Use of direct oral anticoagulants and low molecular weight heparin in venous thromboembolism associated with cancer: real-world evidence in Argentina.

BACKGROUND: Venous thromboembolism (VTE) and major bleeding (MB) are common in cancer patients. Reduced-doses of antithrombotics as secondary prophylaxis have limited data. This work aims to describe and to compare treatments and outcomes for cancer-associated VTE. RESEARCH DESIGN AND METHODS: Retrospective study. Adults with cancer-associated VTE were included. After 3-6 months of full-doses of anticoagulants, three strategies were considered: A) lowering the doses; B) maintaining full-doses; C) stopping treatment. The strategy and medication used were shown in a descriptive analysis and the rate of bleeding and VTE-recurrence between those in a comparative analysis. RESULTS: A total of 420 patients were included, 56.2% received DOACs, 43.8% enoxaparin. Strategy was defined in 257 patients: A (50.2%), B (46.3%), and C (3.5%). Forty-one (9.8%) had VTE-recurrence and 15 (3.6%) had MB or clinically relevant non-major bleeding (CRNMB).According to strategy, recurrent-VTE was 8.5% (A), 4.2% (B), and 11.1 (C) (p = 0.22), MB or CRNMB was 0.8% (A), 1.7% (B), and 0% (C) (p = 0.64). CONCLUSIONS: DOACs and strategy A were the most frequently used agent and strategy, respectively. There were no differences between medications or strategies used. The results must be interpreted with caution, and it is a retrospective single-center study, probably with information and selection bias.

Hepatectomía en dos tiempos por metástasis hepáticas bilobares de origen colorrectal: reporte de un caso / Two-stage hepatectomy for bilobar colorectal liver metastases: case report / Hepatectomia em dois estágios para metástases hepáticas bilobares de origem colorretal: relato de um caso

La mitad de los pacientes con cáncer de origen colorrectal desarrollan metástasis hepáticas durante el curso de su enfermedad y de esas el 80% son irresecables. La resecabilidad se define no por la extensión de la hepatectomía, sino por la función del hígado remanente, por lo que para pacientes con ciertos factores favorables se pueden realizar técnicas de remodelación hepática para aumentar el volumen del hígado remanente para que este sea suficiente. La hepatectomía en dos tiempos se basa en procedimientos secuenciales que buscan tratar metástasis hepáticas colorrectales consideradas inicialmente irresecables, logrando la resección completa de las mismas dejando un remanente hepático funcionante suficiente, lo cual no sería posible en un solo acto quirúrgico. El objetivo de este trabajo es presentar el caso clínico de un paciente portador de metástasis hepáticas sincrónicas de origen colorrectal irresecables, que luego de una quimioterapia de conversión, con el fin de aumentar el futuro remanente hepático y evitar falla hepática postoperatoria y realizar una resección oncológica, fue sometido a una hepatectomía en dos tiempos, técnica utilizada con baja frecuencia en nuestro medio, destacando una evolución favorable, con marcadores tumorales en valores normales y sin evidencia imagenológica de recaída local ni sistémica.

Half of colorectal cancer patients develop liver metastases during the course of their disease, 80% of which are unresectable. Resectability is defined not by the extent of the hepatectomy, but by the function of the liver remnant. Therefore, for patients with certain factors, liver remodeling techniques can be performed to increase volume of the remaining liver so that it is sufficient. Two-stage hepatectomy is performed on colorectal liver metastases which are initially considered unresectable in one stage resection procedures, in which sequential procedures are performed in order to achieve complete resection and preserve a sufficient functioning liver remnant. The objective of this paper is to present the case of a patient with unresectable synchronous colorectal liver metastases, in which after conversion chemotherapy, in order to increase the future liver remnant, avoid postoperative liver failure and perform an oncological resection underwent a two-stage hepatectomy, a technique used with low frequency in our setting, highlighting a favorable evolution, with tumor markers in normal values and without imaging evidence of local or systemic relapse.

Metade dos pacientes com câncer colorretal desenvolve metástases hepáticas durante o curso da doença e, desses, 80% são irressecáveis. A ressecabilidade é definida não pela extensão da hepatectomia, mas pela função do fígado remanescente; portanto, para pacientes com certos fatores favoráveis, técnicas de remodelação hepática podem ser realizadas para aumentar o volume do fígado remanescente de forma que seja suficiente. A hepatectomia em dois estágios é baseada em procedimentos sequenciais que buscam tratar metástases hepáticas colorretais inicialmente consideradas irressecáveis, obtendo ressecção completa, deixando um remanescente hepático funcional suficiente, o que não seria possível em um único ato cirúrgico. O objetivo deste trabalho é apresentar o caso clínico de um paciente com metástases hepáticas sincrônicas irressecáveis ​​de origem colorretal, que após quimioterapia de conversão, com o objetivo de aumentar o futuro remanescente hepático e evitar insuficiência hepática pós-operatória e realizar uma ressecção oncológica, foi submetido a dois Hepatectomia em estágio, técnica utilizada com baixa frequência em nosso meio, evidenciando evolução favorável, com marcadores tumorais em valores normais e sem evidências de imagem de recidiva local ou sistêmica.

Infection dynamics of Mycoplasma hyorhinis in three commercial pig populations.

Mycoplasma hyorhinis is one of the causative agents of polyserositis and arthritis in postweaning pigs. Knowledge regarding colonisation frequency and age distribution in modern pig production is lacking. The objective of this study was to estimate the prevalence of M hyorhinis colonisation in different age groups across three commercial pig populations. Nasal swabs were collected from sows, piglets and nursery pigs of different ages. Oral fluids were collected from nursery pigs. Necropsies were performed to assess the presence of M hyorhinis-associated disease. M hyorhinis was detected in 5/60 sows in herd A, 3/60 in herd B and none in herd C. In herd A and B, the prevalence was low in preweaning piglets (∼8 per cent) and high in postweaning pigs (∼98 per cent). A total of 7/8 oral fluids tested PCR positive in herds A and B, while 1/8 tested positive in herd C. In herd C, the preweaning and postweaning prevalence was low. In herds A and B, necropsied pigs had polyserositis lesions where M hyorhinis was detected by PCR. This study showed that prevalence of M hyorhinis colonisation varies with pig age and across farms. Information generated will aid in the design and implementation of control and prevention strategies.

Risk-adjusted treatment selection and outcome of patients with acute cholecystitis.

PURPOSE: Age and comorbidities increase the surgical risk for patients with acute cholecystitis and impact on the initial treatment selection. The aim of this article is the implementation of objective risk criteria that may be used to select the most appropriate treatment. METHODS: We carried out a prospective cohort study of all patients who were admitted to the hospital with a diagnosis of acute cholecystitis during 2014. They were initially allocated to three different treatment groups according to cholecystitis grade, number of days from clinical onset, and surgical risk scores as follows: immediate surgery by sepsis (EmergS), early surgery (EarlyS), or medical treatment group (MedT). Differences in the outcomes between the treatment groups were evaluated using bivariate and logistic regression analyses. RESULTS: A total of 149 patients were admitted; 44 % were >80 years old and 40 % were American Society of Anesthesiologists (ASA) > II. The mortality rate of the series was 0 % in EarlyS, 17 % in MedT, and 19 % in EmergS. The mortality rate was significantly associated with a higher degree of cholecystitis, age, and worse score values in risk scales and Charlson index. Logistic regression identified that the only independent predictors of death at the time of admission were the degree of cholecystitis (OR 2.87, p = 0.018) and the Portsmouth Physiological and Operative Severity Score for the enumeration of Mortality and Morbidity (P-POSSUM) score (OR 1.14, p = 0.001). CONCLUSION: The evaluation for the initial treatment in acute cholecystitis should include a systematic determination of the degree of cholecystitis and a surgical risk assessment. Tokyo guideline recommendations should be reviewed.

Insuficiencia renal transitoria tras la administración de la vacuna antigripal / Transitory renal failure after administration of flu vaccine

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Diagnóstico de síndrome de Peutz-Jeghers / The diagnosis of Peutz-Jeghers syndrome

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Tumores gástricos estromales: factores pronósticos y tratamiento quirúrgico / Gastric stromal tumors: prognostic factors and surgical treatment

Introducción. Los criterios para determinar el grado de malignidad de los tumores gástricos estromales no están claramente definidos, por lo que el tratamiento quirúrgico de estas lesiones es controvertido. Métodos. Se han estudiado las características clínicas, morfológicas y quirúrgicas de 49 pacientes diagnosticados de tumor gástrico estromal entre 1968 y 1999. Se han analizado las tablas de frecuencias y se ha llevado a cabo un estudio de supervivencia. Resultados. Se han hallado 29 tumores malignos, mientras que el resto eran benignos. Los síntomas más frecuentes consistieron en un síndrome constitucional, hemorragia digestiva alta y masa abdominal en el 20 por ciento de los casos. El análisis de la supervivencia demostró que la presencia de masa abdominal, el tamaño tumoral mayor de 10 cm y la necrosis tumoral son indicadores de mal pronóstico, mientras que la presencia de ulceración indica buen pronóstico. Un índice mitótico elevado (> 10) y una resección quirúrgica amplia no tienen impacto en la supervivencia de estos pacientes. Conclusiones. Recomendamos una resección completa pero limitada de estos tumores dada la menor complejidad técnica, la menor morbilidad y el idéntico pronóstico que los asociados con resecciones más amplias (AU)

Virtual sonography through the Internet: volume compression issues.

BACKGROUND: Three-dimensional ultrasound images allow virtual sonography even at a distance. However, the size of final 3-D files limits their transmission through slow networks such as the Internet. OBJECTIVE: To analyze compression techniques that transform ultrasound images into small 3-D volumes that can be transmitted through the Internet without loss of relevant medical information. METHODS: Samples were selected from ultrasound examinations performed during, 1999-2000, in the Obstetrics and Gynecology Department at the University Hospital in La Laguna, Canary Islands, Spain. The conventional ultrasound video output was recorded at 25 fps (frames per second) on a PC, producing 100- to 120-MB files (for from 500 to 550 frames). Processing to obtain 3-D images progressively reduced file size. RESULTS: The original frames passed through different compression stages: selecting the region of interest, rendering techniques, and compression for storage. Final 3-D volumes reached 1:25 compression rates (1.5- to 2-MB files). Those volumes need 7 to 8 minutes to be transmitted through the Internet at a mean data throughput of 6.6 Kbytes per second. At the receiving site, virtual sonography is possible using orthogonal projections or oblique cuts. CONCLUSIONS: Modern volume-rendering techniques allowed distant virtual sonography through the Internet. This is the result of their efficient data compression that maintains its attractiveness as a main criterion for distant diagnosis.

Marcadores ecográficos de cromosomopatía del segundo trimestre (semana 20) / Ultrasonographic markers of chromosomal abnormalities in the second trimester

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Influencia del grado de reducción de la fractura en el ambiente mecánico del callo durante el proceso de reparación ósea mediante fijación externa / Influence of fracture reduction on the mechanical environment of callus formation during bone repair using external fixation

Objetivo: Se evalúa la influencia que, sobre el ambiente mecánico del callo, ejercen distintos grados de reducción no anatómica de fracturas tratadas mediante fijación externa unilateral. Diseño experimental: Se desarrolla un modelo de elementos finitos del conjunto fijador externo-tibia fracturada, validado con ensayos mecánicos de compresión, flexión en los planos frontal y sagital, y torsión. El modelo considera, además, la evolución del callo desde un estado inicial hasta su consolidación, mediante la variación de sus propiedades elásticas. Del modelo desarrollado se obtienen valores de fuerzas, momentos y tensiones en el foco de fractura, considerando diversos grados de reducción no anatómica según las configuraciones siguientes: ángulo entre fragmentos (planos sagital y frontal), desalineación entre ejes de fragmentos (planos sagital y frontal) y separación longitudinal. Resultados: Los momentos presentes en el callo aumentan al disminuir el grado de reducción, especialmente en los casos de angulación y desalineación, con valores máximos de 60 Nm (+600 por ciento). La tensión de von Mises también aumenta con menores grados de reducción, produciéndose incrementos del 180 por ciento (hasta 80 MPa) respecto a los valores obtenidos en fracturas con reducción anatómica. Conclusiones: Una reducción de fractura no adecuada incrementa los momentos flectores en el callo, así como su estado tensional en general, que se hace más crítico cuanto menor es el grado de reducción alcanzado, fundamentalmente en el caso de angulación y desalineación entre fragmentos. Ciertos grados de reducción no anatómica representan, por tanto, un mayor riesgo de retardo en la consolidación o incluso ausencia de la misma (AU)

Simultaneous determination of organotin compounds by hydride generation-gas phase molecular absorption spectrometry.

This study describes the determination of ternary mixtures of dimethyltin chloride (DMT), trimethyltin chloride (TMT) and monobutyltin chloride (BT) by hydride generation-gas phase molecular absorption spectrometry and the application of different chemometric methods: principal components regression (PCR) and partial least squares (PLS). The two methods are applied to the absorption spectra of mixtures of DMT, TMT and BT. Two different experimental designs are tested for the mixtures, a triangular design and a central composite design. The models obtained from the triangular design offer the best prediction results. The effects of the number of working wavelengths and the number of factors included in the calibration model is studied and a different behaviour is seen for each compound and calibration model. The methods are applied to the analysis of artificial aqueous samples containing different concentrations of DMT, TMT and BT species. No significant differences are observed between the calibration models investigated.

Decay study of pesticide residues in apple samples.

A method for monitoring pesticides in apple samples, including Soxhlet extraction, an evaporation step and capillary gas chromatography with nitrogen-phosphorus detection, is applied to a decay study of the carbamate pesticide ethiofencarb. The evaporation step is carried out by a surface nitrogen flow and the recoveries of ethiofencarb measured in standard solutions of ethyl acetate and apple extracts. The results of the decay studies show that ethiofencarb is degraded in the apple peel faster than in the interior of the fruit. The methodology is then applied to decay studies in the laboratory of the organophosphorus pesticides, diclofluanid, fenitrothion and malathion.

Hemoptisis; analisis de 22 casos / Hemoptysis; analysis of 22 cases

El presente estudio se ha realizado en una serie de 22 casos de hemoptisis leve a masiva (50 a 500 ml en 24 horas) internados en el servicio de neumologia del Hospital Clinico Francisco Viedma de Cochabamba Bolivia en el periodo de mayo de 1990 a mayo de 1992. En todos los casos se realizaron Rx de Torax, microbacteriologico de espectoracion y fibrobroncoscopia. Se realizo tratamiento a base de oxitocicos (Syntocinon), y antibioticos o tratamiento antituberculoso, dependiente del caso. La edad vario de 20 a 90 anos fueron 5 casos de sexo femenino y 17 de sexo masculino. Las alteraciones radiologicas mas frecuentes fueron retraccion cicatricial en V3 superior siendo el hemitorax derecho el mas afectado. Endoscopicamente se observo congestion y aumento de vascularizacion en mucosa bronquial en un 27// de los casos, lesion vegetante 23//, lesion granulomatosa 18//, disminucion de calibre bronquial 18//, ensanchamiento de carina bronquial 14//. El arbol bronquial superior mas afectado fue el derecho , 73// siendo afectado el lobulo superior derecho en un 32// el resultado histopatologico fue: carcinoma bronquial 10 casos (46//), bronquitis cronica 4 casos (18//), tuberculosis pulmonar 3 casos (13//), micosis pulmonar (aspergilosis) 3 casos (13//), fibrosis pulmonar y leptospirosis pulmonar con un caso cada uno (5//). Se concluye que toda hemoptisis deberia ser bien estudiada y siempre pensar en carcinoma broquial en pacientes mayores a 40 anos.

Uso de medicamentos no prescritos por médico en la gestación y riesgos teratogenicos asociados

Con el objeto de analizar los riesgos tertatogénicos asociados al hábito de la automedicación en el embarazo, fueron entrevistadas 300 puérperas atendidas en la maternidad del HRSB de Bogotá. Se verificó que del total de medicamentos consumidos 34 por ciento no tuvieron prescipcion medica, siendo que de este grupo 52.5 por ciento fueron consumidos en el primer trimestre de la gestación. El 49.3 por ciento de las gestantes hicieron uso de por lo menos un medicamento no prescrito por médico. Se encontró una asociación significativa entre el grupo de pacientes que se automedicaron con relación a la falta de asistencia a la consulta pre-natal en el primer trimestre de embarazo (p<0,05; "odds ratio"= 1,84). Se identificaron riesgos teratogénicos asociados en 3.3 por ciento de las pacientes que se automedicaron (principalmente uso de tetracíclinas y hormonas sexuales con acción endogénica)