Prevalence of active infection by herpes simplex virus type 2 in patients with high-risk human papillomavirus infection: A cross-sectional study.

The aim is to determine the prevalence of active infection by herpes simplex virus type 2 (HSV-2) among Mexican women with high-risk human papillomavirus (HR-HPV) cervical infection, recruited from public gynecology and colposcopy services. In a cross-sectional study, HSV-2 antibodies, HSV-2 DNA, and HR-HPV DNA were quantified. Significant differences in HSV-2 seroprevalence and HSV-2 active infection rates were found between negative and positive HR-HPV cases. HSV-2 seroprevalence was 28.15% and 16.1% (P = .0001), while HSV-2 active infection rates were 6.83% and 0.62% (P = .001) for positive and negative HR-HPV groups, respectively. The risk of HSV-2 seropositivity was 1.7 times greater for HR-HPV-positive cases (P = .02). Similarly, HR-HPV-positive cases were nine times more likely to have an HSV-2 active infection than HR-HPV-negative cases (P = .03). High HSV-2/h-HPV coinfection rates were observed among women recruited from public gynecology and colposcopy services. The main factors related to an HSV-2 active infection are a history of risky sexual behavior and HR-HPV infection. The prevalence of HSV-2 active infection among positive HR-HPV subjects indicate that these infections constitute an important group of STIs in Mexico.

Age protects from harmful effects produced by chronic intermittent hypoxia.

Obstructive sleep apnoea (OSA) affects an estimated 3­7% of the adult population, the frequency doubling at ages >60­65 years. As it evolves, OSA becomes frequently associated with cardiovascular, metabolic and neuropsychiatric pathologies defining OSA syndrome (OSAS). Exposing experimental animals to chronic intermittent hypoxia (CIH) can be used as a model of the recurrent hypoxic and O2 desaturation patterns observed in OSA patients. CIH is an important OSA event triggering associated pathologies; CIH induces carotid body (CB)-driven exaggerated sympathetic tone and overproduction of reactive oxygen species, related to the pathogenic mechanisms of associated pathologies observed in OSAS. Aiming to discover why OSAS is clinically less conspicuous in aged patients, the present study compares CIH effects in young (3­4 months) and aged (22­24 months) rats. To define potential distinctive patterns of these pathogenic mechanisms, mean arterial blood pressure as the final CIH outcome was measured. In young rats, CIH augmented CB sensory responses to hypoxia, decreased hypoxic ventilation and augmented sympathetic activity (plasma catecholamine levels and renal artery content and synthesis rate). An increased brainstem integration of CB sensory input as a trigger of sympathetic activity is suggested. CIH also caused an oxidative status decreasing aconitase/fumarase ratio and superoxide dismutase activity. In aged animals, CIH minimally affected CB responses, ventilation and sympathetic-related parameters leaving redox status unaltered. In young animals, CIH caused hypertension and in aged animals, whose baseline blood pressure was augmented, CIH did not augment it further. Plausible mechanisms of the differences and potential significance of these findings for the diagnosis and therapy of OSAS are discussed.

Experimental Observations on the Biological Significance of Hydrogen Sulfide in Carotid Body Chemoreception.

The cascade of transduction of hypoxia and hypercapnia, the natural stimuli to chemoreceptor cells, is incompletely understood. A particular gap in that knowledge is the role played by second messengers, or in a most ample term, of modulators. A recently described modulator of chemoreceptor cell responses is the gaseous transmitter hydrogen sulfide, which has been proposed as a specific activator of the hypoxic responses in the carotid body, both at the level of the chemoreceptor cell response or at the level of the global output of the organ. Since sulfide behaves in this regard as cAMP, we explored the possibility that sulfide effects were mediated by the more classical messenger. Data indicate that exogenous and endogenous sulfide inhibits adenyl cyclase finding additionally that inhibition of adenylyl cyclase does not modify chemoreceptor cell responses elicited by sulfide. We have also observed that transient receptor potential cation channels A1 (TRPA1) are not regulated by sulfide in chemoreceptor cells.

The Carotid Body Does Not Mediate the Acute Ventilatory Effects of Leptin.

Leptin is a hormone produced mostly in adipose tissue and playing a key role in the control of feeding and energy expenditure aiming to maintain a balance between food intake and metabolic activity. In recent years, it has been described that leptin might also contributes to control ventilation as the administration of the hormone reverses the hypoxia and hypercapnia commonly encountered in ob/ob mice which show absence of the functional hormone. In addition, it has been shown that the carotid body (CB) of the rat expresses leptin as well as the functional leptin-B receptor. Therefore, the possibility exists that the ventilatory effects of leptin are mediated by the CB chemoreceptors. In the experiments described below we confirm the stimulatory effect of leptin on ventilation, finding additionally that the CB does not mediate the instant to instant control of ventilation.

Bloqueo de los nervios periféricos a nivel de la muñeca guiado por ecografía para el tratamiento de la hiperhidrosis idiopática palmar con toxina botulínica / Ultrasound-guided peripheral nerve block at wrist level for the treatment of idiopathic palmar hyperhidrosis with botulinum toxin

Objetivo. Evaluación del dolor y el grado de satisfacción en pacientes sometidos a bloqueo regional periférico guiado por ultrasonidos para el tratamiento de la hiperhidrosis palmar idiopática con toxina botulínica. Pacientes y métodos. Estudio descriptivo, observacional, de pacientes con hiperhidrosis palmar tratados con toxina botulínica A, a los que se les realizó un bloqueo regional periférico guiado por ecografía de los nervios mediano y cubital con 3 ml de mepivacaína al 1% en cada uno. El bloqueo del nervio radial se llevó a cabo con infiltración en abanico a nivel de la tabaquera anatómica. Tras establecer el bloqueo, el dermatólogo realizó un mapeo e inyectó alrededor de 100 UI de toxina botulínica distribuidas en toda la palma de la mano. Fueron evaluados el dolor experimentado en la inyección de toxina botulínica mediante la escala verbal numérica (de 0 a 10), el grado de satisfacción con la técnica anestésica y las posibles complicaciones postanestésicas. Resultados. Se incluyeron 40 pacientes, 11 hombres y 29 mujeres. La intensidad del dolor evaluado con la escala numérica verbal fue de 1,03 (desviación típica 1,37). Ninguno de los pacientes presentó un valor superior a 5. El grado de satisfacción de los pacientes con la técnica anestésica fue muy bueno para el 85% de los pacientes, y bueno para el 7,5%. No hubo complicaciones derivadas del procedimiento anestésico. Conclusiones. El bloqueo de los troncos nerviosos distales guiado por ultrasonidos puede ser una técnica sencilla, eficaz y segura para los pacientes sometidos a inyección palmar de toxina botulínica. La intensidad del dolor fue muy baja y proporcionó un grado de satisfacción muy bueno en la mayoría de los pacientes (AU)

ObjectiveEvaluation of pain and degree of satisfaction in patients undergoing ultrasound-assisted peripheral regional block for the treatment of idiopathic palmar hyperhidrosis with botulinum toxin.Patients and methodsA descriptive, observational study of patients with palmar hyperhidrosis treated with botulinum toxin A, who underwent ultrasound-guided peripheral regional block of the median and ulnar nerves with 3 ml of mepivacaine 1% in each one. The radial nerve block was injected in the anatomical snuffbox. After establishing blocking, the dermatologist performed a mapping and injected around 100 IU of botulinum toxin across the whole palm. The pain experienced during the injection of botulinum toxin was evaluated by verbal numerical scale (from 0 to 10), along with the degree of satisfaction with the anesthetic technique, and the post-anesthetic complications.ResultsA total of 40 patients were enrolled in the study, 11 men and 29 women with no significant differences. The pain intensity assessed with verbal numerical scale was 1.03 (standard deviation of 1.37). No patients had a value greater than 5. The degree of patient satisfaction with the anesthetic technique was very good for 85% of the patients, and good for 7.5%. There were no complications related to type of anesthesia.ConclusionsThe ultrasound-assisted peripheral regional block could be a simple, effective and safe technique for patients undergoing palmar injection of botulinum toxin. Pain intensity was very low, and it provided a very good level of satisfaction in most patients (AU)

[Ultrasound-guided peripheral nerve block at wrist level for the treatment of idiopathic palmar hyperhidrosis with botulinum toxin]. / Bloqueo de los nervios periféricos a nivel de la muñeca guiado por ecografía para el tratamiento de la hiperhidrosis idiopática palmar con toxina botulínica.

OBJECTIVE: Evaluation of pain and degree of satisfaction in patients undergoing ultrasound-assisted peripheral regional block for the treatment of idiopathic palmar hyperhidrosis with botulinum toxin. PATIENTS AND METHODS: A descriptive, observational study of patients with palmar hyperhidrosis treated with botulinum toxin A, who underwent ultrasound-guided peripheral regional block of the median and ulnar nerves with 3 ml of mepivacaine 1% in each one. The radial nerve block was injected in the anatomical snuffbox. After establishing blocking, the dermatologist performed a mapping and injected around 100 IU of botulinum toxin across the whole palm. The pain experienced during the injection of botulinum toxin was evaluated by verbal numerical scale (from 0 to 10), along with the degree of satisfaction with the anesthetic technique, and the post-anesthetic complications. RESULTS: A total of 40 patients were enrolled in the study, 11 men and 29 women with no significant differences. The pain intensity assessed with verbal numerical scale was 1.03 (standard deviation of 1.37). No patients had a value greater than 5. The degree of patient satisfaction with the anesthetic technique was very good for 85% of the patients, and good for 7.5%. There were no complications related to type of anesthesia. CONCLUSIONS: The ultrasound-assisted peripheral regional block could be a simple, effective and safe technique for patients undergoing palmar injection of botulinum toxin. Pain intensity was very low, and it provided a very good level of satisfaction in most patients.

Molecular Mechanism and Potential Targets for Blocking HPV-Induced Lesion Development.

Persistent infection with high-risk HPV is the etiologic agent associated with the development of cervical cancer (CC) development. However, environmental, social, epidemiological, genetic, and host factors may have a joint influence on the risk of disease progression. Cervical lesions caused by HPV infection can be removed naturally by the host immune response and only a small percentage may progress to cancer; thus, the immune response is essential for the control of precursor lesions and CC. We present a review of recent research on the molecular mechanisms that allow HPV-infected cells to evade immune surveillance and potential targets of molecular therapy to inhibit tumor immune escape.

Carotid body function and ventilatory responses in intermittent hypoxia. Evidence for anomalous brainstem integration of arterial chemoreceptor input.

Obstructive sleep apnea is a frequent medical condition consisting in repetitive sleep-related episodes of upper airways obstruction and concurrent events of arterial blood hypoxia. There is a frequent association of cardiovascular diseases and other pathologies to this condition conforming the obstructive sleep apnea syndrome (OSAS). Laboratory models of OSAS consist in animals exposed to repetitive episodes of intermittent hypoxia (IH) which also develop cardiovascular pathologies, mostly hypertension. The overall OSAS pathophysiology appears to be linked to the repetitive hypoxia, which would cause a sensitization of carotid body (CB) chemoreflex and chemoreflex-driven hyperreactivity of the sympathetic nervous system. However, this proposal is uncertain because hyperventilation, reflecting the CB sensitization, and increased plasma CA levels, reflecting sympathetic hyperreactivity, are not constant findings in patients with OSAS and IH animals. Aiming to solve these uncertainties we have studied the entire CB chemoreflex arch in a rat model of IH, including activity of chemoreceptor cells and CB generated afferent activity to brainstem. The efferent activity was measured as ventilation in normoxia, hypoxia, and hypercapnia. Norepinephrine turnover in renal artery sympathetic endings was also assessed. Findings indicate a sensitization of the CB function to hypoxia evidenced by exaggerated chemoreceptor cell and CB afferent activity. Yet, IH rats exhibited marked hypoventilation in all studied conditions and increased turnover of norepinephrine in sympathetic endings. We conclude that IH produces a bias in the integration of the input arising from the CB with a diminished drive of ventilation and an exaggerated activation of brainstem sympathetic neurons.

Effects of cigarette smoke and hypoxia on pulmonary circulation in the guinea pig.

Cigarette smoke (CS) and chronic hypoxia (CH) can produce pulmonary hypertension. Similarities and differences between both exposures and their interaction have not been explored. The aim of the present study was to investigate the effects of CS and CH, as single factors or in combination, on the pulmonary circulation in the guinea pig. 51 guinea pigs were exposed to CS for 12 weeks and 32 were sham-exposed. 50% of the animals in each group were additionally exposed to CH for the final 2 weeks. We measured pulmonary artery pressure (P(pa)), and the weight ratio between the right ventricle (RV) and left ventricle plus the septum. Pulmonary artery contractility in response to noradrenaline (NA), endothelium-dependent vasodilatation and distensibility were evaluated in organ bath chambers. The number of small intrapulmonary vessels showing immunoreactivity to smooth muscle (SM) α-actin and double elastic laminas was assessed microscopically. CS and CH induced similar increases of P(pa) and RV hypertrophy (p<0.05 for both), effects that were further enhanced when both factors were combined. CH increased the contractility to NA (p<0.01) and reduced the distensibility (p<0.05) of pulmonary arteries. Animals exposed to CS showed an increased number of small vessels with positive immunoreactivity to SM α-actin (p<0.01) and those exposed to CH a greater proportion of vessels with double elastic laminas (p<0.05). We conclude that CH amplifies the detrimental effects of CS on the pulmonary circulation by altering the mechanical properties of pulmonary arteries and enhancing the remodelling of pulmonary arterioles.

HPV 16 E2 protein induces apoptosis in human and murine HPV 16 transformed epithelial cells and has antitumoral effects in vivo.

OBJECTIVE: Our aims were to examine the ability of the human papillomaviruse (HPV) 16 E2 protein to induce apoptosis in a murine HPV-transformed cell line, and to evaluate its antitumor properties on HPV-associated tumors in vivo in immunocompetent mice. METHODS: HPV-transformed murine BMK-16/myc cells and human SiHa cells were transfected with the HPV 16 E2 gene to examine the effects of the E2 protein on cell growth and on the E6 and E7 oncogenes as well as DNA fragmentation and activation of the extrinsic pathway of apoptosis. Finally, to test the antitumor effect of the E2 protein on an experimental mouse tumor model, we generated a recombinant adenovirus expressing the E2 protein. RESULTS: The E2 protein inhibited the growth of SiHa and BMK-16/myc cell lines, and repressed the E6 and E7 oncogenes. Moreover, the E2 protein induced DNA fragmentation and apoptosis through activation of caspases 8 and 3 in BMK-16/myc cells. On the other hand, E2 also showed antitumor effects in vivo. CONCLUSIONS: Our findings indicate that E2 exerts pro-apoptotic activity in a murine HPV-transformed cell line as well as an antitumor effect in vivo.

[Interobserver correlation in the interpretation of 99mTc-sestamibi SPECT in reperfused acute myocardial infarction]. / Correlación interobservadores en interpretación de SPECT de perfusión con 99mTc-sestamibi en infarto agudo de miocardio reperfundido.

INTRODUCTION AND OBJECTIVES: The correct interpretation of myocardial perfusion single photon emission computed tomography (SPECT) requires knowledge of the technique reproducibility. The objective was analyze the interobserver correlation of different experience in the interpretation of myocardial perfusion SPECT in patients following acute myocardial infarction (AMI) in order to improve the quality of our site. METHODS: Sixty cases (56 +/- 11 years, 87 % men) with transmural AMI who had recently undergone successful thrombolysis were included. Resting perfusion with (99m)Tc-sestamibi was performed at one week post-AMI. ANALYSIS: Semiquantitative interpretation using 17 segment-model by 2 independent specialists and 5 observers, was performed blindly. Left ventricular ejection fraction (LVEF) was measured with isotopic ventriculography one month after AMI, with a mean of 38 %. RESULTS: Using independent and then agreed on perfusion analysis, average involved segments/patient was 9.3 +/- 4 and the sum of severity 25 +/- 13. Readings of other observers ranged from 7 +/- 3.7 to 9.4 +/- 3.9 and 16.7 +/- 9.7 to 24.6 +/- 13, respectively, consistent with the reading of the specialists of between 0.779-0.871 (kappa: 0.565-0.741). There was no significant difference when the number of segments were analyzed in 40 % of the cases and for intensity in 60 % of them in more experienced observers. Correlation with consensus reading for the number of segments ranged from 0.84 to 0.94 and for severity from 0.79 to 0.89. Identification of culprit arteries was acceptable, with r values between 0.612 and 0.683 and kappas between 0.629 and 0.656. Correlation of the number of involved segments and severity with LVEF performed one month after AMI was 0.73 and 0.74, respectively. CONCLUSIONS: There was good correlation in the interpretation of myocardial perfusion SPECT, with a significantly better fit in more experienced observers. This academic exercise was also helpful in improving our residents' skills in cardiology.

Correlación interobservadores en interpretación de SPECT de perfusión con 99mTc-sestamibi en infarto agudo de miocardio reperfundido / Interobserver correlation in the interpretation of 99mTc-sestamibi SPECT in reperfused acute myocardial infarction

Introducción y objetivos. La interpretación de la tomografía de emisión de fotón único (SPECT) de perfusión miocárdica requiere conocer la reproducibilidad de la técnica. El objetivo fue analizar la correlación interobservadores de distinta experiencia en interpretación de SPECT en pacientes post-infarto agudo de miocardio (IAM) en un contexto de mejora de la calidad de nuestros centros. Métodos. Se incluyeron 60 casos (56 ± 11 años, 87 % hombres) con infarto transmural reciente sometidos a trombolisis exitosa. Una semana después del IAM se efectuó perfusión de reposo con 99mTc-sestamibi. Análisis. Semicuantitativo mediante lectura ciega por 2 especialistas independientes y 5 observadores utilizando 17 segmentos. La fracción de eyección ventricular izquierda (FEVI) promedio medida con ventriculografía isotópica al mes fue del 38 %. Resultados. En análisis consensuado, el promedio de segmentos comprometidos/paciente fue 9,3 ± 4 y la sumatoria de severidad 25 ± 13; los otros observadores variaron entre: 7 ± 3,7-9,4 ± 3,9 y 16,7 ± 9,7-24,6 ± 13, respectivamente, concordando con los especialistas entre 0,779 y 0,871 (kappa: 0,565-0,741). No hubo diferencia significativa en el 40 % de los análisis para el número de segmentos comprometidos y en el 60 % para intensidad, en observadores con mayor experiencia. La correlación con consenso para el número de segmentos varió entre 0,84 y 0,94, y para severidad entre 0,79 y 0,89. La asignación de arterias fue adecuada (r: 0,612-0,683 y kappas 0,629-0,656). La correlación de segmentos comprometidos y su severidad con la FEVI efectuada al mes del IAM fueron de 0,73 y 0,74, respectivamente. Conclusiones. Existió buena correlación en interpretación de SPECT, con mejor ajuste en observadores experimentados. Este ejercicio sirvió para mejorar habilidades de interpretación en cardiología

Introduction and objectives. The correct interpretation of myocardial perfusion single photon emission computed tomography (SPECT) requires knowledge of the technique reproducibility. The objective was analyze the interobserver correlation of different experience in the interpretation of myocardial perfusion SPECT in patients following acute myocardial infarction (AMI) in order to improve the quality of our site. Methods. Sixty cases (56 ± 11 years, 87 % men) with transmural AMI who had recently undergone successful thrombolysis were included. Resting perfusion with 99mTc-sestamibi was performed at one week post-AMI. Analysis. Semiquantitative interpretation using 17 segment-model by 2 independent specialists and 5 observers, was performed blindly. Left ventricular ejection fraction (LVEF) was measured with isotopic ventriculography one month after AMI, with a mean of 38 %. Results. Using independent and then agreed on perfusion analysis, average involved segments/patient was 9.3 ± 4 and the sum of severity 25 ± 13. Readings of other observers ranged from 7 ± 3.7 to 9.4 ± 3.9 and 16.7 ± 9.7 to 24.6 ± 13, respectively, consistent with the reading of the specialists of between 0.779-0.871 (kappa: 0.565-0.741). There was no significant difference when the number of segments were analyzed in 40 % of the cases and for intensity in 60 % of them in more experienced observers. Correlation with consensus reading for the number of segments ranged from 0.84 to 0.94 and for severity from 0.79 to 0.89. Identification of culprit arteries was acceptable, with r values between 0.612 and 0.683 and kappas between 0.629 and 0.656. Correlation of the number of involved segments and severity with LVEF performed one month after AMI was 0.73 and 0.74, respectively. Conclusions. There was good correlation in the interpretation of myocardial perfusion SPECT, with a significantly better fit in more experienced observers. This academic exercise was also helpful in improving our residents' skills in cardiology

[Subhepatic abscess as a late complication of missed intraperitoneal gallstone after laparoscopic cholecystectomy]. / Absceso subhepático como complicación tardía de un cálculo intraperitoneal abandonado tras una colecistectomía laparoscópica.

Laparoscopic cholecystectomy is the treatment of choice in symptomatic cholelithiasis. Despite its many advantages over the conventional laparotomic approach, accidental perforation of the gallbladder with spilled stones and bile leakage is frequent during this procedure. Complications from missed gallstones are uncommon, although they can sometimes lead to severe consequences. Great effort must be made to achieve laparoscopic retrieval of all the gallstones missed into the peritoneal cavity and conversion to an open procedure should be used only in selected cases. We report a case of subhepatic abscess as a late complication of a missed gallstone during a previous laparoscopic cholecystectomy.

[Primary hepatic actinomycosis]. / Actinomicosis hepática primaria.

Primary hepatic actinomycosis is a rare infection that can clinically be confused with hepatic pyogenous abscesses or neoproliferative processes. We present the case of a 71-year-old man who had previously undergone total gastrectomy for gastric adenocarcinoma. After 4 years of favorable clinical course he presented a space-occupying lesion in the right hepatic lobe. Diagnostic tests were nonspecific and the diagnosis was confirmed by histological study of a biopsy of the lesion obtained through laparotomy. Prolonged antibiotic treatment produced a complete response. The etiopathogenesis and diagnostic-therapeutic options of hepatic actinomycosis are reviewed.

Rotura espontánea de la vena ilíaca / Spontaneous iliac vein rupture

Se presenta el caso de un paciente varón intervenido quirúrgicamente por shock hipovolémico secundario a una rotura espontánea de la vena ilíaca común izquierda, tratado con ligadura de la vena. La rotura espontánea de la vena ilíaca es una rara urgencia vascular de etiología incierta, con frecuencia confundida con un sangrado arterial intraabdominal. Se realiza una revisión de los casos descritos en la literatura, comentando las formas más frecuentes de presentación, posibles mecanismos desencadenantes y manejo perioperatorio. Las medidas intensivas de estabilización y un tratamiento quirúrgico urgente son fundamentales para poder reducir la elevada mortalidad de esta causa infrecuente de hemorragia exanguinante (AU)

Splenic and adrenal lymphangiomatosis.

Lymphangiomatosis is a rare syndrome that can affect different organs, although simultaneous splenic and adrenal involvement is exceptional. We report the case of a young female with a symptomatic massive splenomegaly and no-nhypersecreating bilateral adrenal masses incidentally discovered that represented a diagnostic challenge. The management of adrenal incidentalomas is controversial, as the presence of large sized bilateral masses are highly indicative of malignancy. Despite the different diagnostic techniques available, it is sometimes impossible to reach an accurate preoperative diagnosis. Elective splenectomy and left adrenalectomy were performed, preserving the functioning of the right adrenal gland, radiologically similar to the left one, to prevent the development of definitive adrenal insufficiency. Postoperative evolution has been favourable without initial increase of the size of the right adrenal lesion. However, the persistence of this mass obligated long-term follow-up and shall assist us in better understanding the behavior of this bening lesion.

[Evaluation of lercanidipine in the general practice setting]. / Evaluación del lercanidipino en Atención Primaria: seguridad y eficacia. Resultados de estudio LAPSE.

OBJECTIVE: To determine the efficacy and tolerability of a long-acting dihydropyridine in the clinical settings of general practice. MATERIAL AND METHODS: 110 essential hypertensives were included (age 62.3 +/- 10.8 years, 51 men and 53 women, 38/ obese -IMC >30 kg/m2, ten diabetics). 104 patients ended the followup. Patients were treated with lercanidipine 10 mg once daily in the morning. Follow-up lasted 6 months. When blood pressure was not controlled (BP < 140/90 mmHg) in any visit, a second drug was added, excluding calcium channel blockers. Antiadrenergic drugs were recommended. If patients were not controlled ittwo consecutive visits they were excluded from follow-up. RESULTS: Significant reductions in both systolic (baseline 157.4 +/- 11.7 vs 131.1 +/- 6.8 mmHg, p < 0,001) and diastolic BP (baseline 94.7 +/- 5.8 vs 80.0 +/- 5.5 mmHg, p < 0,001) were attained at six months. Mean SBP decrease was 26.7 mmHg and mean DBP reduction was 15.6 mmHg. At the study end, 84.3/ of the patients achieved a BP < 140/90 mmHg. Thirty patients needed a second drug to become controlled (26 at the study end). The overall incidence of adverse effects was 4,4/ (n=6) and just three patients withdrew the treatment due to untoward effects. Plasmatic cholesterol lowered from 225.3 +/- 41.0 to 216.7 +/- 25.3 mg/dl (p = 0,03) and urate decreased from 5.6 +/- 1.6 to 5.1 +/- 1.4 mgldl, p = 0,03). CONCLUSIONS: Lercanidipine is a calcium channel blockers of high efficacy and low incidence of adverse effects in the clinical settings of general practice. It seems to have a positive metabolic effects on plasmatic levels of cholesterol and urate.

Evaluación del lercanidipino en Atención Primaria: seguridad y eficacia. Resultados del estudio LAPSE / Evaluation of lercanidipine in general practice setting

Objetivo: Evaluar la seguridad y eficacia de una calcioantagonista con escasos efectos secundarios en los estudios hospitalarios en el ambiente habitual de trabajo de Atención Primaria. Material y métodos: Se incluyeron 110 pacientes, de los cuales 104 terminaron el estudio. La edad media eran 62,3 ± 10,8 años, siendo 51 hombres y 53 mujeres. Un 38 por ciento de los pacientes eran obesos (IMC > 30 kg/m2) y 10 pacientes eran diabéticos. Los enfermos fueron tratados con lercanidipino a la dosis de 10 mg una vez al día por la mañana. Los enfermos fueron examinados física y analíticamente al principio del estudio y a los 45, 90 y 180 días. En el caso de que la PA no estuviera controlada se añadía un segundo agente no calcioantagonista (se recomendó un agente antiadrenérgico y se reevaluaba al paciente 30 días después, siendo excluido si no había mejorado su PA. Resultados: La PAS se redujo desde 157,4 ± 11,7 hasta 131,1 ± 6,8 mmHg (p < 0,001). La PAD mostró una reducción similar (de 94,7 ± 5,8 a 80,0 ± 5,5 mmHg, p < 0,001). EI descenso medio final fue de 26,7 mmHg en la PAS y 15,6 mmHg en la PAD. Un 84,3 por ciento de los enfermos presentaban ambos componentes de la PA controlados en la última visita. Treinta pacientes precisaron añadir un segundo fármaco en la primera visita, pero sólo 26 de ellos seguían necesitándolo al acabar el estudio. Un 4,4 por ciento de los pacientes presentaron efectos secundarios n = 6 y solamente 3 de ellos abandonaron el tratamiento por esta causa. Durante el seguimiento se demostró una reducción del colesterol total (225,3 ± 41,0 frente a 216,7 ± 25,3 mg/dl, p = 0,03) y urato séricos (5,6 ± 1,6 frente a 5,1 ± 1,4 mg/dl, p = 0,03). Conclusiones: El lercanidipino parece un calcioantagonista de gran eficacia y escasos efectos secundarios cuando se prueba en condiciones reales de utilización en Atención Primaria. Su neutralidad desde el punto de vista metabólico es un aspecto importante de sus benetlcios (AU)

Pharmacokinetics and tissue distribution of intravenous pefloxacin for antibiotic prophylaxis in biliary surgery.

The plasma levels and tissue penetration of pefloxacin were studied after prophylactic administration to patients undergoing elective biliary surgery. Pefloxacin was administered as a single dose of 800 mg given intravenously as an infusion 1 h before surgery. Over a period of two years, cultures of bile and stone were performed after cholecystectomy in order to find the main pathogens present in the geographical area of the hospital of Txagorritxu (Vitoria, Spain), as well as to test the antimicrobial susceptibility of these bacteria to pefloxacin. Thirty seven per cent of the bile and stone cultures were positive, and 75 different species were isolated. E. coli was the predominant microorganism (25%). Other frequent microorganisms were E. faecium (9.3%), S. epidermidis (6.6%) and Cl. perfringens (6.6%). Most species isolated were susceptible to pefloxacin, with MIC(90) values of 0.125 microg/ml for E. coli, 0.5 microg/ml for S. epidermidis and 1 microg/ml for Cl. perfringens. E. faecium was resistant, with a MIC(90) value of 8 microg/ml but a MIC(50) of 4 microg/ml (intermediate). After pefloxacin infusion, adequate drug plasma levels (>MIC(90)) for the most frequent pathogens were found throughout the procedure. Elimination half-life was estimated as 22.03+/-6.91 h; the area under the concentration-time curve from zero to infinite had a value of 275.07+/-130.02 mg h/l and the values for volume of distribution at steady-state and plasma clearance were 96.48+/-28.65 L and 3.60+/-1.83 l/h, respectively. Bile pefloxacin concentrations generally exceeded the minimum inhibitory concentrations for most relevant pathogens. Drug levels in gallbladder and subcutaneous tissues were also above the MIC(90) for extended periods. Patients were observed daily throughout their hospital stay. This included examination of the surgical wound and recording of body temperature. No cases of anaerobic infection were noted in the study patients. Other constants such as hospitalization stay and time of recuperation were normal for this type of surgery. According to these results, pefloxacin presents many features that make it suitable for use as a therapeutic prophylactic agent, such as its broad spectrum of antimicrobial activity and favorable pharmacokinetic properties.

Miofibroblastoma de mama en un paciente varón / Myofibroblastoma of the breast in a male patient

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