[Flat, depressed and polypoid colorectal lesions: a comparative study using a index of histological advance]. / Lesiones planas, deprimidas y polipoides colorrectales: estudio comparativo utilizando un índice de avance histológico.

BACKGROUND: It has been described that the histological changes in flat and depressed colon lesions are more advanced than the ones in polypoid lesions. OBJECTIVES: To compare the histological findings in flat or depressed (non polypoid) and elevated (polypoid) colon lesions. To validate the use of a newly developed Histological Advance Index to compare results. MATERIALS & METHODS: Prospective observational study. Population in study consisted of adult patients programmed for an elective colonoscopy at a private endoscopy center in Lima- Perú. Two groups: 417 found to have non polypoid lesions (which included flat, depressed and lateral spreading tumors or LST), and 405 with polypoid lesions. RESULTS: Total of 8,248 patients, with 417(5%) in the non polypoid group; 368(4.5%) in the flat lesion group, 27(0.32%) in the depressed and 22 (0.26%) LSTs. According to our index, flat and polypoid lesions showed no difference in histological findings. LSTs had a more advanced histology and depressed lesions reached the highest index scores. Flat lesions were found more often in right colon compared with polypoid ones (31% vs 22%, p<0.01), with a higher percentage of serrated lesions (9% vs 2%, p<0.01) and high grade dysplasia (5% vs 3%, NS). In contrast, depressed lesions, showed high grade dysplasia in 3.7% (NS) but cancer in 18% (p<0.01) LSTs were found mainly in right colon and rectum, showing villous component in 23%(p< 0.01) and high grade dysplasia in 32%(p <0.01), but no cancer was found. CONCLUSIONS: Flat and polypoid lesions showed similar histological findings, but LSTs were found to have a higher prevalence of villous lesions and high grade dysplasia. Depressed lesions were found to have a higher prevalence of malignancy. Histological Advance Index proved to be a useful tool to compare groups and quantify differences. .

Lesiones planas, deprimidas y polipoides colorrectales: estudio comparativo utilizando un índice de avance histológico / Flat lesions, and polypoid colorectal depressed: a comparative study using a histologic progress index

ANTECEDENTES: Se ha descrito que las lesiones planas y deprimidas colorrectales, llamadas también no polipoides (LNP) tienen una histología más avanzada que las polipoides o protruidas (LP). OBJETIVOS: Comparar el grado de avance histológico de las LNP con el de las LP, a nivel del colon y recto. Validar el uso de un Índice de Avance Histológico (IAH) para objetivar estas diferencias. METODOLOGÍA: Estudio observacional, prospectivo, realizado en adultos programados a colonoscopía en un Centro Endoscópico privado de Lima- Perú. Dos grupos: 417 pacientes con LNP (planas, deprimidas y de crecimiento lateral o LST) y 405 pacientes con solo LP. RESULTADOS: 417/ 8,248 pacientes (5%) tuvieron LNP; 368 (4.5%) planas, 27(0.32%) deprimidas y 22(0.26%) LST. Según nuestro IAH, las lesiones planas y polipoides mostraron similar avance histológico. Las LST tuvieron una histología más avanzada y las deprimidas alcanzaron los valores más altos. Las lesiones planas tuvieron mayor tendencia que las polipoides a situarse en colon derecho (31% vs 22% p< 0.01), a presentar histología aserrada (9% vs 2% p< 0.01) y displasia de alto grado (5% vs 3% NS), pero menor tendencia al cáncer (0.2% vs 1% NS). Comparadas con las polipoides, las deprimidas tuvieron similar displasia de alto grado (3.7% /NS) pero una alta proporción de cáncer (18 % p < 0.01), mientras que las LST se localizaron sobre todo en colon derecho y recto, con componente velloso en 23% (p< 0.01) y displasia de alto grado en 32% (p< 0.01), pero no cáncer. CONCLUSIONES: Las lesiones planas mostraron un grado de avance histológico similar a las polipoides, pero las de crecimiento lateral si tuvieron una histología más avanzada y las deprimidas desarrollaron cáncer en una elevada proporción. El Índice de Avance Histológico fue una herramienta útil para comparar los grupos y resaltar sus diferencias.

BACKGROUND: It has been described that the histological changes in flat and depressed colon lesions are more advanced than the ones in polypoid lesions. Objectives: To compare the histological findings in flat or depressed (non polypoid) and elevated (polypoid) colon lesions. To validate the use of a newly developed Histological Advance Index to compare results. MATERIALS & METHODS: Prospective observational study. Population in study consisted of adult patients programmed for an elective colonoscopy at a private endoscopy center in Lima- Perú. Two groups: 417 found to have non polypoid lesions (which included flat, depressed and lateral spreading tumors or LST), and 405 with polypoid lesions. RESULTS: Total of 8,248 patients, with 417(5%) in the non polypoid group; 368(4.5%) in the flat lesion group, 27(0.32%) in the depressed and 22 (0.26%) LSTs. According to our index, flat and polypoid lesions showed no difference in histological findings. LSTs had a more advanced histology and depressed lesions reached the highest index scores. Flat lesions were found more often in right colon compared with polypoid ones (31% vs 22%, p<0.01), with a higher percentage of serrated lesions (9% vs 2%, p<0.01) and high grade dysplasia (5% vs 3%, NS). In contrast, depressed lesions, showed high grade dysplasia in 3.7% (NS) but cancer in 18% (p<0.01) LSTs were found mainly in right colon and rectum, showing villous component in 23%(p< 0.01) and high grade dysplasia in 32%(p <0.01), but no cancer was found. CONCLUSIONS: Flat and polypoid lesions showed similar histological findings, but LSTs were found to have a higher prevalence of villous lesions and high grade dysplasia. Depressed lesions were found to have a higher prevalence of malignancy. Histological Advance Index proved to be a useful tool to compare groups and quantify differences.

Solubility Enhancement of a Poorly Water Soluble Drug by Forming Solid Dispersions using Mechanochemical Activation.

Mechanochemical activation is a practical cogrinding operation used to obtain a solid dispersion of a poorly water soluble drug through changes in the solid state molecular aggregation of drug-carrier mixtures and the formation of noncovalent interactions (hydrogen bonds) between two crystalline solids such as a soluble carrier, lactose, and a poorly soluble drug, indomethacin, in order to improve its solubility and dissolution rate. Samples of indomethacin and a physical mixture with a weight ratio of 1:1 of indomethacin and lactose were ground using a high speed vibrating ball mill. Particle size was determined by electron microscopy, the reduction of crystallinity was determined by calorimetry and transmission electron microscopy, infrared spectroscopy was used to find evidence of any interactions between the drug and the carrier and the determination of apparent solubility allowed for the corroboration of changes in solubility. Before grinding, scanning electron microscopy showed the drug and lactose to have an average particle size of around 50 and 30 µm, respectively. After high speed grinding, indomethacin and the mixture had a reduced average particle size of around 5 and 2 µm, respectively, showing a morphological change. The ground mixture produced a solid dispersion that had a loss of crystallinity that reached 81% after 30 min of grinding while the drug solubility of indomethacin within the solid dispersion increased by 2.76 fold as compared to the pure drug. Drug activation due to hydrogen bonds between the carboxylic group of the drug and the hydroxyl group of lactose as well as the decrease in crystallinity of the solid dispersion and the reduction of the particle size led to a better water solubility of indomethacin.

[Necrotic acute pancreatitis in the intensive care unit: a comparison between conservative and surgical medical treatment]. / Pancreatitis Aguda Necrótica en la Unidad de Cuidados Intensivos: Una Comparación entre el Tratamiento Médico Conservador y Quirúrgico.

OBJECTIVE: To determine the prognosis of patients with necrotic acute pancreatitis receiving medical and surgical treatments. SUMMARY: The severe acute pancreatitis treatment is multidisciplinary and requires a daily evaluation of the patient that will allow to observe changes and apply therapy in due time. The treatment includes: Admission in the ICU, fluids, nutrition and antibiotics, as well as other life supports for high-risk patients. Thus, patients undergo conservative treatment or, if it is necessary, surgery. METHODS: A retrospective study of patients with necrotic acute pancreatitis admitted to the ICU between January 2004 and August 2006. The patients with necrotic acute pancreatitis without signs of sepsis underwent a conservative medical treatment, while fine needle punction-aspiration was performed in all patients who were suffering from necrotic acute pancreatitis and persistent sepsis four weeks after their admission and after discarding and eradicating every non-pancreatic focus of infection. All Gram stain or culture positive patients underwent surgery immediately. RESULTS: Seventy patients with necrotic acute pancreatitis were included in the study. Thirty-six patients (51%) suffered acute pancreatitis with sterile necrosis and underwent a conservative treatment, while 34 patients (49%) developed acute pancreatic with infected necrosis and underwent surgery. The average age was 55.19 vs. 57.65 (p=0.57). The average amylase was 1421.74 vs. 1402.45. (p=0.96). The tomography severity index was 8.47 vs. 8.79 (p=0.36). The Apache II was 8.22 vs. 9 (p=0.46). The average number of failed organs was 0.39 vs. 0.68. (p=0.19). The ICU stay was 10.75 vs. 26.5 days (p<0.05) while the total hospital stay was 46.47 vs. 57.26 days (p<0.05). The mortality rate was (3/36) 8.3% vs. (9/34) 26.5% (p<0.05) for conservative medical treatment vs. surgical treatment, respectively. Between the first and the twelfth month the evaluated patients who attended consultation, after discharge, showed: pancreatic pseudocyst 9/36 (25%) vs. 8/34(23.5%); recurring abdominal pain 3/36 (8.3%) vs. 4/34 (11.8%); and relapsing acute pancreatitis 3/36 (8.3%) vs. 2/34 (5.8%); while 4/36 (11.1%) vs. 3/34 (8.8%) did not show any problem. There were not significant differences between the conservative and the surgical medical treatment, respectively. CONCLUSIONS: Patients suffering acute pancreatitis with sterile necrosis can undergo conservative medical treatment which will result in a lower mortality rate, while the hospital stay, in comparison with acute pancreatitis with infected necrosis, will not be affected.

Pancreatitis aguda necrótica en la unidad de cuidados intensivos: Una comparación entre el tratamiento médico conservador y quirúrgico / Necrotic acute pancreatitis in the intensive care unit: A comparison between conservative and surgical medical treatment

OBJETIVO: Determinar el pronostico del tratamiento medico y quirúrgico de pacientes con pancreatitis aguda necrótica. INTRODUCCION: El tratamiento de pancreatitis aguda severa es multidisciplinario y requiere la evaluación de los pacientes día a día, esto permite observar los cambios y dar terapia oportuna. El tratamiento incluye: admisión en UCI, fluidos, nutrición y antibióticos, así como otros soportes de vida para paciente critico. Con esto, los pacientes pueden ser tratados conservadoramente o si fuese necesario, con intervención quirúrgica. METODOS: Un estudio retrospectivo de pacientes con pancreatitis aguda necrótica, que ingresaron a la Unidad de Cuidados Intensivos, entre enero del 2004 a agosto del 2006. Los pacientes con pancreatitis aguda necrótica sin signos de sepsis fueron sometidos a tratamiento medico conservador. Se realizó una punción aspiración con aguja fina, a partir de la cuarta semana, a los pacientes con pancreatitis aguda necrótica y sepsis persistente. Previamente se descartó y erradicó todos los focos infecciosos no pancreáticos. Todos los pacientes con coloración Gram. ó cultivo positivo fueron sometidos a cirugía de inmediato. RESULTADOS: Setenta pacientes con pancreatitis aguda necrótica fueron incluidos, de los cuales 36 (51%) tuvieron pancreatitis aguda necrótica estéril con tratamiento medico conservador y 34 (49%) tuvieron pancreatitis aguda necrótica infectada con tratamiento quirúrgico. El promedio de edad fue 55.19 vs. 57.65 (p=0.57). El promedio de amilasas 1421.74 vs. 1402.45. (p=0.96). El índice de severidad tomográfica fue 8.47 vs. 8.79 (p=0.36). Apache II fue 8.22 vs. 9 (p=0.46). El promedio de órganos fallados 0.39 vs. 0.68. (p=0.19). La estancia en UCI fue de 10.75 vs. 26.5 días (p < 0.05). La estancia hospitalaria total fue 46.47 vs. 57.26 días (p < 0.05). La mortalidad (3/36) 8.3% vs. (9/34) 26.5% (p < 0.05) para el tratamiento medico...

OBJECTIVE: To determine the prognosis of patients with necrotic acute pancreatitis receiving medical and surgical treatments. SUMMARY: The severe acute pancreatitis treatment is multidisciplinary and requires a daily evaluation of the patient that will allow to observe changes and apply therapy indue time. The treatment includes: Admission in the ICU, fluids, nutrition and antibiotics, as well as other life supports for high-risk patients. Thus, patients undergo conservative treatment or, if it is necessary, surgery. METHODS: A retrospective study of patients with necrotic acute pancreatitis admitted to the ICU between January 2004 and August 2006. The patients with necrotic acute pancreatitis without signs of sepsis underwent a conservative medical treatment, while fine needle punction-aspiration was performed in all patients who were suffering from necrotic acute pancreatitis and persistent sepsis four weeks after their admission and after discarding and eradicating every non-pancreatic focus of infection. All Gram stain or culture positive patients underwent surgery immediately. RESULTS: Seventy patients with necrotic acute pancreatitis were included in the study. Thirty-six patients (51%) suffered acute pancreatitis with sterile necrosis and underwent a conservative treatment, while 34 patients (49%) developed acute pancreatic with infectednecrosis and underwent surgery. The average age was 55.19 vs. 57.65 (p=0.57). The average amylase was 1421.74 vs. 1402.45. (p=0.96). The tomography severity index was 8.47 vs. 8.79 (p=0.36). The Apache II was 8.22 vs. 9 (p=0.46). The average number of failed organs was 0.39 vs. 0.68. (p=0.19). The ICU stay was 10.75 vs. 26.5 days (p < 0.05) while the total hospital stay was 46.47 vs. 57.26 days (p < 0.05). The mortality rate was (3/36) 8.3% vs. (9/34) 26.5% (p < 0.05) for conservative medical treatment vs. surgical treatment, respectively...

[Effect of pamidronate infusion time on renal function in patients with multiple myeloma]. / Influencia del tiempo de perfusión de pamidronato en la función renal de pacientes con mieloma múltiple.

INTRODUCTION: Administration of biphosphonates in patients with renal failure requires a dosage adjustment. OBJECTIVES: Analyse renal function evolution in multiple myeloma patients after reducing infusion time for 90 mg pamidronate by 2 h. METHODS: In 2007, a retrospective study was carried out on all patients who presented multiple myeloma and bone metastasis treated with pamidronate administered every 4 h. Following a review of the literature, a protocol for administering pamidronate every 2 h was created in partnership with Haematology, and a specific dose reduction framework was established for patients with baseline renal failure. Additionally, a prospective follow-up study of those patients' renal function was completed to analyse its evolution after the change in infusion time. RESULTS: A total of six patients received 90 mg pamidronate every 4 h. 33.32% of the patients (2/6) presented baseline renal insufficiency, and therefore needed to have the pamidronate dose adjusted according to the new protocol. Subsequently, all of them received the treatment every 2 h, and one patient (16.6%) experienced altered renal function after two treatment cycles. DISCUSSION: Reducing administration time for pamidronate from four to 2 h did not lead to significant variations in patients' renal function. This therapeutic practice can improve patients' quality of life by shortening their hospital stay without aggravating their renal function.

Influencia del tiempo de perfusión de pamidronato en la función renal de pacientes con mieloma múltiple / Effect of pamidronate infusion time on renal function in patients with multiple myeloma

Introducción La administración de bifosfonatos requiere un ajuste de dosis en pacientes con insuficiencia renal. Objetivos Analizar la evolución de la función renal tras reducir 2h el tiempo de infusión de pamidronato en pacientes con mieloma múltiple. Métodos Estudio descriptivo retrospectivo de los pacientes que presentaban mieloma múltiple y metástasis óseas tratados con pamidronato administrado en 4h. Se elaboró un protocolo conjunto con Hematología para administrar pamidronato en 2h, realizándose un seguimiento prospectivo de la función renal de dichos pacientes. Resultados Un total de 6 pacientes recibieron pamidronato en 4h. Posteriormente, todos recibieron la administración en 2h, y uno de ellos (16,6%) evidenció alteración de la función renal. Discusión La reducción en el tiempo de administración de pamidronato no mostró variaciones significativas en la función renal de los pacientes. Esta práctica terapéutica podría mejorar la calidad de vida de los pacientes, al disminuir el tiempo de estancia hospitalaria, sin empeorar su función renal (AU)

Introduction Administration of biphosphonates in patients with renal failure requires a dosage adjustment. Objectives Analyse renal function evolution in multiple myeloma patients after reducing infusion time for 90mg pamidronate by 2h.MethodsIn 2007, a retrospective study was carried out on all patients who presented multiple myeloma and bone metastasis treated with pamidronate administered every 4h. Following a review of the literature, a protocol for administering pamidronate every 2h was created in partnership with Haematology, and a specific dose reduction framework was established for patients with baseline renal failure. Additionally, a prospective follow-up study of those patients’ renal function was completed to analyse its evolution after the change in infusion time. Results A total of six patients received 90mg pamidronate every 4h. 33.32% of the patients (2/6) presented baseline renal insufficiency, and therefore needed to have the pamidronate dose adjusted according to the new protocol. Subsequently, all of them received the treatment every 2h, and one patient (16.6%) experienced altered renal function after two treatment cycles (AU)

Técnica quirúrgica para el tratamiento de la pancreatitis aguda grave con necrosis: Hospital Nacional Edgardo Rebagliati Martins / Surgery technic for treatment of serious acute pancreatitis with necrosis: Edgardo Rebagliati Martins Hospital

Se presenta una técnica quirúrgica de tipo cerrado con drenaje continuo y relaparotomías programadas para el tratamiento de la Pancreatitis Aguda Grave con necrosis, en 60 pacientes intervenidos por el autor y col. entre octubre de 1997 a enero del 2002 en la Unidad de Pancreatitis Aguda Grave del Hospital Nacional Edgardo Rebagliati Martins de Lima Perú como una alternativa para el manejo quirúrgico de esta patología.

[Desiccated rattlesnake capsules: a potential source of gram-negative bacterial infection]. / Cápsulas de víbora desecada: una fuente potencial de infección por bacterias gram negativas.

The ingestion of rattlesnake powder capsules is frequent in Mexico in view of their alleged curative properties in various diseases, among them different malignancies. Based on previous reports showing both bacteremia and septicemia in patients with malignant diseases ingesting such capsules, we conducted a study to evaluate the presence of microorganisms in 16 different preparations of rattlesnake powder capsules, obtained in six different cities of our country. We found that all the samples were significantly contaminated with gram-negative coliform bacteria: Escherichia coli, Klebsiella pneumoniae, Enterobacter agglomerans, E. cloacae, Salmonella arizona and Salmonella of groups B, E4 and G. Eighty one percent of the capsules were contaminated with Salmonella sp. The most frequent was S. arizona with a natural reservoir in snakes. Contamination was probably derived from both the flesh of the snake and fecal contamination during the domestic preparation of the powder to produce the capsules. These data, together with those previously published regarding bacteremia and septicemia derived from the ingestion of the capsules, suggests that there is danger in their use.

Sequence analysis of a human gene responsible for drug resistance: a rapid method for manual and automated direct sequencing of products generated by the polymerase chain reaction.

We developed a system for rapid, manual and automated sequence analysis by utilizing and modifying methods used in conjunction with the polymerase chain reaction (PCR). We are using these techniques to detect single base mutations in the dihydrofolate reductase (DHFR) gene giving rise to methotrexate (MTX) resistance of tumor cells obtained from patients with malignancies. Amplifying in vitro both genomic DNA and transcripts of the human DHFR we are able to reproducibly generate single-stranded templates. Utilizing [alpha-35S]dATP and both the universal and reverse sequencing primers we obtain sequence information from either strand. The methods described have been successfully used for automated sequencing with the Applied Biosystems Model 370A Sequencer using both modified T7 DNA polymerase and Taq I. DNA polymerase for dideoxy-termination sequencing. The use of this methodology to detect a single base change in a human colon carcinoma cell line, HCT-8, is illustrated.

Predictive value of the "clue cells" investigation and the amine volatilization test in vaginal infections caused by Gardnerella vaginalis.

Although still controversial, an etiologic role of Gardnerella vaginalis is imputed in vaginitis. Besides isolation of the organism by culture, two alternative diagnostic procedures have been claimed to be useful: the investigation of "clue cells" in clinical specimens and the amine volatilization test or fishy odor perception in genital secretions. Herein we report on the findings of the simultaneous use of G. vaginalis isolation, the clue cell test and amine volatilization perception in specimens from 1,263 consecutive female patients referred to our clinic. Our results show that the simultaneous use of both alternative tests is very useful as a screening procedure. A negative result of both tests predicts a negative culture result in 99% of the cases. However, a positive result of either or both should be considered as an indication to proceed to culture and not as diagnostic of infection.

Protease nexin. Properties and a modified purification procedure.

The present paper describes chemical and functional properties of protease nexin, a serine protease inhibitor released from cultured human fibroblasts. It is shown that protease nexin is actually synthesized by fibroblasts and represents about 1% of their secreted protein. Analysis of the amino acid composition of purified protease nexin indicates that it is evolutionarily related to antithrombin III and heparin cofactor II. Protease nexin contains approximately 6% carbohydrate, with 2.3% amino sugar, 1.1% neutral sugar, and 3.0% sialic acid. The Mr calculated from equilibrium sedimentation analysis is 43,000. Protease nexin is a broad specificity inhibitor of trypsin-like serine proteases. It reacts rapidly with trypsin (kassoc = 4.2 +/- 0.4 X 10(6) M-1 s-1), thrombin (kassoc = 6.0 +/- 1.3 X 10(5) M-1 s-1), urokinase (kassoc = 1.5 +/- 0.1 X 10(5) M-1 s-1), and plasmin (kassoc = 1.3 +/- 0.1 X 10(5) M-1 s-1), and slowly inhibits Factor Xa and the gamma subunit of nerve growth factor but does not inhibit chymotrypsin-like proteases or leukocyte elastase. In the presence of heparin, protease nexin inhibits thrombin at a nearly diffusion-controlled rate. Two heparin affinity classes of protease nexin can be detected. The present characterization pertains to the fraction of protease nexin having the higher affinity for heparin. The low affinity material, which is the minor fraction, is lost during purification.

Frecuencia de anticuerpos sericos anti-vibrio parahaemolyticus en manejadores de alimentos / Frequency of serum antibodies to Vibrio parahaemolyticus in seafood manipulators

Se determino la frecuencia de anticuerpos anti Vibrio parahaemolyticus en diversas poblaciones de sujetos asintomaticos seleccionados basandose en la ocupacion que desempenaban. Se emplearon para tal efecto dos metodos de aglutinacion que difieren solamente la forma de preparar el antigeno el metodo del antigeno "vivo" y el antigeno "muerto". La especificidad de la prueba se demostro al descartar la reactividad de cruzada de Vibrio parahaemolyticus con las enterobacterias mas comunes. De 100 personas encargadas de expender alimentos al publico se encontro que 17 tenian anticuerpos sericos para el germen. Diez personas de esta poblacion tenian mayor contacto con productos derivados del mar, demostrandose anticuerpos en cinco de ellas; asociacion que es significativa desde el punto de vista estadistico. Finalmente, se encontro en la poblacion general una frecuencia de 16.5% de sujetos con anticuerposnti Vibrio parahaemolyticus.Estos datos indican que las infecciones por Vibrio parahaemolyticus en nuestro medio mas aun entre personas manejadoras de alimentos procedentes del mar