 11 years for LTG and 68.2 ± 11 years for OTG (p = 0.5). A score was obtained in LTG versus OTG: global 83.3 and 80.2 (p = 0.6), symptomatic 17.1 and 25.5 (p = 0.2) and functional score 87.9 and 70.9 (p = 0.03). After that we got LTG versus OTG functionality; physical 92.2 versus 73.1 (p = 0.04), emotional 84.1 versus 78.5 (p = 0.6), cognitive 84.9 versus 79.0 (p = 0.3) and social 80.9 versus 72.2 (p = 0.4). When analyzing symptoms I highlight; fatigue 14.6 versus 33.1 (p = 0.04) and pain 13.4 versus 24.3 (p = 0.05). Finally, in upper digestive symptoms, we obtained 0.84 LTG versus 17.3 OTG in dysphagia (p = 0.04). Conclusion: LTG achieves results comparable to OTG in quality of life and even offers significant advantages in physical functionality as well as symptoms such as pain, fatigue and dysphagia.

Determination of early bone metastasis on Bone Scans Using the Gray Levels Histogram / Búsqueda de metástasis ósea temprana en gammagramas óseos usando el histograma de tonos de gris

ABSTRACT The aim of this paper is to show a technique to speed up the interpretation of bone scans in order to determine the presence of early bone metastasis. This is done using the gray levels histogram of the region of interest. The technique is intended to assist in the bone scans interpretation in order to provide a successful diagnosis. During the analysis, three types of histograms were observed on the regions of interest. If the histogram is narrow and shifted toward the origin, the bone scan is free of metastasis. If it is shifted to the right and slightly broadened, indicates the presence of a bone anomaly different from a metastasis. On the other hand, if the histogram is more broadened and shifted to the right, is suggests the presence of metastasis. This histogram is characterized by displaying small curls on the right side providing information about the metastatic disease stage, which could be low-amplitude peaks and have a short length, if the metastasis is in early stage, or high-amplitude peaks and a long length, if is advanced. Finally, the analyzed region is displayed in false color considering the minimum gray levels observed in the histogram.

Infecciones osteoarticulares en niños: experiencia de cinco años

Resumen Introducción: Las infecciones osteoarticulares (IOA) son consideradas una urgencia infectológica en niños. Los principales microorganismos causales son Staphylococcus aureus y Streptococcus pyogenes. Objetivo: Describir las características bio-demográficas y clínicas de pacientes de 2 meses a 15 años hospitalizados entre 2012 y 2017 con diagnóstico de IOA. Pacientes y Métodos: Estudio retrospectivo en un hospital pediátrico. Se revisaron fichas clínicas de pacientes internados con diagnóstico de IOA. Resultados: Se incluyó a 146 pacientes. Un 60,3% fueron de sexo masculino, mediana de edad 3 años 11 meses. El síntoma más frecuente al ingreso fue dolor articular (90%) y la mediana de PCR fue de 43 mg/L. Se obtuvo identificación microbiológica en 48%; de ellos, 67,8 % S. aureus (10,2% resistentes a meticilina). El 94,5% de los pacientes recibió de forma empírica β-lactámico anti-estafilocócico. Un 70,5% de los niños requirió procedimiento quirúrgico. A las 72 h se observó respuesta clínica y a los 4,7 días descenso de parámetros inflamatorios de laboratorio. El 88% de los pacientes cursó sin complicaciones. Conclusiones: Las IOA son más frecuentes en varones, el agente infeccioso más frecuentemente identificado fue S. aureus, por lo cual se sugiere inicio del esquema antimicrobiano con un β-lactámico anti-estafilocócico, ampliando cobertura en pacientes bajo 5 años de edad. A los 5 días del tratamiento antimicrobiano ya hay respuesta clínica y descenso de parámetros inflamatorios.

Abstract Background: Osteoarticular infections (IOA) are considered infectious emergencies. The main microorganisms isolated are Staphylococcus aureus and Streptococcus pyogenes. Aim: To describe demographic and clinical characteristics of patients from 2 months to 15 years old, hospitalized between the years 2012 and 2017 with IOA diagnosis. Methods: Retrospective study in a pediatric hospital. Clinical records of hospitalized patients with IOA were reviewed. Results: 146 met inclusion criteria. 60.3% of the patients were male, median age 3 years 11 months. The main symptom at admission was joint pain (90%) and the median CRP was 43 mg/L. 48% of the patients had microbiological identification; 67.8% were positive for Staphylococcus aureus (10.2% SAMR). 94.5% of the sample received empirical antistaphylococcal beta-lactam treatment and 70,5% had a surgical intervention. Clinical response was observed 72 hours of beginning of treatment, and a decreased in inflammatory laboratory markers was observed at 4.7 days. 88% of patients attended without complications. Conclusions: IOA infections are more common in boys, S. aureus is the main isolated pathogen, so we suggest to initiate the antimicrobial scheme with an antistaphylococcal beta-lactam, adding broad spectrum antimicrobial in children under 5 years. After 5 days of treatment, clinical resolution and decreased inflammatory laboratory parameters were observed.

[Osteoarticular infections in children: five-year experience]. / Infecciones osteoarticulares en niños: experiencia de cinco años.

BACKGROUND: Osteoarticular infections (IOA) are considered infectious emergencies. The main microorganisms isolated are Staphylococcus aureus and Streptococcus pyogenes. AIM: To describe demographic and clinical characteristics of patients from 2 months to 15 years old, hospitalized between the years 2012 and 2017 with IOA diagnosis. METHODS: Retrospective study in a pediatric hospital. Clinical records of hospitalized patients with IOA were reviewed. RESULTS: 146 met inclusion criteria. 60.3% of the patients were male, median age 3 years 11 months. The main symptom at admission was joint pain (90%) and the median CRP was 43 mg/L. 48% of the patients had microbiological identification; 67.8% were positive for Staphylococcus aureus (10.2% SAMR). 94.5% of the sample received empirical antistaphylococcal beta-lactam treatment and 70,5% had a surgical intervention. Clinical response was observed 72 hours of beginning of treatment, and a decreased in inflammatory laboratory markers was observed at 4.7 days. 88% of patients attended without complications. CONCLUSIONS: IOA infections are more common in boys, S. aureus is the main isolated pathogen, so we suggest to initiate the antimicrobial scheme with an antistaphylococcal beta-lactam, adding broad spectrum antimicrobial in children under 5 years. After 5 days of treatment, clinical resolution and decreased inflammatory laboratory parameters were observed.

Caracterización de indicadores de detección de glaucoma con los equipos OCT Spectralis y campímetro Humphrey II en pacientes altos miopes y altos miopes glaucomatosos del Hospital Clínico Universidad de Chile / Characterization of glaucoma detection indicators with OCT Spectralis equipment and Humphrey II campimeter in patients with high myopia and high myopia glaucomatous at the Hospital Clínico Universidad de Chile

Purpose: Characterize and describe glaucoma index parameters of the results of visual exams, Optical Coherence Tomography and Visual Field, in high myopic subjects with and without the pathology. Method: Cross sectional and observational study of 39 eyes, 15 high myopic with glaucoma y 24 high myopic without it. Visual Field (VF) were performed, where the global index between both groups were analyzed; Mean Deviation (MD), Model Standard Deviation (MSD) and Visual Field Index (VFI), beside Optical Coherence Tomography (OCT), in which the thickness of the ganglion cells layer (GCL) inside 3 central mm was compared. Results: The results were satisfactory, demonstrating different characteristics between the high myopic group with glaucoma and without it, both in VF and OCT exams. It was obtained in the VF analysis difference in average MD of -4,92 dB + 3,71 (p<0,05); difference in average DSM of 2,01 dB + 2,85 (p>0,05) and VFI with Friedman Test 10,29 (p>0,05). The statistical OCT analysis, when comparing GCL, observed that the Temporary sector (T) had a statistically significant decrease (p<0,05). Conclusions: To continue studies in this investigative line, can expand the knowledge in this area, mainly in the study of the GCL. (AU)

Visualizando Gammagramas Óseos en Colores / Displaying Bone Scans in Color

Resumen En este trabajo se describe el uso de un software para detectar metástasis óseas en gammagramas cuyo funcionamiento está basado en un método cuantitativo. En la investigación se incluyeron cuarenta y tres gammagramas óseos de pacientes con cáncer de próstata, los cuales fueron previamente analizados visualmente por tres especialistas y su diagnóstico se tomó como referencia. Debido a que no todos los huesos de un paciente muestran los mismos tonos de gris, cada uno de los gammagramas se segmentó para su análisis en cuatro regiones: cráneo, hombros, tórax y pelvis. La segmentación se hizo con el fin de obtener intervalos de tonos de gris en cada una de las regiones empleando un proceso estadístico. Para ello se calcularon la media y la desviación estándar de cuatro muestras que contenían cada una cuarenta y tres regiones. Tomando en consideración los intervalos, siete colores fueron asignados a cada región. Mediante los colores fue posible diferenciar los casos sanos e infiltrados en cada región, lo que facilita el diagnóstico. Se muestran ejemplos de los resultados en cada una de las regiones.

Abstract The use of software based on a quantitative method for detecting skeletal metastasis in bone scans is presented. Forty-three bone scans of patients with prostate cancer were previously analyzed visually by three specialists and their diagnosis were taken as a reference. Later, these scans were analyzed by segmenting them into four regions: skull, shoulders, chest, and pelvis. The segmentation was made to obtain intervals of gray levels for each of the regions using a statistical process. Tríese values were found by calculating the mean and standard deviation of four samples containing each forty-three regions. Using these intervals, seven colors were assigned to each region. By means of the colors it is possible to differentiate healthy and infiltrated cases in each region, which may facilitate the diagnosis. Examples of results in each region are shown.

Noticeable Bone Degradation on a Plain Radiography: a Case / Degradación Ósea Observable en una Radiografía Simple: un Caso

Abstract: In this paper, an image of the humeral head obtained from a plain radiography was analyzed. The radiograph was obtained from a forty year-old female with diagnosed breast cancer and discomfort on the right shoulder. The aim of the study was to determine whether it is possible to observe early bone metastasis with plane radiography using the so called scanning method. Plotting the intensity distribution along the rows of the image is a fast, qualitative way to know if the bone has some abnormality. If the curves are "smooth" then the bone is healthy, but if they are discontinuous then it is sick. To obtain quantitative results, the rows intensities were analyzed around discontinuous zones. Using this technique it was possible to observe bone degradations of the order of 11%.

Resumen: En este trabajo se analiza una imagen de una cabeza humeral obtenida de una radiografía simple. La radiografía se obtuvo de una mujer de cuarenta años de edad diagnosticada con cáncer de mama y molestias en el hombro derecho. El objetivo del estudio fue determinar si es posible observar metástasis ósea temprana en una radiografía plana utilizando el método de escaneo. Graficar la distribución de intensidad de las filas de la imagen es una manera rápida y cualitativa de saber si el hueso tiene alguna anormalidad. Si las curvas son "suaves" entonces el hueso está sano, pero si son discontinuas entonces está enfermo. Para obtener resultados cuantitativos, se debe analizar la intensidad de las filas alrededor de las zonas discontinuas. Utilizando esta técnica fue posible observar una degradación ósea del orden del 11%.

Pautas Éticas del Consejo de Organizaciones Internacionales de las Ciencias Médicas: avances y temáticas no resueltas en la actualización 2016 / Council for International Organizations of Medical Sciences (CIOMS) Ethical Guidelines: advancements and unsolved topics in 2016 upgrade

A fines del año 2016 se publicó la nueva edición de las Pautas Éticas Internacionales para la Investigación Relacionada con la Salud con Seres Humanos del Consejo de Organizaciones Internacionales de las Ciencias Médicas (CIOMS, por sus siglas en inglés Council for International Organizations of Medical Sciences), estándares universalmente reconocidos en la investigación biomédica. En este artículo se realiza un análisis crítico de las potencialidades y falencias de las nuevas pautas del CIOMS 2016. Algunos avances alcanzados consideran la importancia asignada al valor social de la investigación y su repercusión en la toma de decisiones y la creación de políticas públicas, el desarrollo de investigación en escenarios de bajos recursos, la participación de las comunidades en el proceso investigativo, la determinación de la vulnerabilidad de los participantes de una investigación y los cambios en los procedimientos de consentimiento informado. Esta actualización es una gran herramienta para investigadores y miembros de los comités de ética científica. Asimismo, aunque constituye una adaptación a los rápidos cambios científicos, tecnológicos y sociales; permanecen aspectos no resueltos, principalmente en torno al manejo del riesgo mínimo de los participantes y de los conflictos de interés involucrados en una investigación, además del desarrollo de ésta en escenarios de bajos recursos. No obstante, se hace un positivo progreso en cuanto al contexto y las necesidades de las poblaciones en las que se desarrollarán las investigaciones y la participación comunitaria en las distintas fases del proyecto, accediendo a sus potenciales beneficios. El impacto de las pautas del CIOMS 2016, deberá evaluarse en el tiempo, en particular en escenarios de inequidades socio-sanitarias y de intereses comerciales de la industria en la investigación biomédica.

In 2016, the new edition of the Council for International Organizations of Medical Sciences (CIOMS) Ethical Guidelines was released, which are universally acknowledged as ethical standards in biomedical research. In this article, we critically analyze the improvements and shortcomings of the CIOMS Ethical Guidelines 2016. Among the improvements are the relevance assigned to the social value of research and its effects on decision-making and the creation of public policies; the research development in low-resources scenarios; the communities' involvement in the research process; the determination of participants' vulnerability and changes on informed consent related proceedings. Despite the improved harmonization with scientific, technologic and social changes, and that the guidelines provide a tool for researchers and members of research ethics committees alike, some topics remain unsolved, namely the management of participants' minimal risk and conflicts of interest involved in research, and the development of research in low-incomes scenarios. Nonetheless, we recognize that these new guidelines constitute a progress regarding the context and needs of populations in which research will be conducted, with greater community involvement in the different phases of the investigation project, thus allowing them to access the potential benefits. The impact of the CIOMS Ethical Guidelines 2016, should be appraised over time, particularly in socio-sanitary inequities scenarios and in the context of commercial interests of industry on biomedical research.

Clinical and demographic profile of traumatic spinal cord injury: a Mexican hospital-based study.

STUDY DESIGN: Review of clinical data. OBJECTIVES: The objective of this study was to describe the clinical and demographical profile of patients with traumatic spinal cord injury (TSCI) admitted to a single center. SETTING: Unidad de Medicina Física y Rehabilitación Centro, México. PARTICIPANTS: Patients with TSCI attending rehabilitation for the first time. INTERVENTION: Not applicable. MAIN MEASUREMENTS: Age, gender, educational level, occupational activity, causes of injury, level of injury, neurological level, injury severity and category were recorded. RESULTS: Four hundred and sixty-four clinical files of patients with TSCI were collected. The mean age was 37.9 ± 15.9 years; 78.2% (363/464) were male, basic educational level predominated in 63.6% (296/464) and 73.1% (339/464) were employed. A fall was the main mechanism of the injury in 41.6% (193/464), replacing automobile accidents from the first place. The mean age of persons who suffered falls was 44 ± 16 years. Injuries sustained by younger persons were due to violence (28.4 ± 10.1 years) and the cause of injury associated with male gender was violence. Thoracic level was most often affected (in 56.7%, 263/464) and neurological level C4 in 13.4% (62/464). In regard to the extent of the injury, lesions classified as American Spinal Injury Association A predominated (56.2%, 261/464) as with complete paraplegia in 43.3% (201/464). CONCLUSIONS: The mean age of our patients was 37 years. Men are affected in a higher proportion. Our population has <9 years of study. Physical labor was the usual pre-injury activity. The main mechanism of injury was falls. Thoracic spine was the most affected.

Clinical and molecular studies reveal a PSEN1 mutation (L153V) in a Peruvian family with early-onset Alzheimer's disease / Estudios clínicos y moleculares revelan una mutación PSEN1 (L153V) en una familia peruana con enfermedad de Alzheimer de inicio temprano

Presenilin 1 (PSEN1) gene mutations are found in 30-70% of familial early-onset Alzheimer disease (EOAD) cases (onset <60 years). Prevalence of these mutations is highly variable including ethnic differences worldwide. No Peruvian kindred with familial AD (FAD) have been described. Standardized clinical evaluation and cognitive assessment were completed in a Peruvian family with severe EOAD. Clinical course was characterized by very early onset (before age 35 years), progressive cognitive impairment with early memory loss, spatial disorientation and executive dysfunction. We sequenced all exons of PSEN1 in the proband and identified a c.475C>G DNA change resulting in a p.L153V missense mutation in the transmembrane domain 2 of the gene. This mutation is also present in the three additional affected siblings but not in a non-affected family member consistent with segregation of this mutation with the disease. This is the first report of a Peruvian family affected with EOAD associated with a PSEN1 mutation. This same mutation has been reported previously in English and French families, but a novel variants very close to the mutation and ancestry informative markers analysis suggests the mutation might be of Amerindian or African origin in this Peruvian family.

Las mutaciones del gen de presenilina 1 (PSEN1) se encuentran en el 30-70% de los casos de enfermedad de Alzheimer de inicio temprano (EAIP) familiar (inicio <60 años). La prevalencia de estas mutaciones es muy variable, incluidas las diferencias étnicas en todo el mundo. No se han descrito parientes peruanos con EA familiar (EAF). Se realizó una evaluación clínica estandarizada y una evaluación cognitiva en una familia peruana con EAIP grave. El curso clínico se caracterizó por un inicio muy temprano (antes de los 35 años), deterioro cognitivo progresivo con pérdida temprana de memoria, desorientación espacial y disfunción ejecutiva. Secuenciamos todos los exones de PSEN1 en el probando e identificamos un cambio de ADN c.475C>G que resultó en una mutación sin sentido p.L153V en el dominio transmembrana 2 del gen. Esta mutación también está presente en los tres hermanos afectados adicionales, pero no en un miembro de la familia no afectado, lo que es consistente con la segregación de esta mutación con la enfermedad. Este es el primer informe de una familia peruana afectada con EAIP asociada con una mutación PSEN1. Esta misma mutación se ha informado previamente en familias inglesas y francesas, pero una nueva variante muy cercana a la mutación y el análisis de marcadores informativos de ascendencia sugieren que la mutación podría ser de origen amerindio o africano en esta familia peruana.

Genotoxicity in oral epithelial cells in children caused by nickel in metal crowns.

The micronucleus (MN) assay evaluates the effects of low doses of genotoxic carcinogens and can detect structural lesions that survive mitotic cycles. The objective of this study was to determine both the genotoxicity of nickel (Ni) in buccal epithelial cells and the urinary excretion of Ni in children with metal crowns. This was a prospective longitudinal study based on 37 patients selected at the Facultad de Odontología de la Universidad Autónoma de Coahuila. MN assays were performed using buccal cells from the 37 patients, and Ni levels were determined from urine samples using inductively coupled plasma mass spectrometry at 1 (basal value), 15, and 45 days following the placement of crowns in each patient. Ni urinary excretion levels increased from 2.12 ± 1.23 to 3.86 ± 2.96 mg Ni/g creatinine (P < 0.05) and the frequency of exposed micronuclei increased from 4.67 ± 0.15 to 6.78 ± 0.167/1000 cells (P < 0.05) between 1 and 45 days post-crown placement. These results suggest that odontological exposure to metal crowns results in genotoxic damage at the cellular level of the oral mucosa and an increase in the urinary excretion of Ni within 45 days of exposure.

Dietary anhydrous milk fat naturally enriched with conjugated linoleic acid and vaccenic acid modify cardiovascular risk biomarkers in spontaneously hypertensive rats.

Saturated and trans fatty acids have been associated with the risk to develop cardiovascular diseases. However, health-promoting effects are associated with consumption of anhydrous milk fat (AMF) and ruminant trans fatty acids, such as conjugated linoleic acid (CLA) and vaccenic acid (VA) contained in the lipid fraction of milk and dairy products. The purpose of this study was to evaluate the effect of AMF naturally enriched with CLA and VA in spontaneously hypertensive rats (SHR), using sterculic oil to inhibit the conversion of VA into CLA. The administration of AMF to SHR during 7 weeks exerted beneficial effects on cardiovascular risk biomarkers (reduction of insulin, blood lipids, increase of adiponectin). When sterculic oil was included, some parameters were further ameliorated (reduction of insulin, increase of adiponectin). Sterculic oil alone reduced body weight and adiposity, and improved blood pressure, adiponectin and triglyceride levels.

Chaetognatha in the Bahía Magdalena lagoon complex, Baja California Sur, México: species composition and assemblages.

The chaetognaths from 187 zooplankton samples collected from the Bahia Magdalena lagoon complex, Baja California Sur, Mexico during March, June, July, August, September, November, and December 1982 were studied. Twelve species belonging to two genera were identified. Sagitta euneritica and S. enflata were the most abundant and most frequent species with maximum abundance in July (40,000 org/100 m(3) and 6100 org/100 m(3) respectively). Sagitta pacifica, S. regularis and S. pseudoserratodentata were stenothermic (21 to 25 degrees C), whereas the rest of the species were eurythermic (15.5 to 29.5 degrees C). Sagitta euneritica contributed considerably to the zooplanktonic biomass, increasing the density in particular in BahíaAlmejas. The analysis of the species assemblages (Morisita index) showed that S. pacifica and S. regularis interact more frequently in August when there is a change of the water masses that converge in this zone during summer, when the California Countercurrent predominates. The composition of taxa during winter is characterized by the dominance of S. euneritica. Entering the warm period, an abrupt change occurs in taxa composition of the three zones studied: channels, Bahía Magdalena, and BahíaAlmejas. The amplitude and distribution of S. peruviana was influenced possibility by the oceanographic conditions of ENSO 1982.

Linfoma testicular primario: estudio descriptivo: Instituto Especializado de Enfermedades Neoplásicas: Lima - Perú: 2006 / Primary testicular lymphoma: descriptive study: Instituto Especializado de Enfermedades Neoplásicas: Lima - Perú

El linfoma testicular es una enfermedad poco frecuente con características peculiares y un pronóstico pobre. Evaluamos en forma retrospectiva 32 pacientes con este diagnóstico estudiando sus características epidemiológicas, valores hematológicos, tipo histológico, lugares de metástasis, tratamiento recibido y tiempo de sobrevida. Así mismo comparamos nuestros resultados con los reportes internacionales, haciendo énfasis en la necesidad de estudios prospectivos para obtener mejores conclusiones.

Testicular lymphoma is a rare illness with peculiar characteristics but with a poor prognosis. We evaluated 32 patients retrospectively studying their epidemiologic characteristics, hematologic values, histological type, metastasis sites, the treatment given and the survival. We compared our results with international reports and we think that prospective studies are needed for better conclusions.

Sobrevida de la disfunción sistólica severa del ventrículo izquierdo con la terapia farmacológica actual / Survival of patients with severe left ventricular systolic dysfunction under current medication

Antecedentes: La disfunción sistólica severa del ventrículo izquierdo, con su secuela de insuficiencia cardiaca(IC) ha aumentado en las dos últimas décadas, pero su mortalidad ha disminuido con la introducción delos inhibidores de la enzima convertidora y beta-bloqueadores de tercera generación. Objetivo: Evaluar la sobrevida de un grupo de pacientes con IC desde su primera crisis Métodos: Seguimiento de una cohorte de 24 pacientes con IC de diversas etiologías (hipertensiva, alcohólica e idiopática), pero con predominio de arterioesclerosis coronaria (16 pac) durante 11 años. Los pacientes fueron tratados con terapia asociada de enalapril y carvedilol en dosis bajas, además del tratamiento clásico de la IC. Resultados: La mortalidad global fue de 8 pac (33 por ciento) y, expresada en años de seguimiento, fue de 1.8 pac/año. Las crisis de descompensación alcanzaron el 54 por ciento y las hospitalizaciones el 46 por ciento. Conclusiones: En nuestra experiencia, el tratamiento con inhibidores de la enzima convertidora y beta-bloqueadores de tercera generación, asociados a la terapia clásica de la IC, permitió una sobrevida satisfactoria a largo plazo.

Background: Severe left ventricular systolic dysfunction leading to congestive heart failure (CHF) has become more prevalent in the last decades, but mortality from this condition has decreased following the introduction of convertingenzymeinhibitors (ACE) and third generation beta blockers. Aim: To evaluate survival in a group of patients with CHF Methods: Twenty-four patients with congestive heart failure secondary to coronary artery disease (n=16), hypertension, alcoholic or idiopathic cardiomyopathy were followed during 11 years. Patients were treated with combined therapy of enalapril and low dose carvedilol, along with other conventional drugs. Results: Eight patients died during follow up (33 percent or 1.8 patients per year). Decompensation of heart failure occurred in 54 percent and rehospitalization in 46 percent of patients. Conclusion: Treatment with an ACE inhibitor and a third generation beta blocker along with conventional drugs was associated to a satisfactory long term survival in patients with CHF.

Carcinoma urotelial micropapilar de vejiga: reporte de un caso y revisión de la literatura / Micropapillary urothelial carcinoma of the bladder: a case report and literature review

El carcinoma urotelial micropapilar (CMP) de vejiga es una variante anatomopatológica infrecuente, de comportamiento agresivo. Se presenta habitualmente como carcinoma de alto grado, en estadios avanzados, sin signos clínicos distintos al del carcinoma vesical convencional. El tratamiento debe ser precoz y agresivo, fundamentalmente quirúrgico, dado que la radioterapia y la quimioterapia no han demostrado utilidad hasta el momento. Es necesario el reconocimiento de esta entidad pues su capacidad metástasica está asociada a una alta incidencia de mortalidad. Presentamos el caso de un varón de 64 años con hematuria de larga evolución diagnosticado de carcinoma micropapilar infiltrante de vejiga con compromiso de uréter.

Micropapillary urothelial carcinoma (MCP) of the urinary bladder is an rare anatomopathology variant aggressive behaviour. It is usually found as a high grade and stage carcinoma, and doesn't differ clinically from normal cell carcinoma of the bladder. Treatment should be early and aggressive, because radiotherapy and chemotherapy have shown limited results the therapy is surgically based. The diagnosis of this disease is required because its metastasic capacity is associate with a significantly increased mortality risk. In this study we report de case of a 64 years old man with a long development hematuria diagnosed of Micropapillary carcinoma infiltrating the bladder involving the ureter.

Expression and function of the purinergic receptor P2X7 in patients with pulmonary tuberculosis.

P2X(7) is a channel receptor gated by adenosine triphosphate (ATP) that is involved in the killing of intracellular mycobacteria. To explore further the role of P2X(7) in immunity against Mycobacterium tuberculosis, we studied its expression and function in 19 patients with pulmonary tuberculosis (TB) and 19 healthy contacts. Flow cytometry analysis showed a similar and variable expression of P2X(7) in TB patients and healthy subjects. In contrast, P2X(7) mARN levels were significantly higher in TB patients. When the function of the P2X(7) receptor in peripheral blood mononuclear cells (PBMC) was assessed by the effect of exogenous ATP on apoptosis, the uptake of the fluorescent marker Lucifer yellow or extracellular signal regulated kinase (ERK) phosphorylation, no significant differences were detected in patients and controls. However, mRNA macroarray analysis showed that upon stimulation with ATP, the PBMC from TB patients showed a significant induction of a higher number of cytokine genes (27 of 96), and a lower number of apoptosis genes (20 of 96) compared to healthy controls (17 and 76 genes, respectively). These results suggest that although the PBMC from TB patients do not show apparent abnormalities in the expression of P2X(7), and the intracellular signals generated through it, the pattern of gene expression induced by ATP in these cells is different from that found in healthy contacts. This phenomenon suggests a defective function of P2X(7) in the immune cells from TB patients, a condition that may contribute to the inability of these patients to eliminate the mycobacteria.

Molecular characterisation of a dominant methicillin-resistant Staphylococcus aureus (MRSA) clone in a Mexican hospital (1999-2003).

Methicillin-resistant Staphylococcus aureus (MRSA) isolates (n = 216), collected between January 1999 and May 2003 in a tertiary-care university hospital in Guadalajara, Mexico, were characterised by antibiotype, pulsed-field gel electrophoresis (PFGE) of SmaI macrorestriction fragments, and hybridisation of ClaI digests with mecA- and Tn554-specific DNA probes. Representatives of the single clonal type found were analysed by spa typing, multilocus sequence typing and staphylococcal chromosomal cassette mec (SCCmec) typing, and were tested for the presence of 22 virulence determinants and agr type. A single PFGE pattern was identified, with minor variations over time, with spa type 2, sequence type 5, SCCmec type II, agr type 2 and the presence of the enterotoxin genes seg and sei, the gamma-haemolysin variant gene hlg-v and the leukocidin lukE-lukD genes. In addition, the isolates showed antimicrobial resistance to beta-lactams, macrolides, chloramphenicol and imipenem, and susceptibility to gentamicin, rifampicin, trimethoprim-sulphamethoxazole and vancomycin. Following its appearance in 1997, this clone spread within the hospital, and is now present in most of the hospital units and wards.

Electrical activity of prefrontal cortex and ventral tegmental area during rat maternal behavior.

Maternal behavior is a motivated behavior that includes pup-directed sequential motor acts. The dopaminergic (DAergic) brain systems have been proposed to play an important role in voluntary maternal acts, however, not much is known about the way these systems function during the performance of this behavior. The electroencephalogram (EEG) is a sensitive tool that allows determination of the simultaneous functioning of different structures in relation to specific cognitive processes or motor acts. The present study recorded the function of the two structures that constitute the mesoprefrontal DAergic system, ventral tegmental area (VTA) and prefrontal cortex (PFC) by EEG during the performance of various maternal behaviors. Bilateral EEG from the VTA and medial PFC (mPFC) was simultaneously recorded during typical maternal acts and was compared to that recorded during non-maternal behaviors in freely moving female rats. Three different frequency bands (6-7, 8-11, and 12-21 Hz) were obtained from principal component analysis applied to the EEG for both structures. In the left and right mPFC and VTA, absolute power (AP) of the 8-11 Hz band showed a significant increase during pup retrieval compared to the EEG during walking. In the left and right mPFC and VTA, AP of the three bands showed a significant increase during pup licking with respect to forepaw licking. No differences in the EEG were found during inactive nursing behaviors compared to the awake quiet condition. The mPFC and VTA presented characteristic EEG patterns during active maternal behaviors but not during inactive maternal behaviors. This provides electrical evidence of the involvement of these structures in the performance of maternal behavior.

Surveillance of methicillin-resistant Staphylococcus aureus in a pediatric hospital in Mexico City during a 7-year period (1997 to 2003): clonal evolution and impact of infection control.

Between 1997 and 2000 a single multidrug-susceptible methicillin-resistant Staphylococcus aureus clone, M (sequence type 30 [ST30]-staphylococcal cassette chromosome mec [SCCmec] type IV), was present in a pediatric hospital in Mexico City, Mexico. In 2001 the international multidrug-resistant New York-Japan clone (ST5-SCCmec type II) was introduced into the hospital, completely replacing clone M by 2002.