Gastric carcinoma and renal cell carcinoma as an atypical presentation of multiple primary malignancies: a case report and review of the literature.

BACKGROUND: Gastric carcinoma (GC) with second primary malignancy (SPM) is the most frequent combination within the multiple primary malignancies (MPM) group. The presentation of a GC associated with a synchronized SPM in the kidney is extremely rare and unusual. This study presents a rare case of synchronous tumors, describes the main associated risk factors, and emphasizes the need to rule out SPM. MAIN BODY: We present the case of a 63-year-old Hispanic woman with a history of smoking, weight loss, and gastrointestinal (GI) bleeding. GC was diagnosed by endoscopy, and during her workup for metastatic disease, a synchronous SPM was noted in the left kidney. The patient underwent resection of both tumors with a satisfactory postoperative course. A systematic review of the literature was performed using the Medline/PubMed, Science Direct, Scopus, and Google Scholar databases. A search of the literature yielded 13 relevant articles, in which the following main risk factors were reported: the treatment utilized, the grade and clinical stage, histopathological report, and in some cases survival. It is concluded that advanced age (> 60 years) and smoking are the main associated risk factors. CONCLUSION: Gastric carcinoma is the second most frequent neoplasm of the GI tract and the main neoplasm that presents a SPM. MPM screening is recommended in patients with gastric cancer. The clinical discovery of MPM of renal origin is rare and hence the importance of the current report.

Recomendaciones sobre el tratamiento farmacológico perioperatorio / Perioperative pharmacological treatment recommendations

A pesar de los avances en las técnicas quirúrgicas y en la anestesia, todavía se produce un número significativo de complicaciones en el postoperatorio de la cirugía mayor. Las más frecuentes son las infecciones de la herida quirúrgica, la sepsis, las complicaciones cardiovasculares y respiratorias y los fenómenos tromboembólicos. La aparición de estas complicaciones aumenta la estancia hospitalaria, los costes sanitarios y la mortalidad. Para reducir su incidencia, se han introducido diferentes estrategias farmacológicas perioperatorias que, sin embargo, han estado sometidas a una gran variabilidad de unos hospitales a otros e incluso entre los profesionales de un mismo centro. En el presente artículo se revisan las recomendaciones de las guías de práctica clínica más establecidas sobre la medicación habitualmente empleada en esta situación, como los antibióticos, antitrombóticos, analgésicos y antieméticos (AU)

Despite the advances in surgical techniques and anaesthesia, there are still a significant number of postoperative complications in surgery, the most common being, surgical wound infections, sepsis, respiratory and cardiovascular complications, and thromboembolic events. All of these complications increase hospital stay, health costs and mortality. Different pharmacological perioperative strategies have been employed to reduce their incidence, but these have varied widely between hospitals, and even among professionals in the same hospital. In this article we review the recommendations of clinical practice guidelines on the medication routinely used in this situation, such as antibiotics, antithrombotics, analgesics and antiemetics (AU)

[Perioperative pharmacological treatment recommendations]. / Recomendaciones sobre el tratamiento farmacológico perioperatorio.

Despite the advances in surgical techniques and anaesthesia, there are still a significant number of postoperative complications in surgery, the most common being, surgical wound infections, sepsis, respiratory and cardiovascular complications, and thromboembolic events. All of these complications increase hospital stay, health costs and mortality. Different pharmacological perioperative strategies have been employed to reduce their incidence, but these have varied widely between hospitals, and even among professionals in the same hospital. In this article we review the recommendations of clinical practice guidelines on the medication routinely used in this situation, such as antibiotics, antithrombotics, analgesics and antiemetics.

In vitro induction of apoptosis in U937 cells by perillyl alcohol with sensitization by pentoxifylline: increased BCL-2 and BAX protein expression.

BACKGROUND: Chemotherapy is effective against a wide variety of tumor cells, although its use is limited by side effects. In vitro experiments and phase I and II trials have shown that phytochemicals such as perillyl alcohol (P-OH) have antitumor effects. Pentoxifylline (PTX), a synthetic methylxanthine used mainly to treat pathologies associated with hematological diseases, sensitizes tumor cells to chemotherapy. The aim of this study was to determine whether PTX amplifies the antitumor effects of P-OH in U937 human myelomonocytic leukemia cells. METHODS: Apoptosis was measured by the loss of mitochondrial membrane potential determined by flow cytometry using dihexyloxacarbocyanine iodide (DiOC6) and propidium iodide. Bcl-2 and Bax protein expression was also assessed by Western blot analysis. RESULTS: P-OH and PTX induced loss of the mitochondrial membrane potential in U937 cells in vitro. Culturing the cells in the presence of both compounds caused a significant increase (p < 0.001) in apoptosis and expression of anti-apoptotic Bcl-2 and pro-apoptotic Bax proteins. However, despite their coexistence, Bax expression prevailed in our experiments. These data suggest that the effects of PTX might be attributable to changes in the mitochondrial membrane potential. CONCLUSION: PTX sensitizes tumor cells to the anti-neoplastic action of P-OH. These observations may have clinical relevance in the treatment of cancer patients.

[Retinopathy of prematurity and oxidative stress]. / Retinopatía del prematuro y estrés oxidativo.

INTRODUCTION: There is some evidence that retinopathy of prematurity is due to excessive oxidative stress on the developing retina caused by high free radical production or reduced ability to eliminate these radicals. OBJECTIVE: To determine the relationship between high levels of oxidative stress and retinopathy of prematurity. MATERIAL AND METHODS: A prospective cohort study was designed. Fifty premature infants of less than 33 weeks' gestational age were included. Serum lipoperoxide levels were determined as a measure of oxidative stress. Samples were taken once a week for 1 month, starting from the first week of life. The results of all four samples were compared between infants who developed any degree of retinopathy of prematurity and those without it. Ophthalmological examinations were performed after the fourth week of life. RESULTS: The incidence of retinopathy of prematurity was 22 % (11/50). The mean values of all the samples showed a significant difference between infants who developed retinopathy of prematurity (5.44 +/- 1.30 nmol/ml) and those who did not (2.94 +/- 0.89 nmol/ml, p = 0.0001). The relative risk of developing retinopathy of prematurity with high serum lipoperoxide levels was 5.15, 5.63, 4.15 and 12.70 for each of the weekly samples. CONCLUSIONS: There is an association between high serum lipoperoxide levels, as a measure of oxidative stress, and the incidence of retinopathy of prematurity.

Retinopatía del prematuro y estrés oxidativo / Retinopathy of prematurity and oxidative stress

Introducción: Existen algunas evidencias de que la retinopatía del prematuro es consecuencia de un elevado estrés oxidativo sobre la retina en desarrollo, lo cual se debe a la generación exagerada de radicales libres o a una disminución en la capacidad para su eliminación. Objetivo: Determinar la asociación entre la concentración elevada de estrés oxidativo y la presencia de retinopatía del prematuro. Material y métodos: Se realizó un estudio de cohorte prospectiva. Se incluyeron 50 prematuros de menos de 33 semanas de gestación. El estrés oxidativo se midió con la concentración sérica de lipoperóxidos. Se tomaron muestras a partir de la primera semana de vida y después, cada semana hasta la cuarta. Se compararon los resultados de las 4 muestras juntas, entre los prematuros con retinopatía de cualquier grado con los que no la desarrollaron. Las evaluaciones oftalmológicas se realizaron a partir de la cuarta semana de vida. Resultados: La incidencia de retinopatía en el estudio fue del 22 % (11/50). Hay una diferencia significativa en los valores promedio de todas las muestras, entre aquellos que presentaron retinopatía del prematuro, 5,44 ± 1,30 nmol/ml, comparados con los que no presentaron la enfermedad, 2,94 ± 0,89 nmol/ml, con una p = 0,00001. El riesgo relativo para el desarrollo de retinopatía con concentraciones elevadas de lipoperóxidos fue de 5,15, 5,63, 4,15 y 12,70 para las muestras de cada una de las semanas, respectivamente. Conclusiones: Existe una asociación entre la concentración elevada de lipoperóxidos séricos, como una medida de estrés oxidativo y la incidencia de la retinopatía del prematuro

Introduction: There is some evidence that retinopathy of prematurity is due to excessive oxidative stress on the developing retina caused by high free radical production or reduced ability to eliminate these radicals. Objective: To determine the relationship between high levels of oxidative stress and retinopathy of prematurity. Material and methods: A prospective cohort study was designed. Fifty premature infants of less than 33 weeks' gestational age were included. Serum lipoperoxide levels were determined as a measure of oxidative stress. Samples were taken once a week for 1 month, starting from the first week of life. The results of all four samples were compared between infants who developed any degree of retinopathy of prematurity and those without it. Ophthalmological examinations were performed after the fourth week of life. Results: The incidence of retinopathy of prematurity was 22 % (11/50). The mean values of all the samples showed a significant difference between infants who developed retinopathy of prematurity (5.44 ± 1.30 nmol/ml) and those who did not (2.94 ± 0.89 nmol/ml, p = 0.0001). The relative risk of developing retinopathy of prematurity with high serum lipoperoxide levels was 5.15, 5.63, 4.15 and 12.70 for each of the weekly samples. Conclusions: There is an association between high serum lipoperoxide levels, as a measure of oxidative stress, and the incidence of retinopathy of prematurity

In vivo modification of adriamycin-induced apoptosis in L-5178Y lymphoma cell-bearing mice by (+)-alpha-tocopherol and superoxide dismutase.

Apoptosis was followed in L5178Y lymphoma cell-bearing mice at different times after intraperitoneal injections of adriamycin (ADM). Apoptosis was determined morphologically and confirmed by DNA laddering on electrophoresis. Apoptosis was observed 36h after injection of 5mg/kg ADM (apoptotic cell index 64.2+/-5.6 vs. 1.5+/-2.1 from the untreated group) and confirmed by DNA electrophoresis. However, when the animals were pretreated with (+)-alpha-tocopherol acid succinate or superoxide dismutase before ADM administration apoptotic index significantly diminished (P<0.05) and the DNA electrophoresis did not show fragmentations. We conclude that in ADM-treated mice, tumour cell death occurs in two ways: first by necrosis, then later by apoptosis. These observations are likely to be associated with or caused by the generation of reactive oxygen species.

Espermiograma para control de la vasectomía / Semen examination after vasectomy

La vasectomía está considerada como uno de los métodos más efectivos y populares para el control de la natalidad. Tiene el inconveniente de que no es efectiva de modo inmediato, ya que los espermatozoides tardan un tiempo variable en ser eliminados del tracto genitourinario masculino y, a veces, no lo hacen completamente. Además, existe un mínimo riesgo de que se recanalice el conducto seccionado y vuelvan a aparecer espermatozoides en el semen. Por estos motivos, es necesario realizar un espermiograma para comprobar que la intervención ha tenido éxito y que se ha conseguido la esterilidad. Esto ha supuesto que el análisis del semen sea muy importante a la hora de intentar asegurar el éxito de la operación y de tratar de evitar las consecuencias médico-legales de los fallos. Los diversos estudios existentes sobre el control de la vasectomía ponen de manifiesto la necesidad de implantar unos protocolos económicamente rentables, basados en la evidencia científica, que arranquen con la información exhaustiva preoperatoria y se continúen con un análisis estructurado posoperatorio del semen. En este sentido, la Sociedad Británica de Andrología ha publicado una guía de práctica clínica sobre el análisis seminal posvasectomía para ayudar a los profesionales del laboratorio en la estandarización de los espermiogramas de control y en el informe de los resultados. Para la recogida de semen, esta guía sigue las recomendaciones de la Organización Mundial de la Salud

Vasectomy is regarded as one of the most reliable and popular method of birth control. It has the disadvantage that it is not immediately effective because spermatozoa take some time to be cleared from the genitourinary tract of the male and sometimes they do not disappear completely. In addition, there is a minimal risk of recanalisation of the dissected duct and renewed patency. Because of this, it is necessary to do a spermiogram to confirm the success of the operation and that sterility has been achieved. This has produced that seminal examination becomes an important tool to document operative success and to avoid medicolegal consequences of failure. The studies about semen examination after vasectomy reveal the need of cost-efective evidence-based protocol, which begin by the adequate preoperative counselling and follow with a postoperative structurated semen analysis. The British Andrology Society guidelines about the assessment of semen samples after vasectomy were published to give guidance to laboratory staff to ensure standarisation of seminal analysis protocols and reporting of results that, for semen collection, follows the World Health Organization recommendation

In vivo inhibition by antioxidants of adriamycin-induced apoptosis in murine peritoneal macrophages.

Adriamycin (ADM) is an oncostatic of the anthracycline family with confirmed experimental and clinical efficiency. This antitumoral drug has been reported to stimulate macrophage activity and is able to induce apoptosis (AP) in some tumour cells. The objective of the present work was to investigate if in vivo administration of ADM to mice induces AP in their peritoneal macrophages (PM). AP was expressed by the apoptotic index (AI) of peritoneal macrophages observed under fluorescence microscope after ethidium bromide and acridine orange staining and confirmed by detection of the ladder pattern on DNA electrophoresis, indicates DNA fragmentation in 80-120 bp characteristic of apoptotic state. 24 hours after i.p. ADM administration, AP was observed in PM. The effect was best visible after the injection of 5 mg/kg ADM. (Al: 76.3+/-8.9 vs untreated control group AI: 2.8+/-1.1). In the ADM treated group a DNA ladder electrophoretic pattern was observed while DNA from normal PM was genomic. Since ADM toxicity has been attributed to reactive oxygen species generation, we investigated its possible participation in AP induction by pretreating mice with antioxidants: (+)-alpha-tocopherol acid succinate (30 IU/mouse per os) for 3 days before ADM administration with E. coli lipopolysacharide (0.15 microg/mouse i.p.) 24 hours before ADM administration or with superoxide dismutase (10,000 IU/mouse i.p.) 1 hour before ADM administration. AI was significantly decreased, with values close to those of the untreated control group (AI: 15+/-5.7, 9.6+/-8.0 and 32.9+/-6.9, respectively). Antioxidants given before ADM treatment significantly increased the live cell index (p < or = 0.001) in PM the groups while inactivated antioxidants no longer protect PM against the ADM AP induction. DNA analysis confirmed the effect: in the untreated control and in the antioxidant protected groups DNA was genomic while in either ADM or inactivated-antioxidants + ADM treated groups, DNA presented the ladder pattern. AP can thus be induced in PM by ADM and inhibited by antioxidants. These observations may have clinical applications.

[Modified procedure for screening anticonvulsants. Re-evaluation of sodium diphenylhydantoin and phenobarbital]. / Procedimiento modificado para tamizaje anticonvulsionante. Reevalucación del difenilhidantoinato sódico y el fenobarbital.

A modified antiepileptic screening procedure to test anticonvulsant drugs is shown. Diphenylhydantoin sodium salt (DFH-Na) and phenobarbital (Phb) were tested throughout 8 h, at hourly intervals after a single oral drug intake in rats. Another group was tested at steady stage of DFH-Na during 7 days period. A single dose of DFH-Na was orally administrated to male and female rats (30 mg/kg) and after testing throughout 8 h: 0, 5, 28, 38, 52, 70 and 75% and 10, 18, 50, 35, 62, 50 and 70% protection against MES, was found. Only 20% protection was found in females to METsc test on the 6th and 7th h. However, 80, 60, 60 and 20% males were found protected against METsc test from the 4th to the 8th hour. Maximum blood serum levels were 2 micrograms/ml. Phenobarbital at doses 12 mg/kg in males and females as well showed: 30, 64, 66, 74, 84, 90, 40, 34% and 14, 36, 53, 41, 55, 70, 82 and 82% protection against MES, respectively. On the other hand, 60, 60, 46, 47, 94, 100, 80 and 20% and 80, 80, 46, 70, 60, 40, 80 and 20% of males and females were protected against METsc test, respectively. An average of 8 micrograms/ml and 12 micrograms/ml of Phb serum levels were found since the 1 to the 8th and 5th hours, correspondingly. A 28% protection of both male and female rats to MES test was found following 7 days of treatment with DFH-Na (30 mg/kg) treatment. Also an average of 10% female and males were found protected against METsc test.