Laparoscopic Appendectomy in the Setting of Clinical Prediction Rules.

PURPOSE: Acute appendicitis (AA) is the most frequent surgical entity in the emergency department, but its correct diagnosis remains challenging. To improve diagnosis, clinical prediction rules (CPRs) have been created to establish objective scores for the probability of suffering AA. In this study, we establish scores indicating whether laparoscopy would be superior to clinical observation or repeat diagnostic test. METHODS: A retrospective observational study was conducted with 433 patients submitted to surgery for suspected AA using a laparoscopic approach. The Alvarado, Raja Isteri Pengiran Anak Saleha Appendicitis, appendicitis inflammatory response, and adult appendicitis score scales were applied in each case to establish a high, medium, or low probability of suffering AA. RESULTS: Of the 433 patients analyzed, 381 (88.0%) had AA. Twelve (2.8%) were converted to open surgery, and complications were observed in 54 (12.5%) cases. The CPRs studied showed statistically significant differences between AA and negative appendectomies. However, in patients with intermediate probability scores, the diagnostic accuracy of the CPRs evaluated was not adequate. CONCLUSIONS: Laparoscopic surgery can serve as a diagnostic tool for patients with intermediate AA probability scores because of its low associated morbidity and mortality and because it affords a direct diagnosis of the problem, allowing determination of the appropriate treatment.

Imaging of ß-amyloid plaques by near infrared fluorescent tracers: a new frontier for chemical neuroscience.

Brain amyloid depositions are the main hallmarks of Alzheimer's and other protein misfolding diseases. Since they are believed to precede clinical symptoms by several years, imaging of such fibrillar aggregates is particularly suitable to diagnose the onset of the disease in its early stage and monitor its progression. In this context, near infrared (NIR) imaging has been proposed as a promising and non-invasive method to visualize amyloid plaques in vivo because of its acceptable depth of penetration and minimal degree of tissue damage. In this tutorial review, we describe the main chemical and physicochemical features of probes associated with fluorescence emission in the NIR region. The review focuses on the recent progress and improvements in the development of small-molecule NIR fluorescent probes and their in vivo application in living animals. In addition, the possible therapeutic application of NIR probes to block the pathological aggregation process will be discussed, raising the fascinating possibility of their exploitation as theranostic agents.

Caracterización de pacientes con síndrome cerebral perdedor de sal en afecciones en neurológicas graves / Characterization of patients presenting with salt wasting cerebral syndrome in severe neurologic affections

Introducción: La hiponatremia es un problema común y grave en la medicina clínica. Objetivo: caracterizar a los pacientes con síndrome cerebral perdedor de sal en la evolución y pronóstico de las afecciones neurológicas graves y su relación con la evolución neurológica. Métodos: se realizó un estudio observacional, analítico, longitudinal y prospectivo con un universo de 114 pacientes. Resultados: se presentó el síndrome cerebral perdedor de sal en 23 de los 114 casos para un 20,2 por ciento de pacientes afectados. Se encontró mayor incidencia en la hemorragia subaracnoidea (55,6 por ciento), tumores (36,4 por ciento) y la hemorragia intraparenquimatosa (17,6 por ciento). De los 56 pacientes con una evolución neurológica desfavorable, 16 presentaban el síndrome (28,5 por ciento) y hubo mayor porcentaje de fallecidos entre los que lo tenían (23,1 por ciento versus 17,7 por ciento que no lo tenían). La mortalidad no mostró diferencias significativas en cuanto al número total de fallecidos. Conclusiones: el síndrome cerebral perdedor de sal presenta una alta incidencia en pacientes con afecciones neurológicas agudas, asociándose más frecuentemente la hemorragia subaracnoidea, los tumores intracraneales y la enfermedad cerebrovascular isquémica. Tiene relación con la evolución neurológica y es más probable padecerlo cuando esta es desfavorable

Introduction: hyponatremia is common and severe problem in clinical medicine. Objective: to characterize the patients presenting with salt wasting cerebral syndrome in the evolution and prognosis of severe neurological lesions and its relation to the neurologic course. Methods: a prospective, longitudinal, analytical and observational study was conducted in 114 patients. Results: the salt losing cerebral syndrome was present in 23 of the 114 cases for a 20.2 percent of patients involved. There was a great incidence in subarachnoid hemorrhage (55.6 percent), tumors (36.4 percent) and the intra-parenchymatous hemorrhage (17.6 percent). From the 56 patients with a unfavourable, 16 had the above mentioned syndrome (28.5 percent) and there was a greater percentage of deceased among those with it (23.1 percent vs. 17.7 percent without it). Mortality not showed significant differences as regards the total figure of deceased. Conclusions: the salt wasting cerebral syndrome has a high incidence in patients with acute neurological affections, with a more frequent association with subarachnoid hemorrhage, the intracranial tumors and the ischemic cerebrovascular disease. It has relation to the neurologic evolution and it is more probable its suffering when it is unfavourable

Caracterización de pacientes con síndrome cerebral perdedor de sal en afecciones en neurológicas graves / Characterization of patients presenting with salt wasting cerebral syndrome in severe neurologic affections

Introducción: La hiponatremia es un problema común y grave en la medicina clínica. Objetivo: caracterizar a los pacientes con síndrome cerebral perdedor de sal en la evolución y pronóstico de las afecciones neurológicas graves y su relación con la evolución neurológica. Métodos: se realizó un estudio observacional, analítico, longitudinal y prospectivo con un universo de 114 pacientes. Resultados: se presentó el síndrome cerebral perdedor de sal en 23 de los 114 casos para un 20,2 por ciento de pacientes afectados. Se encontró mayor incidencia en la hemorragia subaracnoidea (55,6 por ciento), tumores (36,4 por ciento) y la hemorragia intraparenquimatosa (17,6 por ciento). De los 56 pacientes con una evolución neurológica desfavorable, 16 presentaban el síndrome (28,5 por ciento) y hubo mayor porcentaje de fallecidos entre los que lo tenían (23,1 por ciento versus 17,7 por ciento que no lo tenían). La mortalidad no mostró diferencias significativas en cuanto al número total de fallecidos. Conclusiones: el síndrome cerebral perdedor de sal presenta una alta incidencia en pacientes con afecciones neurológicas agudas, asociándose más frecuentemente la hemorragia subaracnoidea, los tumores intracraneales y la enfermedad cerebrovascular isquémica. Tiene relación con la evolución neurológica y es más probable padecerlo cuando esta es desfavorable(AU)

Introduction: hyponatremia is common and severe problem in clinical medicine. Objective: to characterize the patients presenting with salt wasting cerebral syndrome in the evolution and prognosis of severe neurological lesions and its relation to the neurologic course. Methods: a prospective, longitudinal, analytical and observational study was conducted in 114 patients. Results: the salt losing cerebral syndrome was present in 23 of the 114 cases for a 20.2 percent of patients involved. There was a great incidence in subarachnoid hemorrhage (55.6 percent), tumors (36.4 percent) and the intra-parenchymatous hemorrhage (17.6 percent). From the 56 patients with a unfavourable, 16 had the above mentioned syndrome (28.5 percent) and there was a greater percentage of deceased among those with it (23.1 percent vs. 17.7 percent without it). Mortality not showed significant differences as regards the total figure of deceased. Conclusions: the salt wasting cerebral syndrome has a high incidence in patients with acute neurological affections, with a more frequent association with subarachnoid hemorrhage, the intracranial tumors and the ischemic cerebrovascular disease. It has relation to the neurologic evolution and it is more probable its suffering when it is unfavourable(AU)

Liquid chromatographic analysis of the anticancer alkaloid luotonin A and some new derivatives in human serum samples.

The quantitation of the natural cytotoxic and anti-inflammatory alkaloid luotonin A and five recently synthesized derivatives is described, constituting the first report of a HPLC method for the analysis of these compounds in human serum samples. The conditions for the chromatographic separation were optimized and the method was validated for the analysis of these compounds in biological samples according to international guidelines. An RP-HPLC method with fluorimetric detection and a C(18) stationary phase was applied. Different ACN/water mobile phases were assayed, including 0-4% of a mobile phase modifier such as tetrahydrofuran, dioxane or tert-butyl methyl ether. Isocratic and gradient elution conditions are compared. The influence of pH on the efficiency and resolution of the separation was also considered. The developed method was applied to the determination of luotonins in pooled human serum samples by gradient elution RP-HPLC using a simple cleanup procedure. The proposed chromatographic method exhibits satisfactory analytical figures of merit, with LOD from 1.0 x 10(-10) to 2.0 x 10(-10) M, intraday and interday precision below 6% except for the concentration level closest to LOD, and good agreement between experimental and theoretical concentrations. Therefore, the developed method is suitable, reliable, rapid, and simple.