Characteristics and prognosis of jejunoileal gastrointestinal stromal tumours (GISTs) in the era of imatinib: a comparative study with gastric GISTs.

BACKGROUND: Gastrointestinal stromal tumours (GISTs) located in the jejunum or ileum (JI-GIST) are considered worse prognosis compared to those of gastric (G-GIST) location. It has been suggested that this dogma should be revised. The aim of this study was to describe the characteristics of jejunoileal GISTs and its prognosis and to compare them with G-GISTs in the era of imatinib. METHODS: We retrospectively reviewed the clinical histories of all the patients diagnosed with GISTs between January 2000 and November 2016: Clinical and pathological data, as recurrence, metastatic state, disease-free survival (DFS) as well as overall survival (OS) rates of patients were reviewed. RESULTS: JI-GIST patients comprise 29 cases (37.7%). Compared to G-GIST, JI-GIST patients had undergone emergency surgery more frequently (37.9% vs. 10.4%, p = 0.007). According to the NIH-Fletcher classification, the low or very-low risk group represents 17.2% of JI-GISTs as opposed to 37.6% of G-GISTs (p < 0.005). When the AFIP-Miettinen system was used the low or very-low group represented 17.2% of JI-GISTs vs. 58.4% in the G-GISTs group (p < 0.001). Both local recurrence (24.1% vs. 12.5%, p < 0.05) and metastatic rate (34.5% vs. 22.9%, p < 0.05) were higher in the JI-GIST group than in G-GIST. 5- and 10-year DFS and 10-year OS rate were lower for JI-GIST (54.5% and 39.6% vs. 77.2% and 60.8%, and 57.9% vs. 65%, respectively, p < 0.05). CONCLUSIONS: The observed differences between both groups in DFS and OS rates at long term could be attributed to the effect of imatinib.

Additional malignancies in patients with gastrointestinal stromal tumors (GIST): incidence, pathology and prognosis according to a time of occurrence-based classification.

BACKGROUND: The aim of the study is to clarify if a classification based on the time of occurrence of associated malignancies in GIST patients can help in the understanding of the clinical controversies observed in these patients. METHODS: We retrospectively reviewed all the patients diagnosed with GIST tumors between January 1999 and October 2016. They were divided into GIST patients associated with other tumors (A-GIST) and those not associated (NA-GIST). A-GIST patients were also divided into four types according to the proposed classification. RESULTS: Of 104 GIST patients, 32 (30.7%) (A-GIST group) had at least one additional primary malignancy. The most frequent location of the associated malignancy was the GI tract (26%). Compared to NA-GIST, A-GIST were more often asymptomatic with a lower risk of recurrence. The main cause of death in NAGIST was GIST itself, being associated tumors the main cause of death in A-GIST group. No differences were found in DFS and OS between A-GIST and NA-GIST. CONCLUSIONS: The use of the proposed classification classifies GIST patients with associated malignancies in different subtypes that differ substantially in terms of incidence, type of neoplasms associated, cause of the association and prognosis.

Utility of 18F-FDG-PET/CT in patients suspected of paraneoplastic neurological syndrome: importance of risk classification.

PURPOSE: To assess the diagnostic impact of 18F-FDG-PET/CT in patients suspected of paraneoplastic neurological syndrome (PNS) based on our own pre-test risk classification (PRC). METHODS: A multicenter retrospective longitudinal study was conducted from 2006 to 2014. We designed a seven-point scoring system using the clinical syndrome characteristics [classical (CS) and non-classical syndromes (NCS)] and its location (central, peripheral, in the neuromuscular junction or combined), onconeural antibodies and tumor markers. Patients were classified as low (score 0-2), intermediate (3-4) and high (5-7) pre-test risk of PNS. FDG-PET/CT was classified as negative or positive. Final diagnosis according Graus' criteria (definite, possible or no PNS) was established. Relations between clinical and metabolic variables with the final diagnosis were studied. RESULTS: 73 patients were included, with a follow-up time of 33 months. Eleven (15 %) patients were finally diagnosed with neoplasm (8 invasive cancers). Ultimately, 13 (18 %) and 24 (33 %) subjects were diagnosed as definite or possible PNS. All the patients with final diagnosis of neoplasm had a CS (p = 0.005). PET/CT was helpful to diagnose 6/8 (75 %) invasive cancers. PET/CT findings were associated with the final diagnosis of neoplasm (p = 0.003) and the diagnosis of PNS attending to Graus' criteria (p = 0.019). PRC showed significant association with the final diagnosis of neoplasm and PET/CT results. A majority of patients (10/11) diagnosed of neoplasm had intermediate/high-risk. CONCLUSIONS: Our PRC seems to be a valid tool to select candidates for PET/CT imaging in this setting. PET/CT detected malignancy in a significant proportion of patients with invasive cancer.

[Comparison of glycemic control in diabetic patients with and without metabolic syndrome]. / Comparación del control glucémico en pacientes diabéticos con y sin síndrome metabólico.

OBJECTIVE: To compare the glycemic level patients with type 2 diabetes (T2DM) with and without Metabolic syndrome (MS). METHODOLOGY: cross sectional study. Included patients randomly DM2 corroborated in your clinical record. The SM was identified in patients with at least 3 of 5 criteria of ATP III (Adult Treatment Panel III). A questionnaire was structured. Hemoglobin was determined (HbA1c), HDL-cholesterol, triglycerides, hypertension (HBP), body mass index (BMI), waist circumference (WC) and hip (NCC). RESULTS: 283 patients were included. Mean age was 59.8 ± 10.6. The predominant sex was female (73.6%). SM Criteria were : low HDL: 62.9%; hypertriglyceridemia: 56.3%; obesity abdominal (OA) 90.1%, hypertension (HBP): 62.5%. The prevalence of MS was 86.6% (95% CI 83% to 89%). There was significant difference in mean HbA1c level in patients with and without MS, HAS, OR, and low HDL. In contrast, subjects with hypertriglyceridemia had an HbA1c level significantly higher than those without hypertriglyceridemia (8.9% 2.3 vs 8.5% 2.1, respectively, P = 0.01). HbA1c is positively correlated with triglycerides (r = 0.24, p = 0.001), and negatively with weight (r = -0.19, p = 0.001), BMI (r = -0172, p = 0.004), CCI (r = -0.12, P = 0.004) and CCA (r = -0.14, p = 0.02). In adjusted multivariate analysis, only the duration of diabetes was associated with glycemic level (OR = 1.014, 95% in 1.010 to 1.016). CONCLUSIONS: We not found differences significant glycemic level in patients with and without MS.

Objetivo: Comparar el nivel glucémico en pacientes con diabetes tipo 2 (DM2) con y sin síndrome metabólico (SM). Metodología: Estudio transversal analítico. Se incluyeron aleatoriamente pacientes con DM2 corroborado en su expediente clínico. El SM se identificó en pacientes con al menos 3 de 5 criterios del ATP III (AdultTreatment Panel III). Se aplicó un cuestionario estructurado. Se determinó hemoglobina glucosilada (HbA1c), colesterol-HDL, triglicéridos, hipertensión arterial sistémica (HAS), índice de masa corporal (IMC), circunferencia de cintura (CCi) y cadera (CCa). Plan de análisis: prevalencia, prueba t de Student, correlación de Pearson y regresión logística. Resultados: Se incluyeron 283 pacientes. Edad promedio: 59.8±10.6 años. Predominó el sexo femenino (73.6%)Criterios cubiertos para SM: hipocolesterolemia-HDL: 62.9%; hipertrigliceridemia: 56.3%; obesidad abdominal (OA) 90.1%; hipertensión arterial sistémica (HAS): 62.5%. La prevalencia de SM fue 86.6% (IC95% 83% a 89%). No hubo diferencia significativa en el promedio de HbA1c en pacientes con y sin SM, HAS, OA, e hipocolesterolemia-HDL. En cambio, sujetos con hipertrigliceridemia tuvieron un promedio significativamente mayor de HbA1c que aquellos sin hipertrigliceridemia (8.9±2.3 vs 8.5±2.1, respectivamente; p=0.01). HbA1c correlacionó positivamente con trigliceridemia (r=0.24, p=0.001), y negativamente con el peso (r= -0.19, p=0.001), IMC (r= -0.172, p=0.004), CCi (r= -0.12, p=0.004) y CCa (r=-0.14, p=0.02). En el análisis multivariado ajustado, solamente la duración de la diabetes se asoció con el nivel glucémico (OR= 1.014, IC95% 1.010 a 1.016). Conclusiones: No encontramos diferencias significativas en el nivel glucémico en pacientes con y sin SM.

Comparación del control glucémico en pacientes diabéticos con y sin síndrome metabólico. / [Comparison of glycemic control in diabetic patients with and without metabolic syndrome].

OBJECTIVE: To compare the glycemic level patients with type 2 diabetes (T2DM) with and without Metabolic syndrome (MS). METHODOLOGY: cross sectional study. Included patients randomly DM2 corroborated in your clinical record. The SM was identified in patients with at least 3 of 5 criteria of ATP III (Adult Treatment Panel III). A questionnaire was structured. Hemoglobin was determined (HbA1c), HDL-cholesterol, triglycerides, hypertension (HBP), body mass index (BMI), waist circumference (WC) and hip (NCC). RESULTS: 283 patients were included. Mean age was 59.8 ± 10.6. The predominant sex was female (73.6

). SM Criteria were : low HDL: 62.9

; hypertriglyceridemia: 56.3

; obesity abdominal (OA) 90.1

, hypertension (HBP): 62.5

. The prevalence of MS was 86.6

(95

CI 83

to 89

). There was significant difference in mean HbA1c level in patients with and without MS, HAS, OR, and low HDL. In contrast, subjects with hypertriglyceridemia had an HbA1c level significantly higher than those without hypertriglyceridemia (8.9

2.3 vs 8.5

2.1, respectively, P = 0.01). HbA1c is positively correlated with triglycerides (r = 0.24, p = 0.001), and negatively with weight (r = -0.19, p = 0.001), BMI (r = -0172, p = 0.004), CCI (r = -0.12, P = 0.004) and CCA (r = -0.14, p = 0.02). In adjusted multivariate analysis, only the duration of diabetes was associated with glycemic level (OR = 1.014, 95

in 1.010 to 1.016). CONCLUSIONS: We not found differences significant glycemic level in patients with and without MS.

Comparación del control glucémico en pacientes diabéticos con y sin síndrome metabólico / [Comparison of glycemic control in diabetic patients with and without metabolic syndrome].

OBJECTIVE: To compare the glycemic level patients with type 2 diabetes (T2DM) with and without Metabolic syndrome (MS). METHODOLOGY: cross sectional study. Included patients randomly DM2 corroborated in your clinical record. The SM was identified in patients with at least 3 of 5 criteria of ATP III (Adult Treatment Panel III). A questionnaire was structured. Hemoglobin was determined (HbA1c), HDL-cholesterol, triglycerides, hypertension (HBP), body mass index (BMI), waist circumference (WC) and hip (NCC). RESULTS: 283 patients were included. Mean age was 59.8 ± 10.6. The predominant sex was female (73.6

. The prevalence of MS was 86.6

). There was significant difference in mean HbA1c level in patients with and without MS, HAS, OR, and low HDL. In contrast, subjects with hypertriglyceridemia had an HbA1c level significantly higher than those without hypertriglyceridemia (8.9

2.1, respectively, P = 0.01). HbA1c is positively correlated with triglycerides (r = 0.24, p = 0.001), and negatively with weight (r = -0.19, p = 0.001), BMI (r = -0172, p = 0.004), CCI (r = -0.12, P = 0.004) and CCA (r = -0.14, p = 0.02). In adjusted multivariate analysis, only the duration of diabetes was associated with glycemic level (OR = 1.014, 95

in 1.010 to 1.016). CONCLUSIONS: We not found differences significant glycemic level in patients with and without MS.

Water relationships in Phyllantus orbicularis and Punica granatum antiviral extracts and their influence on stability after freezing and freeze-drying.

The effect of freezing, freeze-drying and storage on inhibitory half dose (ID(50)) and on cytotoxic concentration (CC(50)) of Phyllantus orbicularis and Punica granatum extracts was studied. Selective index SI=(CC(50) /ID(50)) was considered as the antiviral criterion. Both frozen and freeze-dried extracts were analyzed by differential scanning calorimetry (DSC). The values of vitreous transition temperatures of P. granatum (Tg' and Tg) were lower than those of P. orbicularis. Sorption isotherms of freeze-dried products showed a typical sigmoidal shape, where GAB model was fitted instead of bet model. Water adsorption in freeze-dried P. prbicularis extract was higher than in the case of P. granatum. No significant changes in SI were induced by freezing or freeze-drying after a 6 months storage at -20 degrees c, but in the case of P. granatum extract, the effectiveness was highly affected after exposure to 37 degrees c or higher.

A multicenter, randomized, double-blind clinical trial examining the effect of oral human recombinant epidermal growth factor on the healing of duodenal ulcers.

BACKGROUND: Our aim was to study the efficacy of oral human recombinant epidermal growth factor (EGF) in the treatment of duodenal ulcers, on the basis of its repairing actions in the gastrointestinal tract. METHODS: A placebo-controlled, multicenter, randomized, and double-blind study was conducted. Treatment groups were A) placebo solution, B) 10 microg/ml of human recombinant (hr)-EGF, and C) 50 microg/ml of hr-EGF, three times daily during 6 weeks. Patients, 15-65 years old, with a duodenal ulcer >4 mm, who gave their written informed consent to participate were eligible. Exclusion criteria were gastric ulcer and more than one duodenal ulcer, ulcer-related complications, and previous treatment with oral EGF or other specific anti-ulcer drugs in the previous 2 weeks. The main outcome variable was ulcer healing, evaluated by endoscopy after the 2nd, 4th, and 6th week. RESULTS: One hundred and three patients were included. The groups were comparable with regard to age, sex, toxic habits, antecedents of ulcerous disease, initial size and depth or the ulcer, initial symptoms, and positivity for Helicobacter pylori. The ulcers were healed in a larger proportion of patients treated with hr-EGF at the highest dose (70.6% in group C versus 40.0% and 35.3% in placebo and low-dose groups, respectively (P = 0.007)). The difference was significant from week 4 on. Groups A and B did not differ. Eighty-eight percent of group C patients were cured or improved versus 57% and 56% in groups A and B, respectively. No adverse reactions were reported. CONCLUSIONS: Oral hr-EGF was effective in the treatment of duodenal ulcer at a 50-microg/ml dose every 8 h but not at 10 microg/ml.

Evaluación clínica y manométrica anorrectal en niños con anomalías del sacro y de la médula espinal / Clinical and anorrectal manometric evaluation in children with sacral and spinal cord anomalies

En pacientes con anomalías sacras y de la médula espinal(ASME)es difícil identificar características manométricas propias.Por este motivo fueron estudiados clínica y manométricamente 25 niños con esta patologías,con edades comprendidas entre 1 y 14 años.En 9 estos defectos se presentan en forma aislada,mientrasque en 16 estaban asociados a malformaciones anorrectales(MAR)Fueron evaluados los siguientes parámetros:1)Presión de reposo anal(PRA)2)Contracción voluntaria del esfínter externo(CEE)3)Reflejo recto-esfinteriano(RRE)4)curva de presión simple(CPS) y 5)Curva de presión potencializada(CPP)La continencia fecal estuvo relacionada con la forma y los niveles de presión alcanzados en las CPS y CPP.Con respecto a los valores de PRA y CEE los pacientes continentes mostraron niveles de presión más altos.Se concluye que en los niños con ASME los parámetros manométricos anorrectales varían de un paciente a otro con patologías similares.En términos de continencia fecal,estos parámetros pueden predecir la posibilidad de continencia fecal antes de alcanzar la edad del control voluntario defecatorio

Evaluación clínica y manométrica anorrectal en niños con anomalías del sacro y de la médula espinal / Clinical and anorrectal manometric evaluation in children with sacral and spinal cord anomalies

En pacientes con anomalías sacras y de la médula espinal(ASME)es difícil identificar características manométricas propias.Por este motivo fueron estudiados clínica y manométricamente 25 niños con esta patologías,con edades comprendidas entre 1 y 14 años.En 9 estos defectos se presentan en forma aislada,mientrasque en 16 estaban asociados a malformaciones anorrectales(MAR)Fueron evaluados los siguientes parámetros:1)Presión de reposo anal(PRA)2)Contracción voluntaria del esfínter externo(CEE)3)Reflejo recto-esfinteriano(RRE)4)curva de presión simple(CPS) y 5)Curva de presión potencializada(CPP)La continencia fecal estuvo relacionada con la forma y los niveles de presión alcanzados en las CPS y CPP.Con respecto a los valores de PRA y CEE los pacientes continentes mostraron niveles de presión más altos.Se concluye que en los niños con ASME los parámetros manométricos anorrectales varían de un paciente a otro con patologías similares.En términos de continencia fecal,estos parámetros pueden predecir la posibilidad de continencia fecal antes de alcanzar la edad del control voluntario defecatorio

Surgical treatment of lung metastases of head and neck tumors.

BACKGROUND: Head and neck tumors often spread to the lungs, with a variety of presentations. The ideal treatment for those patients is still controversial. Resection of lung metastases was shown to significantly influence overall survival of patients. OBJECTIVE: To evaluate results of surgical resection of lung nodules in patients with head and neck primary tumors. METHODS: A retrospective analysis was made of 53 patients with head and neck tumors and lung nodules (no other metastases detected in other organs) admitted to our department. They were separated into two groups: OPER (thoracotomy, n = 26), and NOTOPER (no thoracotomies, n = 27). Overall survival was compared (Kaplan-Meier, log-rank) between groups. RESULTS: Overall median survival of all patients was 10 months, of OPER 20 months, and of NOTOPER 6 months (P <0.0001). Complete resection (n = 19) of lung metastases was associated with the greatest survival rate (median 23 months). Patients submitted to incomplete resection (n = 7) had a median survival of 16 months, compared with 7 months for patients who received only chemotherapy (n = 7) and 4 months for patients (n = 20) with no treatment (P <0.0001). CONCLUSION: Resection of lung metastases offers a significant survival benefit for patients with head and neck primary tumors, when compared with the current chemotherapeutic regimens. It should be considered for all patients clinically fit and who present with no extrapulmonary disease.

[Post-traumatic diaphragmatic hernia. Report of a pediatric case]. / Hernia diafragmática post-traumática. Reporte de un caso pediátrico.

A case of traumatic rupture of the diaphragm in a seven year-old child is presented. The pathogenesis, clinical signs and symptoms, as well as diagnosis and treatment are discussed.

Mitochondrial DNA analysis of Sporothrix schenckii in Costa Rica.

Mitochondrial DNA (mtDNA) types using restriction patterns with HaeIII were investigated in 21 clinical isolates of Sporothrix schenckii in Costa Rica. Nineteen isolates were found to be a new mtDNA type (Type 14), while the remaining two were Type 3 and Type 6. Based on the phylogeny of 14 mtDNA types constructed by estimating sequence divergences of mtDNA, S. schenckii were clustered into two main groups: Group A and Group B, with Type 14 and Type 3 included in Group A, and Type 6 in Group B. The results suggest that isolates of Group A may exist mainly in Central America including Costa Rica.

[Thyroid nodule. Study of 88 cases]. / Nódulo tiroideo. Estudio de 88 casos.

We present a prospective study of 88 patients with thyroid nodules seen in our institution in 1985-86 and the results of a 5 year follow up. The algorithm for resolution among different therapeutic options was established in regard to the clinical characteristics, imaging and particularly the histopathologic studies. Their age ranged from 18 to 79 years; 94% of the patients were females. Most of the nodules were solid (69%) and measured 1-4 cm in diameter. The image of 62% of the thyroid scans was of a non-functioning nodule and 13% were hyperfunctioning. In 80% the ultrasonographic pattern was solid or mixed. Surgery was undertaken in 19 patients (21%). In 58%, a diagnosis of malignancy was established. The biopsy (aspiration and tru-cut) suggested the presence of the malignant tumors when taken together in 90% of the cases. Hormonal treatment was given to 62 patients; in 40-45% of them there was a significant reduction in the size of the nodule. Aspiration and sclerosis of cystic nodules were performed in 19 patients with significant shrinkage in 82%. Radioactive iodine was used in 11 patients. Our algorithm reduces costs and precludes unnecessary morbidity in patients with thyroid nodules.

[Endoscopic management of biliary lithiasis]. / Manejo endoscópico de la litiasis biliar.

The management of bile duct stones is one of the most important contributions of therapeutic endoscopy. It is considered the elective method to treat cholecystectomized patients with recurrent or residual stones as well as those that have high surgical risk, choledocholithiasis and intact gallbladder. Discussion must yet come to terms with those patients that have low surgical risk. Patients with severe biliary pancreatitis have better outcome when they are treated endoscopically, making the procedure an alternative therapeutic approach. Stones are usually removed with balloons or dormia baskets. When the stones can not be extracted or there is a giant stone, endobiliary prostheses or nasobiliary catheters can be used. Materials and techniques are described in this paper.

Subunits of tetrameric α-amylase inhibitors of Hordeum chilense are encoded by genes located in chromosomes 4H(ch) and 7H (ch.).

Three proteins (components 1, 2, and 4) of the non-prolamin, 70% ethanol soluble fraction from the endosperm of Hordeum chilense have been identified as putative subunits of the tetrameric inhibitors active against insect α-amylases. In experiments carried out with the synthetic alloploid Tritordeum (H. chilense x Triticum turgidum conv. durum), previously described proteins from T. turgidum, designated CM2, CM3 and CM 16, have been also identified as subunits of α-amylase inhibitors. Genes for components 1 and 4 of H. chilense have been located in chromosomes 4H(ch) and 7H(ch), based on the analysis of H. chilense-T.turgidum addition lines. Subunits of the inhibitors from wheat and from cultivated barley had been previously assigned to chromosomes of the same homoeology groups.

Chromosomal location of structural genes controlling isozymes in Hordeum chilense : 1. 6-Phosphogluconate dehydrogenase and malate dehydrogenase.

A study of 6-phosphogluconate dehydrogenase and malate dehydrogenase isozyme expression in Triticum turgidum conv. durum /Hordeum chilense monosomic addition lines has revealed the location of two structural genes, 6-pgd-H (ch) 2 and Mdh-H (ch) 1, on chromosome 1H(ch) of H. chilense. The homoeology between 1H(ch) and other chromosome of Triticeae related species is discussed on the basis of isozyme gene analysis.