Effect of Ceramic Conditioners on Surface Morphology, Roughness, Contact Angle, Adhesion, Microstructure, and Composition of CAD/CAM Ceramics.

The objective of this study was to investigate the effect of surface treatments in maximum profile valley depth (Rv), surface roughness (Sa), contact angle (Ca), shear bond strength (SBS) of a light-cured resin cement, microstructure, and composition of two CAD/CAM ceramics: Cerec Blocs/Dentsply Sirona (feldspathic - FEL) and Empress CAD/Ivoclar Vivadent (leucite-reinforced - LEU). The ceramic specimens were submitted to six surface treatments: (1) 5% hydrofluoric acid (HF) - 20 seconds; (2) 5% HF - 60 seconds; (3) 10% HF - 20 seconds; (4) 10% HF - 60 seconds; (5) self-etching ceramic primer (MEP) - 20 seconds; and (6) MEP - 60 seconds. Specimens treated with HF received silane application for 1 minute. Rv and Sa were evaluated in a confocal laser microscope (n=10) and the Ca in a goniometer (n=6). For the SBS test, two resin cement cylinders were bonded to each specimen, one tested after 24 hours in distilled water storage (37°C) and the other after one year (n=10). The microstructures and compositions were analyzed by scanning electron microscopy (SEM) and energy dispersive x-ray spectroscopy (EDS) (n=4). Rv, Sa, and Ca data were analyzed by two-way ANOVA, and the SBS data by three-way ANOVA, all followed by post-hoc Tukey's test (α=0.05). Results: Surface treatments with HF always produced higher Rv and Sa, and lower Ca than MEP 60s for both ceramics. After 1-year water storage, FEL ceramic treated with MEP for 60 seconds produced higher SBS values than HF treatments, whereas for LEU ceramic there were no differences among treatments. Application of MEP for 20 or 60 seconds produced no difference in Rv, Sa, Ca, and SBS for both ceramics. Surface treatments produced considerable differences in ceramic topography, but subtle ones in composition, for both ceramics. Conclusions: The results indicated that for FEL ceramic, MEP application for 60 seconds yielded higher SBS compared with HF etching, while for LEU ceramic the surface treatments did not influence the SBS results.

Detergent Sclerosants Stimulate Leukocyte Apoptosis and Oncosis.

OBJECTIVE/BACKGROUND: The objective was to investigate the effects of the detergent sclerosants sodium tetradecyl sulfate (STS) and polidocanol (POL) on human leukocytes at sublytic concentrations. METHODS: Leukocytes were isolated and labelled with antibodies to assess for apoptosis and examined with confocal microscopy and flow cytometry. Isolated leukocyte count and viability was assessed using trypan blue, and propidium iodide staining. Phosphatidylserine (PS) exposure, a universal hallmark to measure cell apoptosis, was identified by flow cytometry using lactadherin. Caspases 3, 8, and 9, and Bax activation, as well as inhibitory assays with pan-caspase (Z-VAD-FMK) and Bax (BI-6C9) were assessed to determine apoptotic pathways. Porimin activation was used to assess cell permeability. RESULTS: Up to 40% of leukocytes maintained membrane integrity at sublytic concentrations (≤0.15%) of sclerosants. The remaining 60% did not maintain membrane integrity but were not completely lysed. PS exposure was increased with both STS and POL exhibiting a dose- and time-dependant trend. While activation of caspases 3, 8, and 9, as well as Bax activation, were increased in leukocytes stimulated with low concentrations of STS, only caspases 3 and 9 and Bax were increased with POL. Inhibitory assays demonstrated caspases 3, 8, and 9, and Bax inhibition at low concentrations with both STS and POL. Both agents increased the leukocyte activation of porimin at all concentrations. On confocal microscopy, stains for caspases 3, 8, and 9, and Bax were increased for both STS and POL. Porimin stain was markedly positive for both STS and POL. CONCLUSION: Both sclerosants induced leukocyte apoptosis at sublytic concentrations. STS activated both extrinsic and intrinsic pathways of apoptosis, while POL stimulated the intrinsic pathway of apoptosis only. Both agents induced oncosis. Based on these results, STS appears to have a greater effect than POL.

Morphological changes in vascular and circulating blood cells following exposure to detergent sclerosants.

OBJECTIVES: To investigate morphological changes in vascular and circulating blood cells following exposure to detergent sclerosants sodium tetradecyl sulfate and polidocanol. METHODS: Samples of whole blood, isolated leukocytes, platelets, endothelial cells, and fibroblasts were incubated with varying concentrations of sclerosants. Whole blood smears were stained with Giemsa and examined by light and bright field microscopy. Phalloidin and Hoechst stains were used to analyze cytoplasmic and nuclear morphology by fluorescence microscopy. Endothelial cell and fibroblasts were analyzed by live cell imaging. RESULTS: Higher concentrations of sclerosants induced cell lysis. Morphological changes in intact cells were observed at sublytic concentrations of detergents. Low concentration sodium tetradecyl sulfate induced erythrocyte acanthocytosis and macrocytosis, while polidocanol induced Rouleaux formation and increased the population of target cells and stomatocytes. Leukocytes showed swelling, blebbing, vacuolation, and nuclear degradation following exposure to sodium tetradecyl sulfate, while polidocanol induced pseudopodia formation, chromatin condensation, and fragmentation. Platelets exhibited pseudopodia with sodium tetradecyl sulfate and a "fried egg" appearance with polidocanol. Exposure to sodium tetradecyl sulfate resulted in size shrinkage in both endothelial cell and fibroblasts, while endothelial cell developed distinct spindle morphology. Polidocanol induced cytoplasmic microfilament bundles in both endothelial cell and fibroblasts. Patchy chromatin condensation was observed following exposure of fibroblasts to either agent. CONCLUSION: Detergent sclerosants are biologically active at sublytic concentrations. The observed morphological changes are consistent with cell activation, apoptosis, and oncosis. The cellular response is concentration dependent, cell-specific, and sclerosant specific.

Detergent sclerosants are deactivated and consumed by circulating blood cells.

OBJECTIVE: To investigate the deactivating effects of circulating blood cells on the lytic activity of detergent sclerosants. METHODS: Samples of whole blood (WB), platelet-rich plasma (PRP), and isolated leukocytes were incubated with various concentrations of sodium tetradecyl sulfate (STS) or polidocanol (POL) and added to human umbilical vein endothelial cells (HUVECs), which were then counted using a fluorescent plate reader. Full blood counting was performed using a hematology analyzer. Platelet lysis and microparticle formation was assessed using lactadherin binding in flow cytometry. RESULTS: Detergent sclerosant activity was decreased in WB when compared with plasma and saline controls. The sclerosant lytic activity on endothelial cells was increased 23-fold for STS and 59-fold for POL in saline controls compared with WB. At high concentrations, sclerosants lysed erythrocytes, leukocytes, and platelets. Platelets were more sensitive to the lytic activity of sclerosants than other cell types. Neutrophils were the most susceptible of all leukocytes to the lytic activity of sclerosants. The presence of erythrocytes and leukocytes in samples decreased the lytic activity of sclerosants. Sclerosants at all concentrations induced erythrocyte-derived microparticle formation. CONCLUSIONS: Detergent sclerosants are consumed and deactivated by circulating blood cells. This deactivating effect is above and beyond the neutralizing effects of plasma proteins and contributes to the overall neutralizing effect of blood. Different blood cell types exhibited varying levels of vulnerability to the lytic activity of sclerosants with platelets being the most and erythrocytes the least vulnerable (platelets > leukocytes > erythrocytes).

Intake, digestibility and intake behaviour in cattle fed different levels of palm kernel cake / Consumo, digestibilidad, y comportamiento ingestivo del ganado alimentado con diferentes niveles de torta de palma

Objective. The potential use of palm kernel cake was evaluated as a replacement for soybean and corn meal in cattle feed, by investigating their intake, digestibility levels and the intake behaviour of cattle fed diets containing different levels of palm kernel cake concentrate. Materials and methods. The experiment was conducted at the Experimental Farm of the Federal University of Bahia, between August and October 2009. Five crossbred Holstein x Zebu adults, were used. A 5 x 5 Latin square experimental design was used. The animals were fed Tifton-85 Bermudagrass, which made up 65% of their diet, plus one of five different levels of palm kernel cake concentrate (0, 7, 14, 21 and 28%). Results. A linear decrease in dry matter (kg/day) was observed due to the lower palatability and higher fiber content of the palm kernel cake. Neutral detergent fiber intake by the animals showed a quadratic behavior. The coefficients of fractional digestibilities of the analyzed feed, did not differ due to the inclusion of palm kernel cake. The ingestive behavior of the animals was not influenced by the inclusion of palm kernel cake in the diet. Conclusions. Palm kernel cake can be used as an alternative feed supplement in ruminant production systems to reduce feed costs without changes in the studied variables.

Objetivo. Se evaluó el uso potencial de la torta de palma como sustituto de harina de soja y harina de maíz en la alimentación del ganado mediante el estudio de su consumo, niveles de digestibilidad y el comportamiento ingestivo de los bovinos alimentados con dietas con diferentes niveles de torta de palmiste. Materiales y métodos. El experimento se realizó en la Granja Experimental de la Universidad Federal de Bahía, entre agosto y octubre de 2009. Cinco animales cruzados Holstein x Cebú, fueron utilizados. Se utilizó un diseño experimental de cuadrado latino 5x5. Los animales fueron alimentados con heno de Tifton-85 Bermuda (65% de la dieta). Además, cinco niveles diferentes de concentrado de palma torta de palmiste (0, 7, 14, 21 y 28%). Resultados. Se observó una disminución lineal en la materia seca (kg/día) debido a la palatabilidad inferior y al contenido de fibra superior de la torta de palmiste. La ingesta de fibra en detergente neutro por los animales mostró un comportamiento de segundo grado. Los coeficientes de digestibilidad fraccional de los alimentos analizados no fueron diferentes debido a la inclusión de la torta de palma. El comportamiento ingestivo de los animales no fue afectado por la inclusión de hasta 28% de torta de palma en la dieta. Conclusiones. La torta de palma se puede utilizar como un suplemento alimenticio alternativo en los sistemas de producción de rumiantes para reducir los costos de alimentación, sin cambios de las variables estudiadas.

Staphylococcus aureus meticilino resistente: detección de PBP 2' mediante la técnica de látex y evaluación de la resistencia asociada / Methicillin-resistant staphylococcus aureus: detection of PBP 2 'latex using the technique and evaluation of the resistance associated

El Staphylococcus aureus meticilino resistente representa un patógeno importante en infecciones nosocomiales y adquiridas en la comunidad. Su detección en el laboratorio es en ocasiones difícil motivado a factores tales como la presencia de cepas con patrones de resistencia cercana a los puntos de corte (borderline), heterorresistencia o problemas en la metodología. El objetivo del presente estudio fue la detección mediante la técnica de látex de la proteína PBP 2', responsable de la resistencia a meticilina en Staphylococcus aureus, y la evaluación de la resistencia asociada a antibióticos marcadores de este fenotipo de resistencia: clindamicina, gentamicina, eritromicina, tetraciclina y ciprofloxacina. Para cumplir el objetivo propuesto fueron evaluadas 65 cepas de Staphylococcus aureus meticilino resistente, aisladas entre octubre 2001 y diciembre 2003 a partir de muestras clínicas y conservadas en el cepario del Labortorio Metropolitano de Caracas. De las 65 cepas evaluadas, 30 (46,15 por ciento) mostraron heterorresistencia y 35 (53,85 por ciento) resistencia absoluta (homorresistencia). La resistencia asociada a los antibióticos evaluados fue la siguiente: clendamicina (49,2 por ciento), gentamicina (64,7 por ciento), eritromicina (67,7 por ciento), tetraciclina (46,2 por ciento) y ciprofloxacina (57,0 por ciento). En una de las cepas no se detectó la presencia de la proteína PBP2', pudiendo atribuirse la resistencia a oxacilina a la presencia de otras PBP modificadas o a la hiperproducción de beta lactamasa.

Some effects of repeated handling and the use of a mask on stress responses in zebu cattle during restraint.

The objective of this investigation was to evaluate the effect of repeated handling and the use of a mask on the order of entry, temperament, cortisol concentration and heart and respiratory rates of Brahman cattle during restraint in a squeeze chute. In the first experiment, 18 cows were restrained in the chute for 10min on 19 test-days and blood samples were collected during five of the trials. Habituation to handling was reflected by a decrease in cortisol concentration as the study advanced (P<0.01). In the second experiment, conducted 6 months later, animals were randomly allotted to two groups, alternating the use of a mask over test-days while restraining the cows in the chute for 3min. Respiratory and heart rates were measured at the beginning and end of each 3min trial. A blood sample was also taken at the end of each trial. Respiratory rates decreased while the animals were restrained and this decrease tended to be greater (P=0.09) when the animals were wearing masks (3.06) than when not (2.2breaths/min). Heart rates also decreased and more so for masked animals (10.6beats/min) than for non-masked (5.0, P<0.01). Cortisol values tended to be higher (9.9 versus 4.7ng/ml, P=0.08) when animals were restrained without a mask. Temperament scores were lower (P>0.01) when cows were masked and have a relative high correlation (r=0.58) with flight distance values, (P<0.05). Finally, the order of entrance was found consistent over test-days, (P<0.01). It is concluded that Brahman cattle: (a) habituate to repeat handling in a squeeze chute; (b) are less emotionally reactive when their eyes were covered during this process and (c) establish a repeatable order of entrance to the chute.

[Social representations of the care given to the elderly by health professionals in a nursing home]. / Representaciones sociales del cuidado del anciano en trabajadores de salud en un ancianato.

This study aimed at identifying the social representations of the care given to the elderly by caregivers in a nursing home. Fifteen caregivers aged 28 to 32 years old who worked in a nursing home in the city of Ribeirão Preto, São Paulo, Brazil were subjects for this work and the Theory of Social Representations was used as reference. Data were collected by means of semi-structured interviews and analyzed by content analysis, which enabled the elaboration of categories, thus facilitating comprehension. Among such categories are: informal education, formal education, satisfaction, sadness, modes of confrontation and denegation.

Determinación de beta lactamasas de espectro expandido en el laboratorio: análisis comparativo de tres métodos / Determination of expanded spectrum beta lactamases in the laboratory: comparative analysis of three methods

58 cepas (16 escherichia coli y 42 klebsiella pneumoniae) aisladas de muestras clínicas entre septiembre 1999 y julio 2000 en las secciones de bacteriología del Laboratorio Metropolitano Hospital José Gregorio Hernández y Hospital de Clínicas Caracas, con patrón sugestivo de ser productoras de ß-lactamasa de espectro expandido (BLEE) sensibles a cefoxitin y resistentes a ceftazidime, cefotaxime, ceftriaxone y aztreonam) fueron evaluadas de forma prospectiva por los métodos del doble disco (DD), Etest (AB Biodisk) y ATB BLSE (bioMérieux) para la detección de BLEE, tomando como técnica de referencia la de DD, obteniéndose en general un 100 por ciento de correlación con la prueba de Etest y un 86,2 por ciento con la de ATB BLSE, estadísticamente no significativa (p>0,05). Se recomienda el uso de ambas técnicas para la confirmación de cepas productoras de BLEE en conjunto con el despistaje inicial realizado a través del análisis de los patrones de resistencia obtenido por las metodologías usadas rutinariamente en los laboratorios para la realización del antibiograma.

Comparación de cuatro métodos para la detección de la resistencia a la vancomicina por el enterococo / Comparison of four methods for detection of resistance to vancomycin by enterococcus

Se evaluaron en forma prospectiva 108 cepas de enterococos (83 E. faecalis, 16 E. faecium, 5 E. avium y 4 E. gallinarum) aisladas de diversas muestras clínicas en la sección de Bacteriología del Laboratorio Metropolitano en el período comprendido entre enero y julio de 1999 con la finalidad de comparar cuatro de los métodos descritos para la detección de resistencia a vancomicina in vitro en este grupo de gérmenes: difusión en disco (DD), E test (AB Biodisk, Solina, Sweden), el sistema automatizado Vitek a través de la tarjeta GPS-102 (bioMérieux, Inc., Hazelwood, Mo.), tomando como referencia el agar cerebro-corazón con 6 µ/ml de vancomicina (VSA), observándose una correlación del 93,56 por ciento, 100 por ciento y 97,52 por ciento respectivamente. Se recomienda el uso en paralelo de cualquiera de los métodos en conjunto de la VSA para la segura detección de cepas de enterococcos con sensibilidad disminuida a la vancomicina.

[Role of the family in the care of an elderly person with cerebrovascular disease]. / Representaciones del cuidador familiar. Ante el anciano con ACV.

This study tries to identify the roles family members have in the care of an elderly person experiencing the effects of cerebral-vascular disease in the home and the main strategies to employ in the treatment of such a patient. The theoretical methodological procedure was based on a psychological project, a historical drawing about a theme, in which five subjects who were caretakers drew two achromatic pictures narrating corresponding stories individually in their homes. This form of expression allowed the project designers to have an interpretation of the daily situations involved in the care of these patients. In the first analysis phase, we drew the conclusion that caretakers construct their own particular knowledge system regarding the care of the elderly patient in their home. We verified that this construction started with a network relating common, daily elements which are interwoven in the treatment process occurring within a specific social milieu which as a result generates strategies that rely heavily on common sense knowledge in the manner of carrying out this social function.

[Family care for elderly patients with cerebrovascular accident sequelae]. / O cuidado familiar ao idoso com seqüela de acidente vascular cerebral.

This study had as objectives to identify the nature of the family care given to the elderly with sequels of Cerebral Vascular Accident (AVC); to understand its major problems; and to discuss its meaning from the caregiver's vision. It was developed through a qualitative/descriptive methodology. The subjects, five caregivers of elderly with sequels of Cerebral Vascular Accident, were interviewed at their homes. Semi-structured interviews and the projective technique (story drawing with a theme proposed by Trinca) were used. The data analysis was done through thematic analysis (the first phase of the Enunciation Analysis recommended by d'Unrug, in Bardin, 1994) which rose the following categories: "nature of the family care"; "social-economic changes of the caregiver"; "emotional and physical burnout of the caregiver"; and "the meaning of the family care". The results allowed a characterization of the caregivers group and the identification of total care to the elderly.

[How nurses evaluate home nursing and family caregivers]. / Como os enfermeiros avaliam o cuidado/cuidador familiar.

The aim of this study was to assess the way used by nurses for evaluate the family care and the caregiver. The method used was a quali-quantitative one. A semi-structure interview was the instrument chosen to collect data. It was applied to 20 (twenty) nurses from a University Hospital within the months of April and May, 1996. Data analysis was based on the Bardin's Content Analysis Technique (1994). The results demonstrated that nurses are not systematic in evaluating family care and the caregiver, but they use their intuition, based on momentaneous decisions. This reveal a difficulty of integration between the formal and the informal care caused by lack of interaction or effective valorization of the family care process.

Evaluación de actividad en artritis reumatoide, ¿VSG o PCR? / Evaluation of activity of rheumatoid arthritis, CESR or RCP?

En la artritis reumatoide (AR) es muy importante contar con parámetros fidedignos y accesibles que permitian evaluar la actividad de la enfermedad. Existe controversia en la literatura sobre los métodos de laboratorio óptimos para realizar esta evaluación. Objetivo: Comparar la sensibilidad de la velocidad de sedimentación globular (VSG) y de la proteína C reactiva (PCR) como indicadores de actividad en una cohorte de pacientes con artritis reumatoide. Material y métodos: Se determinó la actividad en 61 pacientes con diagnóstico de AR (ACR, 1987) por medio de una evaluación clínica estandarizada y se midió en forma simultánea PCR (nefelometría) y VSG (Wintrobe). Análisis estadístico: mediciones de tendencia central, dispersión y x². Resultados: Los pacientes fueron 55 mujeres y 6 hombres con edad promedio de 45.75 años. Según la magnitud de la actividad clínica, 16 (26.2 por ciento) pertenecieron al grupo 1 (actividad leve), 40 (65.5 por ciento) al grupo 2 (actividad moderada) y 5 (8.2 por ciento) al grupo 3 (actividad severa). Se encontró dependencia significativa (p < 0.01) y similar entre la magnitud de la actividad y los valores tanto de VSG como de PCR. Conclusiones: en el ámbito clínico, ambos estudios parecen tener una utilidad semejante como indicadores de actividad en la artritis reumatoide

Comparative study of insulin-like growth factor-I (IGF-I) and IGF-binding protein-3 (IGFBP-3) level and IGF-I/IGFBP-3 ratio measurements and their relationship with an index of clinical activity in the management of patients with acromegaly.

To evaluate the utility of measuring the serum insulin-like growth factor (IGF)-binding protein-3 (IGFBP-3) level and the IGF-I/IGFBP-3 ratio in the management of acromegalic patients, we comparatively studied the basal concentration of the aforementioned parameters with determination of plasma IGF-I levels and an index of clinical activity of acromegaly in 16 newly diagnosed acromegalic patients (aged 34 to 64 years) before and after hypophysectomy. After adenomectomy, 10 patients remained with "active" disease and six were "cured." Twenty-nine healthy sex- and age-matched volunteers were also studied. Comparison of individual values between untreated acromegalic patients and control subjects showed that none of the patients had overlapping values for IGF-I, whereas five of 16 and three of 16 patients had overlapping values for serum IGFBP-3 and IGF-I/IGFBP-3 ratio, respectively. When we compared the study parameters between the patients who remained with active disease after adenomectomy and the controls, two of 10 had overlapping values for IGF-I, but six of 10 and five of 10 had overlapping values for serum IGFBP-3 and IGF-I/IGFBP-3 ratio, respectively. Moreover, comparison of these parameters between cured and active patients after hypophysectomy showed that none had overlapping values for IGF-I, whereas three of six and one of six had overlapping values for serum IGFBP-3 and IGF-I/IGFBP-3 ratio, respectively. All biochemical variables studied showed significant relationships with an index of clinical activity of disease. In conclusion, our results seem to indicate that among determinations of plasma IGF-I, serum IGFBP-3, and the ratio IGF-I/IGFBP-3 in the evaluation of acromegalic patients, measurement of the plasma IGF-I level has the most discriminative value in the management of these patients.

Antioxidants, Helicobacter pylori and stomach cancer in Venezuela.

A randomized chemoprevention trial on precancerous lesions of the stomach is being conducted in Tachira State, Venezuela. The aims of the study are to evaluate the efficacy of vitamin supplementation in preventing the progression rate of precancerous lesions. Here we report on the pilot phase of the study in which two antioxidant preparations were evaluated on their ability to raise antioxidant levels in plasma and in gastric juice. The study aimed also to determine the antibiotic sensitivity profiles of Helicobacter pylori isolates prevalent in the area. Forty-three subjects with precancerous lesions (chronic gastritis, chronic atrophic gastritis, intestinal metaplasia and dysplasia) of the stomach were randomized to one of two antioxidant treatments. Treatment 1 (250 mg of standard vitamin C, 200 mg of vitamin E and 6 mg of beta-carotene three times a day) or treatment 2 (150 mg of standard vitamin C, 500 mg of slow release vitamin C, 75 mg of vitamin E and 15 mg of beta-carotene once a day) for 7 days. Blood levels of total vitamin C, beta-carotene and alpha-tocopherol and gastric juice levels of ascorbic acid and total vitamin C were measured before and after treatment on day 8. Both treatments increased the plasma levels of total vitamin C, beta-carotene and alpha-tocopherol/cholesterol but not those of ascorbic acid or total vitamin C in gastric juice. Treatment 1 was the best choice and resulted in a greater increase in the plasma levels of beta-carotene and alpha-tocopherol. H. pylori was cultured from 90% of the gastric biopsies; 35 isolates were identified which were highly resistant to metronidazole, a front-line antibiotic recommended against H. pylori in other settings.

Prevalence of precancerous lesions of the stomach in Venezuela.

Gastric biopsies from 1477 participants in a chemoprevention trial for precancerous lesions of the stomach in Venezuela were evaluated for the prevalence of precancerous lesions and Helicobacter pylori infection. These study subjects were selected from participants in an early detection program for gastric cancer using double-contrast X-ray. Overall, 94% had some type of chronic gastritis (CG) and were positive for H. pylori using Giemsa stain, 49% had atrophic gastritis, 34% had intestinal metaplasia (IM), and 6.5% had dysplasia. There were only three subjects (0.2%) with normal gastric mucosa, and 4% had only superficial gastritis. The prevalence of all of these precancerous lesions increased with age, but there was no clear difference by gender. The prevalence of the various lesions was higher in the antral mucosa than in the fundic mucosa. H. pylori infection was strikingly frequent in our study population, with prevalence rates ranging from 73% in subjects with superficial gastritis to 95% in those with atrophic gastritis and IM and 98% in those with CG. The prevalence of H. pylori was equally high in males and females, and it was significantly positively associated with the degree of infiltration of poly- and mononuclear cells and with that of active regeneration; it was inversely correlated with the degree of atrophy, IM, and dysplasia. Our findings support the precancerous nature of the various gastric lesions and the etiological role of H. pylori infection in CG.

Determinants of plasma pepsinogen levels in a population at high risk for stomach cancer in Venezuela.

Determinants of plasma pepsinogens (PG) levels were studied in 1365 participants in a chemoprevention trial for gastric pre-cancerous lesions being conducted in Venezuela. Gastric biopsies, plasma samples and information on smoking and dietary habits were obtained at baseline examination. Both PG-I and PG-II levels increased progressively with the level of Helicobacter pylori infection in gastric biopsies, resulting in no clear trend in the I/II ratio. Instead, there was a progressive decrease in the I/II ratio with increasing degrees of infiltration of polynuclear cells and monocytes, atrophy, intestinal metaplasia and the stage of pre-cancerous lesions. The mean I/II ratios for atrophic gastritis or more advanced lesions were less than 4.0. When subjects with the I/II ratio 4 or higher were used as controls, severe reduction in the I/II ratio (< 2.0) was inversely associated with tobacco consumption. This may be due to a pharmacological effect of nicotine. The severe reduction of I/II ratio was also inversely associated with fresh fruit consumption. In addition, a decreased I/II ratio was positively associated with rice/pasta and arepas (tortilla made from corn) consumption and inversely associated with plantain consumption. Possible effects of vitamins and starchy food on the development of atrophic gastritis need to be studied further.

Enfermedad de Paget del pezón / Paget's disease of the nipple

La enfermedad de Paget del pezon es una entidad aceptada desde 1874, año de la clasica descripcion de Sir James Paget: representa entre el 1.5 y el 2.0 por ciento de todos Los cánceres mamarios; se caracteriza por ser una lesion eccematosa con exudacion serohemática de la piel del pezon, asociada a la presencia de tumor subyacente palpable en alrededor del 50 por ciento de los casos; el diagnostico se hace por biopsia excisional, que demuestra las celulas tipicas conocidas como celulas de Paget; la etiopatogenia no tiene una total aceptacion, pero lo más aceptado es que las celulas de Paget llegan al pezon por migracion epidermotropica de un carcinoma mamario subyacente, y otros expertos opinan que el tumor es independiente de la lesion dermica. Como toda lesion mamaria, el enfoque terapeutico depende de la estadificacion; para la mayoria de los expertos en enfermedad de Paget con tumor subyacente, la cirugia recomendada es la mastectomia simple o radical modificada; la presencia o no de ganglios axilares positivos, determinan la terapia adyuvante; sinembargo, dentro de los nuevos enfoques terapeuticos para cancer mamario localizado, se acepta que con lesion del pezon de minima extension, ausencia de tumor subyacente, ausencia de lesiones sospechosas mamográficas, la cirugia conservadora se le puede ofrecer a las pacientes deseosas de conservar el seno, con controles clinicos y mamografias muy estrictos.

[Inflammatory response associated with Helicobacter pylori infection in gastric mucosa with intestinal metaplasia in a population in high risk for gastric cancer]. / Respuesta inflamatoria asociada con infeccíon por Helicobacter Pylori en mucosa gástrica con metaplasia intestinal en una población de alto riesgo para cancer gástrico.

Intestinal Metaplasia (IM) and Helicobacter Pylori (HP) infection had been related to gastric carcinogenesis. With the intention to know the relationship among HP infection, IM and inflammatory response of the mucosa in an area of high prevalence of gastric cancer, we studied 800 persons that attended the Gastric Cancer Mass Survey, ongoing in the State Tachira, Venezuela, since 1981. Out of these subjects, 259 had histology diagnosis of IM (32.4%) 52.1% were IM type Y, 19.3% type II and 22.8% type III (sulfomucin secretory). Histology demonstrated with Giemsa stain HP in 94.6% of the cases. Association between HP and inflammation response in gastric mucosa with IM, was statistically significant (p = 0.001). The are heavier bacteria overload in IM type I than in type III although it is not statistically significant. We ponder if gastric mucosa inflammation due to HP, conditions development of IM as a hostile way of the gastric environment to restrain bacterial growth. This phenomenon ally with other oncogeneous factors could induce to premalignant lesions and eventually gastric cancer.