Evaluación de fuerza de concordancia de hallazgos de endometriosis en RM y laparoscopía: análisis de una serie de casos / Assessment concordance of endometriosis findings on MRI and laparoscopy: analysis of a series of cases

OBJETIVO: Evaluar concordancia de sitios de hallazgos de endometriosis profunda encontrados por RM y laparoscopia. MATERIALES Y MÉTODOS: Estudio retrospectivo, no experimental, concordancia intertécnica. Se recolectaron datos en nuestra institución de todos los informes de RM de pelvis que incluyeran la palabra "endometriosis", entre mayo de 2015 y abril de 2018 (36 meses), identificando 339 registros. Se establecieron criterios de inclusión. De los 339 registros, 62 pacientes fueron excluidas por cirugía antes de la RM. Otras 243 pacientes fueron excluidas porque no presentaban registro de protocolo quirúrgico posterior a la RM. 34 pacientes cumplieron los criterios de inclusión del estudio, lo que equivale al 10% de las RM estudiadas. Se revisaron las ubicaciones de los implantes endometriósicos informados en RM y se correlacionaron con los hallazgos encontrados en la cirugía. Se confecciono tabla para identificar la presencia/ausencia de implantes en las ubicaciones descritas en la literatura. Análisis estadístico mediante software Stata, aplicando kappa ponderada con intervalo de confianza de 95%. RESULTADOS: El promedio de edad de las pacientes llevadas a cirugía fue de 38 años. Los lugares con correlación moderada-importante (0.41-0.80) correspondieron a útero, recto-sigmoides, ovario, vagina y fondos de saco. CONCLUSIÓN: La RM de Pelvis es fundamental en la evaluación de pacientes con endometriosis en las que se plantea un manejo quirúrgico, con el objetivo de caracterizar la ubicación, forma y número de lesiones, y así lograr un satisfactorio tratamiento laparoscópico.

OBJECTIVE: To assess inter-observer reliability of sites of deep endometriosis findings found by MRI and laparoscopy. MATERIALS AND METHODS: Retrospective, non-experimental study, inter-observer reliability. Data were collected at our institution from all pelvic MRI reports that included the word "endometriosis", between May 2015 and April 2018 (36 months), identifying 339 records. The following were established as inclusion criteria. Of the 339 records, 62 patients were excluded for surgery prior to MRI. Another 243 patients were excluded because they had no record of the surgical protocol after the MRI. 34 patients met the study inclusion criteria, equivalent to 10% of the MRIs studied. The locations of the endometrial implants reported on MRI were reviewed and correlated with the findings found in the surgery. A table was prepared to identify the presence / absence of implants in the locations described in the literature. Statistical analysis using Stata software, applying weighted kappa with a 95% confidence interval. RESULTS: The average age of the patients undergoing surgery was 38 years. The places with a moderate-important correlation (0.41-0.80) corresponded to the uterus, recto-sigmoid, ovary, vagina, and recto-uterine pouch. CONCLUSION: Pelvic MRI is essential in the evaluation of patients with endometriosis in whom surgical management is proposed, in order to characterize the location, shape and number of lesions, and thus achieve satisfactory laparoscopic treatment.

Actualización en el uso del PET/CT en sarcoma de Ewing, a propósito de un caso

The use of positron emission tomography with computed tomography (PET/CT) for adult cancer patients is widespread, however, its use in pediatric patients is limited by fear of radiation, monetary cost and lack of awareness of its greater sensitivity in the evaluation of some types of tumors. Ewing's sarcoma is one of the primary pediatric malignancies in which PET/CT with 18F-labeled fluorodeoxyglucose (18F-FDG) has demonstrated greater sensitivity in the evaluation of bone metastases compared to scintigraphy, as well as in the evaluation of treatment response. We report a 13 years old female consulting for retrosternal pain. A chest CT scan showed an infiltrating mass originating in the sternum. A biopsy confirmed the presence of an Ewing sarcoma. The tumor was staged with PET/CT which showed multiple bone lesions not visible in previous studies.

[Use of PET/CT for staging of Ewing's sarcoma. Report of one case]. / Actualización en el uso del PET/CT en sarcoma de Ewing, a propósito de un caso.

The use of positron emission tomography with computed tomography (PET/CT) for adult cancer patients is widespread, however, its use in pediatric patients is limited by fear of radiation, monetary cost and lack of awareness of its greater sensitivity in the evaluation of some types of tumors. Ewing's sarcoma is one of the primary pediatric malignancies in which PET/CT with 18F-labeled fluorodeoxyglucose (18F-FDG) has demonstrated greater sensitivity in the evaluation of bone metastases compared to scintigraphy, as well as in the evaluation of treatment response. We report a 13 years old female consulting for retrosternal pain. A chest CT scan showed an infiltrating mass originating in the sternum. A biopsy confirmed the presence of an Ewing sarcoma. The tumor was staged with PET/CT which showed multiple bone lesions not visible in previous studies.

Factors associated with changes in exposure to anticholinergic and sedative medications in elderly hospitalized patients: multicentre longitudinal study.

BACKGROUND AND PURPOSE: Elderly patients exposed to drugs with anticholinergic or sedative properties may have an increased risk of adverse events. This study aimed to assess the relationship between patient characteristics and changes of exposure to anticholinergic and sedative medications during their hospital stay. METHODS: A multicentre longitudinal study was set up on hospitalized patients (aged ≥65 years) using at least one drug at admission. The primary outcome was change of exposure to anticholinergic and sedative drugs between admission and discharge. Sociodemographic characteristics of the patients, comorbidities, life habits and information about the hospital stay (origin of admission, reasons for hospitalization) were collected. RESULTS: The study included 337 patients (mean age, 85.4 years) with an average hospital stay of 30.1 ± 37.5 days. The drug burden index increased during the hospital stay among males (P = 0.03), patients for whom the reason for hospitalization was either a stroke (P = 0.001) or inability to stay in their own home (P = 0.001), and patients with diabetes mellitus (P = 0.009). In the adjusted model, drug burden index increased among patients hospitalized for stroke, inability to stay in their own home or post-surgery, and for patients with diabetes mellitus or hypertension. CONCLUSIONS: The drug management of elderly patients during hospital stays may increase exposure to anticholinergic and sedative drugs. Although the anticholinergic and sedative properties may be in relation to the therapeutic purpose, they also represent an unexpected risk. Physicians and clinical pharmacists should consider performing optimization of the drug prescriptions for patients at risk.

[Role of clinical pharmacist in the therapeutical optimization in geriatric outpatient hospital]. / Place du pharmacien clinicien dans l'optimisation thérapeutique en hôpital de jour gériatrique.

SETTING: Cares in outpatient hospital for elderly patients is a period of interest for multidisciplinary reassessment and pharmaceutical care of the prescription. The objective is to present the implementation of the pharmaceutical care activity at the outpatient hospital. METHODS: Between August and October 2011, elderly patients hospitalized in the outpatient hospital for a brief appraisal had a pharmaceutical care. The clinician introduced pharmaceutical reviews in the synthesis letter for general practitioner. An analysis of the activity was carried out over 3 months. RESULTS: A pharmaceutical care had been realized for 67 patients, mean age of 81.7 years. Among medical related problems identified, 39.6% were for potentially unnecessary medication. A stop was proposed for 44% of pharmaceutical interventions. A total of 91 pharmaceutical interventions and 13 recommendations were made and 34% of patients had potentially inappropriate medication. CONCLUSION: According to the objective to reduce the therapeutics contributing to the iatrogenesis, this approach allowed us to undertake a multidisciplinary collaboration oriented toward the relay between hospital and city cares.

New tricyclic and tetracyclic pyranocoumarins with an unprecedented C-4 substituent. Structure elucidation of tamanolide, tamanolide D and tamanolide P from Calophyllum inophyllum of French Polynesia.

Three new pyranocoumarin derivatives, tamanolide (1), tamanolide D (2) and tamanolide P (3), were isolated from the almond seeds of Calophyllum inophyllum L. (Clusiaceae) grown in French Polynesia. These compounds, having an unprecedented C-4 isobutyl substituent, have been characterized as a new class of pyranocoumarins called tamanolides. Their structures were elucidated on the basis of 1D and 2D NMR techniques (COSY, NOESY, HSQC and HMBC) in association with MS (HR-ESI-MS) data analysis.

1H and 13C NMR signal assignments of some new N,N'-diacyl proflavine derivatives.

The complete 1H and 13C NMR signal assignments of 23 new N,N'-diacyl proflavine derivatives were achieved using one- and two-dimensional experiments (DEPT, HMQC and HMBC).

A novel mutation in the EIF2AK3 gene with variable expressivity in two patients with Wolcott-Rallison syndrome.

Mutations in the EIF2AK3 gene have been identified in patients with Wolcott-Rallison syndrome - a rare autosomal recessive disorder associated with permanent neonatal insulin-dependent diabetes. Despite the fact that different mutations have been observed in every single unrelated case reported so far, most patients presented with similar characteristics, such as osteopenia, epiphyseal dysplasia as well as hepatic and/or renal dysfunction. The EIF2AK3 gene was analyzed using a PCR-based sequencing approach in two Wolcott-Rallison patients and their parents. We report two cases from different families carrying the same and novel truncating nonsense mutation in the EIF2AK3 gene that encodes the pancreatic eukaryotic initiation factor 2alpha kinase 3. This mutation clearly displays different clinical characteristics in the two patients we examined. Remarkably, the onset of diabetes was different for the two patients, and there was also heterogeneity in other clinical manifestations. These cases illustrate the important role of alternative pathways that could, to some extent, take over or supplement a defective metabolic pathway. This supports the idea that there is no simple relationship among clinical manifestations and EIF2AK3 mutations.

(1)H and (13)C chemical shifts for 2-aryl and 2-N-arylamino benzothiazole derivatives.

The (1)H and (13)C NMR resonances for forty-three 2-aryl and 2-N-arylamino benzothiazole derivatives were completely assigned using a concerted application of one- and two-dimensional experiments (DEPT, gs-COSY, gs-HMQC and gs-HMBC).

Structures of cadinane- and guaiane-type sesquiterpenoids from Enterospermum madagascariensis (Baill.) Homolle.

Three new cadinane- and guaiane-type sesquiterpenoids, 2-hydroxy-10-epi-zonarene 1, 2, 15-dihydroxycalamenene 2 and guaia-4, 6-dien-3-one 3, were isolated from the wood of Enterospermum madagascariensis (Rubiaceae) grown in Madagascar. Their structures were established from concerted application of 2D NMR techniques including gs-COSY, gs-HMQC, gs-HMBC and NOESY.

1H and 13C chemical shifts for acridines: Part XIX. N,N'-diacylproflavine derivatives.

The 1H and 13C NMR resonances of 15 N,N'-diacylproflavines were assigned completely and unequivocally using a concerted application of one- and two-dimensional experiments (DEPT, gs-COSY, gs-HMQC and gs-HMBC).

Gluco-indole alkaloids from the bark of Nauclea diderrichii. 1H and 13C NMR assignments of 3alpha-5alpha-tetrahydrodeoxycordifoline lactam and cadambine acid.

Detailed (1)H and (13)C NMR assignments of 3alpha-5alpha-tetrahydrodeoxycordifoline lactam and cadambine acid, isolated from the bark of the Nauclea diderrichii (de Wild.) Merr. (Rubiaceae) were achieved by 1D and 2D techniques such as DEPT, HMBC, HMQC, COSY and NOESY.

Structures of new secofriedelane and friedelane acids from Calophyllum inophyllum of French Polynesia.

Three new friedelane-type triterpenoids, 3,4-secofriedelan-3,28-dioic acid (1), 27-hydroxyacetate canophyllic acid (2) and 3-oxo-27-hydroxyacetate friedelan-28-oic acid (3), were isolated from the leaves of Calophyllum inophyllum (Clusiaceae) grown in French Polynesia. Their structures were established by the concerted application of 2D NMR techniques including gs-COSY, gs-HMQC and gs-HMBC.

Removal of trivalent chromium from tannery waste waters using bone charcoal.

The ability of bone charcoal to remove Cr(III) from aqueous solutions by adsorption has been investigated. The adsorbent used was first characterised and then the adsorption was studied as a function of time and amount of charcoal. Tests were carried out with synthetic solutions whose Cr concentrations (500 mg L(-1)) were similar to those found in some effluents of Moroccan tannery industries. Cr removal efficiencies higher than 90% were obtained at pH 3.5 using 3 g of bone charcoal and a stirring time of about 30 min. Results of Cr removal by all sieved fractions of bone charcoal had shown the same interesting capabilities for Cr(III) retention. The cross interference with other elements was also investigated. Pre-treatment of bone charcoal by nitric acid led to an increase in its specific surface area but induced a drastic reduction in its Cr elimination abilities. Adsorption tests were also carried out using calcinated bone charcoal. The results obtained showed a similar percentage of Cr retention to those found with untreated bone charcoal. On the other hand, a double treatment of bone charcoal with HCl and NaOH provided an enhancement of Cr(III) retention. The role played by the mineral fraction of the solid phase of bone was thus evidenced.

Checkpoints for vesicular traffic?

During interphase the transport of material between different intracellular organelles requires accurate regulation of fusiogenic domains. Recent studies on hepatic endosomes indicated that compartmentalized Cdk2-cyclin E complexes act by braking fusion events. These Cdk2 complexes integrate tyrosine phosphorylation and dephosphorylation inputs, resulting in the control of the number of rounds of fusion at discrete domains. This leads to changes in the intracellular location of internalized receptors and ultimately their biological response.

Triterpenoid saponins from berries of Hedera colchica.

Fifteen triterpenoid saponins were isolated from the berries of Hedera colchica and their structures established on the basis of chemical and spectroscopic evidence. Among them, two are new compounds: coichiside A (3) and colchiside B (15) and four are described for the first time in the berries of Hedera colchica (compounds 1, 8, 9 and 11).

C-C versus C-O anionic domino cycloalkylation of stabilized carbanions: facile one-pot stereoselective preparation of functionalized bridged bicycloalkanones and cyclic enol ethers.

alpha,alpha'-Diactivated cyclic- or acyclic ketones undergo a chemoselective base promoted (K2CO3, DBU) one-pot C-C cycloalkylation, with 1,3- and 1,4-dihalides having a cis-like fixed configuration. This reaction gives highly functionalized bicyclo[3.2.1]octan-9-one and bicyclo[4.2.1]nonan-9-one derivatives, which are easily transformed to seven- and eight-membered rings through a high yield retro-Dieckmann cleavage. Starting from trans-1,4-dibromo-2-butenes, the transformation is governed by stereoelectronic factors and leads, through a chemo- and stereoselective C-O cycloalkylation, to synthetically valuable monocyclic or fused polycyclic functionalized enol ethers of high synthetic value. Semiempirical calculations showed a small difference in energy and the late character of the transition states leading to cis and trans isomers of the corresponding fused polycyclic enol ethers. These results, although minimizing the influence of a destabilizing 1,3-interaction on the outcome of the reaction, are qualitatively in agreement with the experimental results.

Activity of Pt(II) and Ru(III) Triazolopyrimidine Complexes Against Parasites of the Genus Leishmania, Trypanosomas and Phytomonas.

The synthesis and characterization of two Pt(II) Complexes with the isomeric ligands 4,5-dihydro-5-oxo- [1,2,4]triazolo-[ 1,5-a]pyrimidine (5HtpO) and 4,7-dihydro-7-oxo-[ 1,2,4]-triazolo-[ 1,5-a]pyrimidine (7HtpO) are described, as well as a Ru(III) complex with 7HtpO. The crystal structure of cis-[PtCl(2)(7HtpO)(2)].2H(2)O has been solved by X-ray diffraction analysis. In vitro activity of the new isolated complexes against the epimastigote form of T. cruzi, procyclic form of T. b. brucei and promastigote form of L. donnovani and P. characias has also been studied. The three complexes markedly affect the growth of the parasites and none of them shows cytotoxicity against macrophage of the J774.2 line at the heaviest dosages used.

Sustained activation of insulin receptors internalized in GLUT4 vesicles of insulin-stimulated skeletal muscle.

Exposure of target cells to insulin results in the formation of ligand receptor complexes on the cell surface and their subsequent internalization into the endosomal apparatus. A current view is that endocytosis of the insulin receptor (IR) kinase results in its rapid deactivation and sorting of the IR back to the cell surface or to late endocytic compartments. We report herein that, in skeletal muscle, in vivo stimulation with insulin induced a rapid internalization of the IR to an insulin-sensitive GLUT4-enriched intracellular membrane fraction. After 30 min of stimulation, IR content and tyrosine phosphorylation were increased by three and nine times in that fraction, respectively, compared with unstimulated muscles. In vitro autophosphorylation assays revealed that the kinase activity of internalized IRs was markedly augmented (eight to nine times) by insulin. In marked contrast with hepatic endosomes or adipocyte low-density microsomes, no IR tyrosine dephosphorylation activity was observed in GLUT4-enriched vesicles isolated from skeletal muscle. The activated IR was recovered in immunopurified GLUT4 vesicles after insulin stimulation. Insulin also increased tyrosine-phosphorylated insulin receptor substrate 1 and phosphatidylinositol 3-kinase adapter (p85) subunit contents in the intracellular membrane fraction, but these signaling molecules were not directly associated with GLUT4 vesicles. These results show that, in skeletal muscle, the activated IR reaches a GLUT4-enriched compartment where its activity is apparently sustained. We propose that compartmentalization of activated IRs to GLUT4 vesicles may play a role in sustaining insulin signaling at this locus in skeletal muscle.

Peroxovanadium-mediated protection against murine leishmaniasis: role of the modulation of nitric oxide.

The phosphotyrosine phosphatase inhibitor bpV(phen) has the ability to markedly decrease the progression of leishmaniasis in vivo. Here, we have identified the mechanisms that are responsible for this protective effect. We report that two potent peroxovanadium (pV) compounds, bpV(phen) and bpV(pic), control progression of leishmaniasis in a similar manner by modulating NO-dependent microbicidal action. We observed that their injection can rapidly and transiently induce the expression of inducible NO synthase (iNOS) in livers of mice and enhance circulating nitrate levels. Treatment of mice with bpV(phen) or bpV(pic) completely controlled progression of leishmaniasis in an NO-dependent manner, since inhibition of iNOS with aminoguanidine completely reversed this pV-mediated protection. This NO-dependent pV-mediated protection was further demonstrated by the incapacity of bpV(phen)-treated Nramp-/-, iNOS-/- mutant mice to control Leishmania major infection. Using an air pouch model, we showed that bpV(phen) can strongly modulate secretion of L. major-induced pro-inflammatory molecules and neutrophil recruitment. In addition, we observed that bpV(phen) per se can strongly induce the expression of Th1 type cytokines over Th2 in spleens of animals. Overall, this study has allowed us to establish the in vivo functional and immunological events involved in pV-mediated protective mechanism against leishmaniasis and that NO plays a pivotal role in this process.