Surveillance for pancreatic cancer in high-risk individuals.

Background: Surveillance of individuals at high risk of pancreatic ductal adenocarcinoma (PDAC) and its precursors might lead to better outcomes. The aim of this study was to determine the prevalence and outcomes of PDAC and high-risk neoplastic precursor lesions among such patients participating in surveillance programmes. Methods: A multicentre study was conducted through the International CAncer of the Pancreas Screening (CAPS) Consortium Registry to identify high-risk individuals who had undergone pancreatic resection or progressed to advanced PDAC while under surveillance. High-risk neoplastic precursor lesions were defined as: pancreatic intraepithelial neoplasia (PanIN) 3, intraductal papillary mucinous neoplasia (IPMN) with high-grade dysplasia, and pancreatic neuroendocrine tumours at least 2 cm in diameter. Results: Of 76 high-risk individuals identified in 11 surveillance programmes, 71 had undergone surgery and five had been diagnosed with inoperable PDAC. Of the 71 patients who underwent resection, 32 (45 per cent) had PDAC or a high-risk precursor (19 PDAC, 4 main-duct IPMN, 4 branch-duct IPMN, 5 PanIN-3); the other 39 patients had lesions thought to be associated with a lower risk of neoplastic progression. Age at least 65 years, female sex, carriage of a gene mutation and location of a lesion in the head/uncinate region were associated with high-risk precursor lesions or PDAC. The survival of high-risk individuals with low-risk neoplastic lesions did not differ from that in those with high-risk precursor lesions. Survival was worse among patients with PDAC. There was no surgery-related mortality. Conclusion: A high proportion of high-risk individuals who had surgical resection for screening- or surveillance-detected pancreatic lesions had a high-risk neoplastic precursor lesion or PDAC at the time of surgery. Survival was better in high-risk individuals who had either low- or high-risk neoplastic precursor lesions compared with that in patients who developed PDAC.

Antecedentes: Se podrían obtener mejores resultados con el seguimiento de individuos de alto riesgo para adenocarcinoma ductal pancreático (pancreatic ductal adenocarcinoma, PDAC) y lesiones precursoras. El objetivo de este estudio fue determinar la prevalencia y los resultados del PDAC y de las lesiones precursoras de alto riesgo neoplásico en pacientes que participaron en programas de seguimiento. Métodos: Se llevó a cabo un estudio multicéntrico a través del registro internacional del consorcio CAPS (Common Automotive Platform Standard) para identificar a las personas de alto riesgo que se habían sometido a una resección pancreática o habían progresado a PDAC avanzado mientras estaban en seguimiento. Se definieron como lesiones neoplásicas precursoras de alto riesgo la neoplasia intraepitelial pancreática de tipo 3 (PanIN­3), la neoplasia papilar mucinosa intraductal (intraductal papillary mucinous neoplasia, IPMN) con displasia de alto grado y los tumores neuroendocrinos pancreáticos (pancreatic neuroendocrine tumours, PanNET) de ≥ 2 cm de diámetro. Resultados: De 76 individuos con lesiones de alto riesgo identificados en 11 programas de seguimiento, 71 fueron tratados quirúrgicamente y 5 fueron diagnosticados de un PDAC inoperable. De las 71 resecciones, 32 (45%) tenían PDAC o una lesión precursora de alto riesgo (19 PDAC, 4 IPMN de conducto principal, 4 IPMN de rama secundaria y 5 PanIN­3). Los otros 39 pacientes tenían lesiones que se consideraron asociadas con un menor riesgo de progresión neoplásica. La edad ≥ 65 años, el sexo femenino, el ser portador de una mutación genética y la localización de la lesión en la cabeza/proceso uncinado fueron factores asociados a las lesiones precursoras de alto riesgo o al PDAC. No hubo diferencias en la supervivencia de individuos de alto riesgo con lesiones neoplásicas de bajo riesgo frente a aquellos que presentaron lesiones precursoras de alto riesgo. La supervivencia fue peor en los pacientes con PDAC. No hubo mortalidad relacionada con la cirugía. Conclusión: Un elevado porcentaje de individuos de alto riesgo que se sometieron a resección quirúrgica tras la detección de lesiones pancreáticas en el seguimiento tenían una lesión precursora neoplásica de alto riesgo o un PDAC. La supervivencia fue mejor en individuos de alto riesgo que tenían lesiones precursoras neoplásicas de bajo o alto riesgo en comparación con aquellos pacientes que habían desarrollado un PDAC.

Citrus-derived oil inhibits Staphylococcus aureus growth and alters its interactions with bovine mammary cells.

This experiment examined the effects of cold-pressed, terpeneless citrus-derived oil (CDO) on growth of Staphylococcus aureus, which a major cause of contagious bovine mastitis, and invasion of bovine mammary cells (MAC-T). To determine minimum inhibitory concentration, we used the broth dilution method, using CDO concentrations range from 0.0125 to 0.4% with 2-fold dilutions. Growth inhibition was examined by adding 0.00, 0.05, 0.025, 0.0125, and 0.00625% CDO to 10(5) cfu/mL S. aureus in nutrient broth and enumerating colonies after serial dilution. In a 96-well plate, S. aureus (10(7) cfu/mL) was allowed to form a biofilm, treated with 0, 0.025, 0.5, or 1% CDO, and then was measured using a spectrophotometer. Cytotoxic effect on immortalized MAC-T cells was also examined at various concentrations of CDO using a 3-(4,5-dimethylthiazol-2-yl)-2,5-diphenyltetrazolium bromide assay. We observed that the minimum inhibitory concentration of CDO to inhibit the growth of S. aureus in vitro was 0.025% CDO. A time kill curve for CDO action on S. aureus over 4h was generated. The CDO completely eliminated S. aureus after 3h of incubation at a concentration of 0.25%, or after 2h of incubation at concentrations of 0.05%. It was also observed that CDO had no effect on preformed biofilms except at a concentration of 0.05%, in which a significant reduction in the measured absorbance was noted. In addition, the association and invasion of S. aureus to MAC-T cells were significantly inhibited after 1h of treatment with CDO. Citrus-derived oil was also able to increase cellular proliferation of MAC-T cells at concentrations up 0.05% and had no effect at a concentration of 0.1% after 1 h. Our data suggests that CDO should be considered for further research as a preventive and therapeutic against bovine mastitis.

KRAS and guanine nucleotide-binding protein mutations in pancreatic juice collected from the duodenum of patients at high risk for neoplasia undergoing endoscopic ultrasound.

BACKGROUND & AIMS: Pancreatic imaging can identify neoplastic cysts but not microscopic neoplasms. Mutation analysis of pancreatic fluid after secretin stimulation might identify microscopic neoplasias in the pancreatic duct system. We determined the prevalence of mutations in KRAS and guanine nucleotide-binding protein α-stimulating genes in pancreatic juice from subjects undergoing endoscopic ultrasound for suspected pancreatic intraepithelial neoplasia, intraductal papillary mucinous neoplasms, or pancreatic adenocarcinoma. METHODS: Secretin-stimulated juice samples were collected from the duodenum of 272 subjects enrolled in Cancer of the Pancreas Screening studies; 194 subjects were screened because of a family history of, or genetic predisposition to, pancreatic cancer, and 78 subjects were evaluated for pancreatic cancer (n = 30) or other disorders (controls: pancreatic cysts, pancreatitis, or normal pancreata, n = 48). Mutations were detected by digital high-resolution melt-curve analysis and pyrosequencing. The number of replicates containing a mutation determined the mutation score. RESULTS: KRAS mutations were detected in pancreatic juice from larger percentages of subjects with pancreatic cancer (73%) or undergoing cancer screening (50%) than controls (19%) (P = .0005). A greater proportion of patients with pancreatic cancer had at least 1 KRAS mutation detected 3 or more times (47%) than screened subjects (21%) or controls (6%, P = .002). Among screened subjects, mutations in KRAS (but not guanine nucleotide-binding protein α-stimulating) were found in similar percentages of patients with or without pancreatic cysts. However, a greater proportion of patients older than age 50 years had KRAS mutations (54.6%) than younger patients (36.3%) (P = .032); the older subjects also had more mutations in KRAS (P = .02). CONCLUSIONS: Mutations in KRAS are detected in pancreatic juice from the duodenum of 73% of patients with pancreatic cancer, and 50% of asymptomatic individuals with a high risk for pancreatic cancer. However, KRAS mutations were detected in pancreatic juice from 19% of controls. Mutations detected in individuals without pancreatic abnormalities, based on imaging analyses, likely arise from small pancreatic intraepithelial neoplasia lesions. ClinicalTrials.gov no: NCT00438906 and NCT00714701.

Inhibition of growth and alteration of host cell interactions of Pasteurella multocida with natural byproducts.

Pasteurella multocida is a leading cause of fowl cholera in both free-range pasture and conventional/commercially raised poultry. Its infection is a serious threat to poultry health and overall flock viability. Organic poultry is comparatively more vulnerable to this pathogen. It is a significant cause of production loss and price increase of poultry products, specifically organic poultry products. Some plant products are well documented as sources of natural antimicrobials such as polyphenols found in different berry pomaces and citrus oil. Pomace, a byproduct (primarily of seeds and skins) of fruits used for juice and wine production, and citrus oil, the byproduct of citrus juice production, show promising antimicrobial activity against various pathogens. Here, we showed for the first time that blackberry and blueberry pomace extracts and citrus oil inhibited P. multocida growth. Minimum bactericidal concentrations were determined as 0.3 and 0.4 mg/mL gallic acid equivalent for blackberry and blueberry pomace extracts, respectively. Similarly, only 0.05% citrus oil (vol/vol) completely inhibited P. multocida growth. Under shaking conditions, the antimicrobial activity of both pomace extracts and citrus oil was more intensive. Even citrus oil vapor also significantly reduced the growth of P. multocida. In addition, cell surface hydrophobicity of P. multocida was increased by 2- to 3-fold and its adherence to chicken fibroblast (DF1) and bovine mammary gland (MacT) cells was reduced significantly in the presence of pomace extracts only. This study indicates that these natural products might be good alternatives to conventional antimicrobial agents, and hence, may be used as feed or water supplements to control fowl cholera and reduce production loss caused by P. multocida.

Reporte de un caso: sinusitis fúngica invasiva por mucor / Case report: mucor invasive fungal sinusitis

En los últimos años se ha identificado un aumento de la sinusitis fúngica aguda invasiva (mucormicosis), se puede pensar que se debe a la inmunosupresión de la población o por los adelan-tos científicos, que han proporcionado un diagnóstico precoz. Con este artículo se busca realizar, una revisión acerca del manejo de la mucormicosis, la cual se presenta con mayor frecuencia en pacientes con cetoacidosis, determinando los nuevos avances en el tratamiento, sus imitaciones y la posible prevención

Revisión de estudios de meta-análisis en el manejo de la patología infecciosa de oído externo y medio / Meta-analysis study review in the management of infectious pathology of the external and middle ear

El presente artículo pretende mostrar los aspectos más relevantes en el enfoque terapéutico de la patología infecciosa del oído externo y medio. Es por esta razón que se realizó una cuidadosa revisión de los estudios de meta-análisis existentes en la literatura mundial. Como producto de estas revisiones se obtuvo algunos consensos en: otitis externa, otitis media aguda, otitis media con efusión y otitis media crónica supurativa, los cuales fueron revisados y adaptados mostrando en forma clara y concreta el enfoque terapéutico más aceptado por los grandes centros de investigación del mundo. Muchos de los conceptos aquí emitidos son controversias y deben ser analizadas cuidadosamente de acuerdo a las evidencias clínicas e investigativas que se presentan

Síndrome de mobius unilateral / Unilateral mobius syndrome

El síndrome de Mobius es una entidad caracterizada por parálisis del VI y VII par, pudiendo existir compromiso de otros pares craneanos o asociación a alteraciones de la pared torácica, retardo mental y alteraciones de las extremidades. Normalmente es de presentación bilateral, pero puede presentarse en forma unilateral. El presente reporte muestra el caso de una paciente de 15 años de edad quién consulta por presentar parálisis facial congénita unilateral y VI par ipsilateral; siendo estas sus únicas manifestaciones clínicas

Técnica quirúrgica utilizada con el implante coclear Combi 40 plus / Surgical technique used with Combi 40 plus cochlear implant

Los avances tecnológicos en el área de los implantes cocleares ha sido grandes. Es por esta razón que el diseño de nuevas estrategias de codificación, cambios en el procesador en cuanto a velocidad y tamaño; así mismo nuevas innovaciones en la conformación del electrodo, entre otros han hecho que sea un área en donde la tecnología se ha colocado al servicio del paciente. Así mismo cada día son más las personas que requieren de los implantes cocleares y es por esta razón que el conocimiento y estandarización de una técnica quirúrgica son vitales, evitando la presentación de complicaciones y optimizando los resultados que se pueden obtener con el implante coclear. El presente estudio muestra la descripción de la técnica quirúrgica utilizada en la colocación del electrodo del implante coclear Combi 40+ y la experiencia obtenida por el Grupo de Implante Coclear del Hospital Militar Central, en los primeros 5 pacientes (2 adultos y 3 niños), utilizando este equipo

Terapia intratimpánica como una alternativa de manejo para algunas afecciones del oído interno / Inner-tympanic therapy alternative as an alternative in the management of certain inner ear affections

La terapia intratimpánica ha constituido desde 1948 un motivo de inquietud y ha sido objeto de investigación con el único fin de establecer una forma eficaz y segura de tratamiento para aquellas afecciones del oído interno en las que la terapia convencional no ha dado los resultados esperados. Con la presente revisión pretendemos mostrar en una forma concreta los principios teóricos que soportan está técnica, así como las alternativas terapéuticas con las que se pueden contar y que incluye el uso de corticoesteroides, lidocaína y gentamicina, en el tratamiento de afecciones como Enfermedad de Méniére, Hipoacusia Inmunológica y Sordera Súbita

Acueducto vestibular dilatado: a propósito de un caso / Dilated vestibular aqueduct: a case report

El sindrome de acueducto vestibular dilatado se asocia con la presencia de hipoacusia neurosensorial en niños, en este articulo se presenta un caso de una paciente con sindrome de acueducto vestibular dilatado y una otitis media serosa cronica manejado en nuestro Hospital, además se presenta la imagenologia diagnostica en escanografia, resonancia magnetica nuclear y la reconstruccion tridimensional (Fast spin Echo)

Quantitative urine cultures do not reliably detect renal candidiasis in rabbits.

The significance of quantitative urine cultures in patients at risk for hematogenous disseminated candidiasis is controversial. While various concentrations of Candida spp. in urine have been suggested as critical cutoff points in the diagnosis of renal candidiasis, other investigators consider quantitative cultures less critical in diagnosing upper tract infections. To determine the significance of quantitative urine cultures in renal candidiasis, we studied serial quantitative urinary cultures of Candida albicans in a rabbit model of hematogenous infection. Of 197 urine samples from 34 infected animals, 144 were culture positive, with a sensitivity of 73.1% for urine cultures and a lower limit of detection of 10 CFU/ml. The yield of urine cultures varied according to severity and duration of infection. The mean renal and urinary concentrations of C. albicans from rabbits with subacute candidiasis differed significantly from those from rabbits with acute candidiasis (P = 0.013 and P < or = 0.001, respectively). During the first 4 days of subacute renal candidiasis, more than one-half of all urine cultures were negative for C. albicans. Only 12 (8.1%) of 148 urine cultures in animals with subacute renal candidiasis had concentrations of > 10(3) CFU/ml, 2.7% had concentrations of > 10(4) CFU/ml, and none were > or = 10(5) CFU/ml. By comparison, all urine cultures from the animals with lethal acute renal candidiasis had higher concentrations of C. albicans and were positive throughout the course of infection. Urinary concentrations of C. albicans were not predictive of the amount of Candida in the kidney (r < or = 0.49) and did not correlate with survival (r = 0.0232). However, the renal concentration of C. albicans (in CFU/gram) inversely correlated with the duration of survival (in days) of rabbits with renal candidiasis (r = 0.76; P < 0.001). These findings indicate that a negative urine culture in rabbits does not preclude the presence of renal candidiasis. The interpretation of a urine culture positive at any concentration, on the other hand, must involve an analysis of the risk factors for renal candidiasis, for any urinary concentration of C. albicans may reflect kidney infection.

Resonancia nuclear magnética 3D: una nueva herramienta en el diagnóstico otoneurológico / 3D nuclear magnetic resonancy: a new tool in otoneurological diagnosis

Teniendo en cuenta que la IRM es el metodo de elección en el estudio imagenologico de los tejidos blandos, estudiamos una serie de casos de 66 pacientes, 7 de ellos sanos desde el punto de vista otoneurologico y 59 con hipoacusia neurosensorial, con el proposito de evaluar la integridad anatomica del VIII par craneal y del laberinto membranoso con fines diagnosticos. A todos los pacientes se les realizó previamente historia clinica y examen otoneurologico completo. En la tecnica de IRM se utilizaron secuencias 3DT2W-TSE, encontrando en 12 de los sujetos del estudio, evidencias de patologia no diagnosticada por metodos no tradicionales. Concluimos que todo paciente en estudio por enfermedad vertiginosa e hipoacusia neurosensorial con duda diagnostica y todos aquellos pacientes candidatos para implante coclear, deberán incluir en su protocolo de estudio, no solamente el estudio del laberinto oseo, sino del laberinto membranoso y del paquete acustico-facial

Detection of Candida casts in experimental renal candidiasis: implications for the diagnosis and pathogenesis of upper urinary tract infection.

The distinction between upper versus lower urinary tract infection in patients with candiduria is a commonly encountered and therapeutically important diagnostic dilemma. Candida casts have been reported in the urine of several individual case reports of human renal candidiasis. The specificity of Candida casts would identify unequivocally a patient with upper urinary tract disease. Little is known, however, about the sensitivity and the formation of Candida casts. We therefore studied the diagnostic yield, methods for detection and pathogenesis of Candida cast formation in serially collected urine specimens from immunologically intact and granulocytopenic rabbit models of haematogenous disseminated candidiasis. Refractile blastoconidia and pseudohyphae of Candida encased in the granular matrix were seen on wet mounts while Candida stained a brilliant red in the fuschia pink tubular matrix on periodic acid Schiff (PAS) stained cytopathology filters. Among 24 rabbits with disseminated candidiasis, 11 (46%) had Candida casts detectable by wet mount and PAS-stained urine filters in comparison to none of 10 non-infected immunologically normal controls (P = 0.014). Fifteen (70%) of 21 episodes of Candida casts were detected within the first 3 days of infection, indicating possible utility in the early diagnosis of renal candidiasis. No Candida casts were detected in the urine of granulocytopenic rabbits, possibly due to the rapid destruction of tubules and abrogation of cast formation. This absence of detectable Candida in eight infected granulocytopenic rabbits differed significantly from that of 24 non-granulocytopenic infected rabbits, in which Candida casts were detected in 11 (46%) (P = 0.029). Candida cast formation occurred predominantly in the cortex. Histopathological examination demonstrated invasion of Candida into the glomerular tufts and peritubular capillaries, followed by development of Candida casts in the proximal and distal tubules, respectively. Detection of renal Candida casts may be a useful diagnostic marker in distinguishing upper versus lower urinary tract candidiasis.

Hemodialysis-hemoperfusion in fulminant viral hepatitis.

It is theorized that charcoal hemoperfusion and hemodialysis with a highly permeable membrane should be synergistic in the management of fulminant hepatic failure. Previous studies have shown marked differences between these two treatments in their effects in the various biochemical abnormalities of this serious clinical problem. Survival rates in patients treated with charcoal hemoperfusion approximate the rates in those treated with hemodialysis with a highly permeable membrane but are only slightly better than in untreated cases. The excellent recovery of two patients with fulminant viral hepatitis in stage III and IV coma treated with this combined regimen indicates that further studies should be done to confirm this thesis.

Transrectal needle method for biopsy of the prostate: review of 90 cases.

Eighty-three patients undergoing a total of 90 transrectal procedures for obtaining prostatic tissue for biopsy were reported. All were done without preparation or later use of retention catheter. Tetracycline was administered for two or three days before the procedure and continued for a total of five days after. Most patients were hospitalized for this procedure, but we do not think this is necessary or ideal. A complication rate of 9.3 per cent-5.4 per cent for sepsis and 3.9 per cent hematuria-was encountered. Only four false negative results were obtained. We believe that the transrectal procedure is a safe and accurate method for diagnosis carcinoma of the prostate. We would also recommend use of a broad-spectrum antibiotic, preferably before and after operation, but at least after for a minimum of five days.