Mimetización de corona cerámica libre de metal de un incisivo central superior. Reporte de caso / Mimicry of metal-free ceramic crown of an upper central incisor. Case report

Actualmente, la estética dental presenta un papel relevante dentro de las relaciones interpersonales y la autoestima de los pacientes, es por eso que la demanda de tratamientos estéticos y conservadores son cada vez más frecuentes en la consulta dental, esta demanda compromete a los profesionales a una mayor preparación para identificar los procedimientos más adecuados a ejecutarse. Para el odontólogo es un reto conseguir una completa armonización e integración de los tratamientos efectuados en el sector anterior y más aún cuando se requiere reemplazar un único elemento dentario. El presente reporte de caso tiene por objetivo describir un caso de rehabilitación de alta complejidad de un incisivo central superior fracturado, cuyas características de color y forma fueron recrea- das a través de un correcto intercambio de información entre el odontólogo y el técnico dental, obteniendo una corona de disilicato de litio con una excelente mimetización.

Nowadays, dental aesthetics has a relevant role within interpersonal relationships and the self-esteem of patients, that is the reason the demand for aesthetic and conservative treatments are more frequent in dental practice, this demand commits professionals to a greater preparation, in order to identify the most appropriate procedures to be executed. For the dentist it is a challenge to achieve a complete harmonization and integration of the treatments carried out in the anterior sector and even more when it is necessary to replace a single dental element. The objective of this case report is to describe a highly complex rehabilitation case of a fractured upper central incisor, whose color and shape characteristics were recreated through a correct exchange of information between the dentist and the dental technician, obtaining a lithium disilicate crown with excellent mimicry.

Caracterización clínico-epidemiológica de las enterocolitis necrosantes neonatales de siete hospitales públicos

Resumen Introducción: Enterocolitis necrosante (ECN) representa una elevada mortalidad y morbilidad post-quirúrgica, gastrointestinal y del neuro-desarrollo. Existe limitada información en Chile. Objetivo: Describir el comportamiento clínico/epidemiológico de recién nacidos que cursaron con ECN. Pacientes y Métodos: Estudio multicéntrico descriptivo de pacientes con ECN de siete hospitales de Santiago, Chile, durante el 2016. Se realizó estadística descriptiva y análisis univariable/multivariable (software SPSS v22). Resultados: Se recolectaron 75 casos. Mediana de edad al diagnóstico fue 11 días, el promedio de edad gestacional 29 semanas y peso de nacimiento 1.285 g. La incidencia fue 2,6 por 1.000/recién nacidos vivos y letalidad de 18,6%, mayor en ≤ 750 g, ≤ 25 semanas y ECN quirúrgica. Hubo aislamiento microbiológico en 45,3% y se utilizaron 19 distintos esquemas antimicrobianos empíricos para el tratamiento de ECN. El análisis multivariable mostró tendencia a que la ECN fuese quirúrgica en usuarios de catéter umbilical arterial, PCR > 10 mg/L y aislamiento microbiológico, y hubo tendencia a fallecer en usuarios de catéter umbilical arterial. Discusión: Es el primer estudio multicéntrico que recopila información de datos locales. La incidencia fue similar a la descrita en la literatura médica, en cambio la letalidad fue algo menor. No existen consensos del tratamiento antimicrobiano a utilizar. Con estos resultados esperamos avanzar en mejorar el diagnóstico y unificar tratamientos antimicrobianos, para reducir cifras de morbimortalidad.

Abstract Background: Necrotizing enterocolitis (NEC) presents high mortality and postoperative, gastrointestinal and neurodevelopmental morbidity. There is limited information about NEC in Chile. Aim: To describe the clinical/epidemiological behavior of newborns who underwent NEC. Methods: Multicenter descriptive study of patients with NEC from seven hospitals of Santiago, Chile, during 2016. Descriptive statistics and univariate/multivariate analysis were performed (SPSS v22 software). Results: 75 cases were collected. Median days of life at diagnosis was 11, gestational age was 29 weeks, birth weight 1,114 g. The incidence was 2.6 per 1,000 live newborns and mortality was 18.6%, higher in ≤ 750 g, ≤ 25 weeks and surgical NEC. There was 45.3% microbiological isolation and 19 different empirical antibiotic schemes were used for the treatment of NEC. The multivariate analysis showed a higher risk of surgery in umbilical arterial catheter users, CRP > 10 mg/L and positive microbiological isolation. The highest risk of death was in umbilical arterial catheter users. Discussion: This ie the first multicenter study that collects local data information. The incidence was similar to that found in medical reports but with a lower mortality. There is no consensus of antibiotic treatment to use. With these results we hope to advance in improving the diagnosis and unify antimicrobial treatments, to reduce morbidity and mortality figures.

[Clinical-epidemiological characterization of neonatal necrotizing enterocolitis of seven public hospitals]. / Caracterización clínico-epidemiológica de las enterocolitis necrosantes neonatales de siete hospitales públicos.

BACKGROUND: Necrotizing enterocolitis (NEC) presents high mortality and postoperative, gastrointestinal and neurodevelopmental morbidity. There is limited information about NEC in Chile. AIM: To describe the clinical/epidemiological behavior of newborns who underwent NEC. METHODS: Multicenter descriptive study of patients with NEC from seven hospitals of Santiago, Chile, during 2016. Descriptive statistics and univariate/multivariate analysis were performed (SPSS v22 software). RESULTS: 75 cases were collected. Median days of life at diagnosis was 11, gestational age was 29 weeks, birth weight 1,114 g. The incidence was 2.6 per 1,000 live newborns and mortality was 18.6%, higher in ≤ 750 g, ≤ 25 weeks and surgical NEC. There was 45.3% microbiological isolation and 19 different empirical antibiotic schemes were used for the treatment of NEC. The multivariate analysis showed a higher risk of surgery in umbilical arterial catheter users, CRP > 10 mg/L and positive microbiological isolation. The highest risk of death was in umbilical arterial catheter users. DISCUSSION: This ie the first multicenter study that collects local data information. The incidence was similar to that found in medical reports but with a lower mortality. There is no consensus of antibiotic treatment to use. With these results we hope to advance in improving the diagnosis and unify antimicrobial treatments, to reduce morbidity and mortality figures.

Single-cell sequencing unveils the lifestyle and CRISPR-based population history of Hydrotalea sp. in acid mine drainage.

Acid mine drainage (AMD) is characterized by an acid and metal-rich run-off that originates from mining systems. Despite having been studied for many decades, much remains unknown about the microbial community dynamics in AMD sites, especially during their early development, when the acidity is moderate. Here, we describe draft genome assemblies from single cells retrieved from an early-stage AMD sample. These cells belong to the genus Hydrotalea and are closely related to Hydrotalea flava. The phylogeny and average nucleotide identity analysis suggest that all single amplified genomes (SAGs) form two clades that may represent different strains. These cells have the genomic potential for denitrification, copper and other metal resistance. Two coexisting CRISPR-Cas loci were recovered across SAGs, and we observed heterogeneity in the population with regard to the spacer sequences, together with the loss of trailer-end spacers. Our results suggest that the genomes of Hydrotalea sp. strains studied here are adjusting to a quickly changing selective pressure at the microhabitat scale, and an important form of this selective pressure is infection by foreign DNA.

Evaluación de indicación de linfadenectomía en prostactectomía radical laroscópica según grupo de riesgo y capra -score / Evaluation of indication of lymphadenectomy in radical laparoscopy proststectomy risk gropu and capra-Score

Introducción. El beneficio de la linfadenectomía en el cáncer de próstata sigue siendo controversial. Es el único procedimiento que permite un estadiaje anatomopatológico más preciso. Antiguamente se indicaba en pacientes de riesgo intermedio o mayor. Actualmente utilizamos el Score de CAPRA sobre 2 para indicar el procedimiento con el fin de seleccionar de mejor manera los pacientes que se beneficiarían de este procedimiento. Objetivo. Analizar la utilidad de CAPRA-Score para indicar la linfadenectomía. Pacientes y Métodos. Estudio prospectivo de carácter descriptivo. De un universo de 155 Pacientes sometidos a prostatectomía radical laparoscópica entre 2003-2013 por un único cirujano, se analizaron 34 pacientes a los que se le realizó linfadenectomía . Los datos se recopilaron en el momento de la cirugía y controles postoperatorios. Se agruparon datos: edad, PSA, Estadio Clínico, Gleason y porcentaje de cilindros (+) en biopsia TR. Se agruparon según indicación por Riesgo o CAPRA-S y se compararon los resultados obtenidos en la histología de los ganglios extraídos (linfadenectomías +). Los datos se analizaron considerando p<0,05 estadísticamente significativo según prueba de T de Student. Resultados. Se incluyeron en total 34 pacientes. Hasta el año 2010 un total de 23 linfadenectomía indicadas a grupo de riesgo intermedio-alto, el 78 por ciento (18) indicado por Gleason. Se sacó en promedio 12 ganglios por paciente, 72 por ciento linfadenectomía ampliadas. Ningún paciente tuvo ganglios (+). Desde el año 2011 un total de 11 linfadenectomía por CAPRA-Score >2, sacándose promedio 15 ganglios, 9 fueron linfadenectomías ampliadas. Se obtuvo 18 por ciento linfadenectomías (+) para compromiso metastásico. Conclusiones. De los pacientes previo a CAPRA-Score, un 17 por ciento pacientes estarían sobreindicados según éste y coincide con la negatividad del resultado histológico. Hubo diferencia estadísticamente significativa en la aparición de ganglios (+) en pacientes que se aplicó CAPRA-Score. (P<0.05). Según la serie de pacientes presentados, CAPRA-Score seleccionaría mejor los pacientes que se beneficiarían con una linfadenectomía, sin embargo se requieren estudios de mayor cantidad de pacientes.AU

Introduction. The benefit of lymphadenectomy in prostate cancer remains controversial. It is the only procedure that allows a more accurate anatomopathological staging. It was formerly indicated in patients of intermediate or greater risk. We currently use the CAPRA Score of 2 to indicate the procedure in order to better select patients who would benefit from this procedure. Objective. Analyze the utility of CAPRAScore to indicate lymphadenectomy. Patients and Methods. Prospective descriptive study. From a universe of 155 patients who underwent laparoscopic radical prostatectomy between 2003 and 2013 by a single surgeon, 34 patients who underwent lymphadenectomy were analyzed. Data were collected at the time of surgery and postoperative controls. Data were grouped: age, PSA, Clinical Stage, Gleason and percentage of cylinders (+) in TR biopsy. They were grouped according to indication by Risk or CAPRA-S and the results obtained were compared in the histology of the extracted ganglia (lymphadenectomies +). Data were analyzed considering p <0.05 statistically significant according to Student's T test. Results. A total of 34 patients were included. Until the year 2010 a total of 23 lymphadenectomy Original Works indicated to group of intermediate-high risk, 78% (18) indicated by Gleason. An average of 12 lymph nodes per patient, 72% enlarged lymphadenectomy. No patient had lymph nodes (+). Since 2011 a total of 11 lymphadenectomy for CAPRAScore> 2, with a mean of 15 lymph nodes, 9 were enlarged lymphadenectomies. We obtained 18% lymphadenectomies (+) for metastatic compromise. Conclusions. Of the patients prior to CAPRA-Score, 17% patients would be over-reported according to this and coincides with the negativity of the histological result. There was a statistically significant difference in the appearance of lymph nodes (+) in patients who underwent CAPRA-Score. (P <0.05). According to the series of patients presented, CAPRAScore would better select patients who would benefit from lymphadenectomy, however, more studies are required.AU

Correlación del score de gleason en biopsia prostática con el de pieza operatoria. ¿Cuál es nuestro porcentaje de upgrading? / Correlation between Gleason Score of prostate biopsy and prostatectomy specimen. ¿How high is our upgrading rate?

Introducción. El cáncer de próstata es el segundo cáncer más prevalente del mundo y ocupa el quinto lugar en mortalidad en hombres. El score de Gleason es el factor pronósticos más importante. Sin embargo, numerosos estudios han reportado diferencias entre el score de Gleason de la biopsia prostática y el obtenido de la pieza operatoria. Es por este motivo que el objetivo del presente estudio, es evaluar la concordancia entre el score de Gleason de la biopsia prostática transrectal comparado con el de la pieza operatoria de la prostatectomia radical.(AU)

Introduction. Prostate cancer is the second most prevalent cancer in the world, and occupies the fifth place in mortality among men. Gleason score (GS) is the most important prognostic factor. However, a number of studies have reported differences between the GS of the trans rectal biopsy and the prostatectomy specimen. That is the reason of the this study, our objective is to evaluate concordance between Gleason scores, of the biopsy and the prostatectomy specimen.(AU)

[Predictive score of success adapted to our environment to improve results of extracorporeal lithotripsy]. / Sistema predictivo de éxito adaptado a nuestro medio para mejorar los resultados de la Litotricia Extracorpórea.

OBJECTIVE: To present a predictive tool of success of ESWL adapted to our environment. METHODS: We performed a retrospective, descriptive and analytical study of patients with renal and upper ureteral stones whom underwent ESWL with DUET MAGNA lithotripter between January 2014 and March 2015. We included 114 patients in whom demographics and CT scan characteristics were studied. Multivariate analysis by logistic regression was performed to establish independent predictors of success in ESWL. A ROC curve was used to determine success cut-off values of ESWL in each significant variable. The score was established based on the numbers of variables under the cut-off value in each patient. In every one of these categories, percentage of stone free was determined. Finally, the area under the curve of our ESWL treatment success score was made. RESULTS: Of 114 patients studied, 58 (51%) were stone free. After multivariate study, independent predictors of success with ESWL were tomographic density of lithiasis (UH), body mass index (BMI) and stone diameter (mm). Ideal cut off points of treatment success in each one of the score parameters were: density of lithiasis 900 UH, BMI 27 and lithiasis diameter 11 mm. Percentage of stone free was 31.8% for score 0, 37.1% for score 1, 57.5% for score 2 and 88.3% for score 3. Area under the curve for the score was 0.723 (p<0.001). CONCLUSIONS: This score could represent a predictive tool in our environment to predict ESWL results. Utilization of this score could limit the use of this therapy only to patients with favorable profile (score2-3) improving in this way cost-effectiveness of this procedure.

Niño quemado gran secuelado: perfil clínico y calidad de vida / Severe burns in children: clinical profile and quality of life

Las secuelas de quemaduras extendidas son causa de grandes complicaciones tanto a nivel físico como psicosocial en niños y adolescentes. Objetivo: Caracterización de la población con más de 2e por ciento de piel con secuelas por quemadura en Corporación de Ayuda al Niño Quemado, midiendo y comparando su calidad de vida según bienestar físico, bienestar psicológico, relación con los padres y autonomía, apoyo social y pares, ambiente escolar. Método: Se evalúa a través de cuestionario KIDSCREEN-27 a 29 niños de entre 8 a 18 años de edad, habiendo recibido rehabilitación integral, los que son comparados con resultados de niños sanos. Resultados. Dentro del grupo estudiado no hubo diferencias significativas entre género, edad, residencia, aunque si las hubo en cuanto a visibilidad de cicatrices. En el caso de comparación con muestra de población general sana, se evidenciaron diferencias de calidad de vida a favor de niños con quemaduras extendidas.

Introduction: The aftermath of extensive burns cause great complications both physical and psychosocial in children and adolescents. Objective: Characterization of the population over 25 percent of skin with aftermath burn in Assistance Corporation Burned Children, by measuring and comparing their quality of life by physical well, psychological, relationship with parents and autonomy, social support and peers, school environment. Methods: We evaluated through KIDSCREEN-27-29 children aged 8-18 years old having received comprehensive rehabilitation, the results being compared with healthy children. Results. Within the study group no significant differences between gender, age, residence, even if any in terms of visibility of scars. In the case of comparison with general population sample of healthy, were differences in quality of life for children with extensive burns.

Use of PCR-DHPLC with fluorescence detection for the characterization of the bacterial diversity during cassava (Manihot esculenta Crantz) fermentation.

Denaturing high-performance liquid chromatography (DHPLC) has been described as a suitable method to study DNA polymorphisms. Here, cassava (Manihot esculenta Crantz) fermentation liquor was examined using DHPLC analysis to characterize the bacterial diversity during the fermentation process. GC-clamped amplicons corresponding to a variable region of the bacterial community 16S rDNA were synthesized using polymerase chain reaction (PCR) and then resolved on a base-composition basis using preparative DHPLC. Eluate fractions were collected at random and used as a source of whole community DNA that could be used to determine the bacterial diversity. As a first approach, GC-clamps were removed from the eluted DNA fragments using PCR to avoid the possible bias these clamps could cause during the construction of clone libraries. As a second approach, a clone library of each eluate sample was constructed, preserving the GC-clamps of the DNA fragments. The first approach generated 132 bacterial rDNA sequences with an average size of 200 bp, 45% of which had similarity to unculturable or non-classified bacteria. The second approach produced 194 sequences identified as Proteobacteria (48%), uncultured or non-classified environmental bacteria (40%) and Firmicutes (12%). We detected a remarkably greater bacterial diversity using the first approach than the second approach. The DHPLC-PCR method allowed for the fast and non-laborious detection of a vast bacterial diversity that was associated with cassava fermentation, and we conclude that it is a promising alternative for the characterization of the overall microbial diversity in complex samples.

Niño quemado gran secuelado. Perfil clínico y calidad de vida / Child burned great aftermath. Clinical profile and quality of life

Burns are an important cause of morbidity in children. The medical advances in acute trauma care have led to an increase in the number of children with extense area of burned skin, whose sequelaes are cause of complications along their growth. Objective. To characterize population with over 25% of sequelae burn skin at the COANIQUEM Rehabilitation Center, Santiago. Additionally to measure their quality of life and suggest interventions to improve medical attention. Methods. Quantitative, non experimental, descriptive, comparative study. Results. A sample of 59 children were identified as having post-traumatic burned on more than 25% of total body surface. 47% of them were men and 53% female. Most them (64%) were patients who lived outside the capital city, Santiago. 54% was burned during the ages between to 2 to 6 years old. 42% was burned with fire and 56% by scalding. Half the patients were admitted to rehabilitation before 2 month after injury. 64% has good adherence to treatment and a regular follow-up. A group of 29 KIDSCREEN-27 survey was analyzed. There were no significant differences between gender, age, residence or visibility scars. Conclusions. Epidemiology found in children with severe burn sequelae is consistent with findings from literature. Quality of life outcomes are similar to general population. The concept of pediatric major burn sequela is established for future research in this area. (AU)

Evaluación de efecto vasoprotector del consumo de curcumina en ratas macho Sprague-Dawley con dieta hipercolesterolémica / Evaluation of the curcumin vasoprotective effect in Sprague-Dawley male rats with a hypercholesterolemic diet

INTRODUCCIÓN: El hígado graso no alcohólico puede abarcar desde una simple esteatosis hasta una cirrosis hepática. Los mecanismos fisiopatológicos que modulan el estrés oxidativo, la actividad inflamatoria y profibrótica, deberían ser cruciales en su mayor o menor agresividad hepática y vascular. Un compuesto derivado de la Cúrcuma longa L, la curcumina, poseería propiedades vasoprotectoras. OBJETIVO: Comparar en situaciones de dieta hipercolesterolémica los cambios vasculares entre ratas macho Sprague Dawley que consumen curcumina y las que no consumen. MATERIAL Y MÉTODO: Estudio analítico, experimental, longitudinal y prospectivo en ratas macho Sprague-Dawley expuestas a condiciones de hígado graso no alcohólico e hígado graso no alcohólico adicionando curcumina, durante 4 meses. Sacrificadas, se realizó protocolo de función vascular en arteria mesentérica superior aislada (respuesta a acetilcolina, N nitro-L-arginina metil éster y nitroprusiato) y medición de presión portal por punción directa. Los resultados fueron expresados en promedios junto a la desviación estándar de la media. Lasdiferencias entre los grupos fueron probadas mediante t de Studenty test de Mann-Whitney. RESULTADOS: La medición de presión portal no mostró diferencias significativas entre ambos grupos. No hubo diferencias significativas en las pruebas con Nnitro-L-arginina metil éster ni nitroprusiato; diferencia que sí existió con acetilcolina entre la dilatación de la arteria mesentérica superior de hígado graso no alcohólico y las de hígado graso no alcohólico más curcumina. DISCUSIÓN: La curcumina mejoró la respuesta vasodilatadora a acetilcolina, lo que sugiere que el posible efecto antioxidante sería mejorando la función endotelial. Se sugiere su futuro uso terapéutico.

INTRODUCTION: Nonalcoholic fatty liver disease can range from simple steatosis to cirrhosis. The pathophysiological mechanisms that modulate oxidative stress, inflammatory and profibrotic activity should be crucial in the liver injury and vascular aggressiveness. Curcumin, a compound derived from Curcuma longa L, possesses vasoprotectives properties. OBJECTIVE: To compare in hypercholesterolemic diet situations the vascular changes between Sprague-Dawley male rats who consume curcumin and who do not consume. MATERIAL AND METHOD: Analytical, experimental, prospective and longitudinal study in Sprague-Dawley male rats exposed to conditions of Nonalcoholic fatty liver with and without curcumin, for four months. After the sacrifice, a vascular function protocol was performed on an isolated superior mesenteric artery (response to acetylcholine, L-NGNitroarginine Methyl Ester and nitroprusside) and measurement of portal pressure by direct puncture. The results were expressed as average and the standard deviation of the central tendency. The differences between the groups were tested using Student's t-test and Mann-Whitney test. RESULTS: The portal pressure measurement showed no significant differences between groups. There was no significant difference in the nitroprusside test, in the other hand, exist a difference with acetylcholine between arteries of nonalcoholic fatty liver group against nonalcoholic fatty liver plus curcumin group. DISCUSSION: Curcumin improved the vasodilator response in response to acetylcholine, suggesting a possible antioxidant effect which improves endothelial function. It is suggested for future therapeutic use.

Expresion de la proteína P504S en las células prostáticas en la circulación sanguínea (CPCS) en pacientes con cáncer prostático y el efecto de la supresión adrogénica: estudio inmunocitoquímico / Circulating prostate cells(CPCS)in patient with prostate cancer express P504S and androgen blockage effect: an immunocytochemical based study

Determinar la presencia de CPCS en pacientes con cáncer prostático, la expresión de p504 S yel efecto de la supresión androgénica. Pacientes, materiales y método: en muestras de sangre venosa de 92 pacientes portadores de cáncer a la prostáta se separaron las células mononucleares por centrifugación diferencial. Las cpcs fueron identificadas utilizando anticuerpos monoclonales contra APE y P504S. Muestras de sangre de 10 mujeres fueron usadas como controles. Resultados: En ninguna de las muestras utilizadas como control y en el 68 por ciento de los hombres estudiados se detectaron CPCS. Todas las células detectadas fueron positivas para la expresión de P504S. Los pacientes con supresión androgénica, DES o después de una orquidectomía, tuvieron un nivel de P504S promedio menor que aquellos sin terapia sistémica p menor que 0,03. Conclusiones: la detección de CPCS P504S positivas en biopsias de prostáta es utilizada para el diagnóstico de cáncer, las celulas benignas no expresan este antígeno. Este estudio pionero demuestra que la expresión de P504S en CPCS es menor eb hombres con tratamiento hormonal sistémico.

Objective To determine the effect of androgen blockage on the expression of P504S en circulating prostate cells (CPCs) in men with prostate cancer. Patients, material and method: mononuclear cells were separated from venous blood using differential centrifugation and identification fied using monoclonal antibodies against PSA and P504S. 10 women were used as controls and 92 men with prostate cancer formesd the study group. Results: 64,8 percent of men were positive for CPCs, all the CPCs detected expressed the antigen P504S. No controls were positive. Conclusions. The detection of P504S postive cells in prostate biopsies is used to determine whether they are malignant or not, benign cells P504S negative. This is pioner study to show that CPCs are P504S positive, with the implication that they are malignant cells.

El uso de la detección de células prostáticas en la circulación sanguínea podría disminuir el número de biopsias prostáticas necesarias para detectar cáncer prostático / Detection of circulating prostate cells could avoid prostate biopsies

Introducción: El uso del antígeno prostático específico como pesquisa para cáncer prostático ha significado según algunos estudios una disminución en la mortalidad y un cambio hacia las etapas más precoces. Pero, implica también que aproximadamente70 por ciento de los hombres con un APE elevado tendrán una biopsia negativa para cáncer, asumiéndose los riesgos de hemorragia e infección del procedimiento. Presentamos un estudio sobre la detección de células prostáticas en la circulación sanguínea como examen complementario y los resultados de la biopsia prostática. Método y pacientes: A hombres que cumplían con los criterios para someterse a una biopsia prostática, se les tomó una muestra de sangre. Las células mononucleares fueron separadas usando centrifugación diferencial y las células prostáticas detectadas usando anticuerpos monoclonales contra el APE y identificadas con inmunocitoquímica. Los resultados de la presencia o ausencia de las CPCs fueron comparados con los resultados de la biopsia. La biopsia fue dirigida por ecografía y tomada siguiendo la norma estándar en sextante. Resultados: Participaron 358 hombres, de éstos, 91 pacientes cumplieron con los criterios para una biopsia, de los cuales 86 se les tomó una biopsia. La ausencia de CPCs fue asociada con una biopsia negativa en 94,7 por ciento (54/57) y hubo CPCs detectadas en 24/27 (89 por ciento) de los casos con una biopsia positiva para cáncer. En 3 casos biopsia positiva CPC negativa el cáncer fue de bajo grado y localizado. Hubo una sensibilidad de 91,5 por ciento y una especificad de 89,0 por ciento. Conclusiones: Hombres negativo para CPCs tienen una alta posibilidad de una biopsia prostática negativa (94,7 por ciento), en estos hombres es posible postergar la biopsia con un monitoreo cuidadoso del APE sérico. Evitando biopsias no necesarias disminuirán los riesgos asociados al paciente sin aumentar los riesgos de no detectar un cáncer agresivo.

Introduction: The widespread use of PSA screening for prostate cancer has decreased mortality and increased early stage detection. However, approximately 70 percent of biopsies will be negative in men with an increased PSA, incurring in the associated risks of haemorrhage and infection. We report the use of circulating prostate cells (CPCs) as a complementary test and compare the results with the associated prostate biopsy. Patients and Methods: Men fulfilling biopsy criteria had a blood sample taken, the mononuclear cells were separated using differential centrifugation and detected using monoclonal antibodies against PSA and identified using monoclonal antibodies against PSA and identified using immunocytochemistry. Standard ultrasound guided sextant biopsy was used. The presence or absence of CPCs was compared with prostate biopsy results. Results: Of 358 men participating in the study 91 fulfilled biopsy criteria of which 86underwent biopsy. The absence of CPCs was seen in 94.7 percent of cases (54/57) with a negative biopsy. In the 3 remaining cases the CPC negative patient had a low grade local cancer. Overall there was a sensitivity of 91.5 percent and specificity of 89.0 percent. Conclusions: Men with negative CPC have a high probability of a negative biopsy, in these patients the biopsy could be deferred with close monitoring of PSA levels, thus avoiding biopsy complications. This would avoid unnecessary risks without jeopardizing early stage cancer detection.

ARHGAP4 is a novel RhoGAP that mediates inhibition of cell motility and axon outgrowth.

This report examines the structure and function of ARHGAP4, a novel RhoGAP whose structural features make it ideally suited to regulate the cytoskeletal dynamics that control cell motility and axon outgrowth. Our studies show that ARHGAP4 inhibits the migration of NIH/3T3 cells and the outgrowth of hippocampal axons. ARHGAP4 contains an N-terminal FCH domain, a central GTPase activating (GAP) domain and a C-terminal SH3 domain. Our structure/function analyses show that the FCH domain appears to be important for spatially localizing ARHGAP4 to the leading edges of migrating NIH/3T3 cells and to axon growth cones. Our analyses also show that the GAP domain and C-terminus are necessary for ARHGAP4-mediated inhibition of cell and axon motility. These observations suggest that ARHGAP4 can act as a potent inhibitor of cell and axon motility when it is localized to the leading edge of motile cells and axons.

Nefrectomía radical laparoscópica en el tratamiento del carcinoma de células renales: análisis de los primeros 50 casos / Laparoscopic radical nephrectomy for renal cell carcinoma: report of 50 cases

Introducción: Desde que Clayman describió la primera nefrectomía laparoscópica a principios de los noventa se han publicado numerosos reportes señalando los beneficios de esta técnica mínimamente invasiva sobre la nefrectomía radical abierta. Se presenta el análisis de la experiencia personal en los primeros 50 casos. Material y Método: Entre Julio de 2001 y Agosto de 2004, se realizaron 50 Nefrectomías radicales laparoscópicas (NRL) en 13 mujeres y 37 hombres, de las cuales 35 fueron totalmente laparoscópicas y 15 fueron con asistencia manual. La edad promedio fue de 61,4 años (Rango 40-78 años). Se realizaron 24 NRL del lado derecho y 26 NRL del lado izquierdo, todas por vía transperitoneal. En las NRL mano asistidas se realizó una incisión en fosa iliaca izquierda o derecha según el caso, sin utilización de ningún dispositivo adicional. Resultados: El tiempo operatorio promedio fue de 143 minutos con un rango de 45 a 300 min. El sangrado operatorio promedio fue de 176 ml. (Rango 20-2000 ml.) Cuatro pacientes (8 por ciento) requirieron transfusiones sanguíneas. Hubo tres (6 por ciento) complicaciones mayores. El tiempo de hospitalización promedio fue de 2,7 días. Hubo una (2 por ciento) conversión. Conclusión: La NRL es una técnica quirúrgica mínimamente invasiva, reproducible y segura. Presenta menor morbilidad, tiempo de hospitalización y requerimientos analgésicos que la Nefrectomía radical convencional, con similares resultados oncológicos. Esta serie presenta los resultados preliminares necesitando mayor seguimiento para evaluar resultados oncológicos a largo plazo.

Cáncer de pene: revisión de casuística junio de 1995 a junio de 2002 / Penis cancer: stadistics between june of 1995 and june of 2002

Se realizó un estudio retrospectivo en los últimos 7 años, período comprendido entre junio de 1995 y junio de 2002, donde analizamos los pacientes que se presentaron en nuestro servicio con cáncer de pene, evaluando edad promedio de presentación, tipo histológico más frecuente, relación con patologías pre-malignas, presencia de adenopatías al momento del diagnóstico de la lesión primaria, la evolución y presencia de adenopatías durante el seguimiento y su conducta terapéutica. La edad promedio de 57,7 años teniendo en cuenta que más de la mitad de los casos (61,1 porciento) se presentaron en el grupo etario comprendido entre los 51 y 70 años de edad. Se realizaron 12 (67 porciento) penectomías parciales y 6 (33 porciento)penectomías totales. La histología reveló en todos los casos Carcinoma Epidermoide. En 3 casos (16 por ciento), se asoció con H.P.V. y en 1 caso (5 por ciento) con Balanitis Xerótica Obliterante. Tres pacientes presentaron adenopatías al momento del diagnóstico de la lesión peneana y por lo que, tras persistir las mismas pese al tratamiento ATB, se realizó linfadenectomía inguinal bilateral en 2 casos. Las complicaciones posteriores a las linfadenectomías, en orden decreciente de frecuencia fueron linforrea en 6 casos (85,4 por ciento), infección de la herida en 4 casos (57,1 por ciento), edemas de MMII en 3 casos (42,8 porciento) y necrosis de la piel en 2 casos (28,5 porciento. En resumen, de los 18 pacientes que fueron evaluados en este estudio, 9 pacientes (50 por ciento) en la actualidad se encuentran bajo control, de los cuales 8 (44,5 por ciento) se encuentran libre de enfermedad, mmientras que el paciente restante (5,5 por ciento) presenta enfermedad avanzada. Encontramos que la edad promedio, el tipo histológico más frecuente y la concurrencia de cáncer de pene y fimosis, coincide con los datos de la bibliografía mundial. Con respecto a los pacientes sin adenopatías en el momento de la presentación del cáncer, nuestra conducta es el control periódico de los mismos, sin la realización de linfadenectomías, hasta la aparición de ganglios sospechosos, ya que consideramos que la frecuencia de las complicaciones luego de la gran disección ganglionar es alta (30-50 porciento)sin haber informes fehacientes que indiquen una reducción evidente en las tasas de supervivencia a los 5 años.

Distinctive cyclic AMP-dependent protein kinase subunit localization is associated with cyst formation and loss of tubulogenic capacity in Madin-Darby canine kidney cell clones.

Polycystic kidney disease is characterized by abnormal morphological development. Mechanisms that regulate cyst development may involve multiple signaling pathways. Cyst formation by Madin-Darby canine kidney (MDCK) cells in three-dimensional culture is assumed to be cyclic AMP-dependent and due to cyclic AMP-dependent protein kinase (cAPK) activation based on pharmacological responsiveness. To determine if different cyclic AMP (cAMP) pathways are associated with morphological development, the role of cAMP in regulating morphological change was examined in MDCK clones that form tumor-like or tubular structures under basal conditions. Pharmacological cAMP pathway activators induce cyst formation and diminish formation of other structures in three clones, whereas one clone is unaffected. Tyrosine kinase-mediated morphogens have little effect. Although all clones have intact cAMP signaling pathways, each has a unique subcellular distribution of cAPK regulatory subunits. This may reflect distinct mechanisms for cAPK anchoring, allowing cAPK subtype regulation of the unique phenotypic character of each clone through preferential access to substrates. These observations suggest a molecular basis for differential cAMP responsiveness in cells that develop distinct morphological phenotypes. This evidence establishes these MDCK clones as models for understanding the mechanism and functional significance of cAPK subunit localization and may have broader implications for cystogenesis in polycystic kidney disease.

Cell and molecular biology of kidney development.

Studies that address the cellular and molecular biology of renal organogenesis are relevant to our understanding of normal renal developmental mechanisms, developmental renal diseases, and the kidney's response to injury. Responses of the mature kidney to many injuries often involve cellular and molecular reparative processes that mimic development. This article will focus on recent data concerning regulators of renal differentiation; the roles of cell growth regulation, apoptosis, and intracellular signaling in kidney development; and specific mechanisms of renal epithelial, vascular, and interstitial development. Understanding the basic processes that occur in renal organogenesis provides insight into possible pathophysiological mechanisms operative in a wide range of renal diseases.

Novel Madin Darby canine kidney cell clones exhibit unique phenotypes in response to morphogens.

Novel Madin Darby Canine Kidney cell clones were isolated. These cell clones exhibit differential responsiveness to inducers of tubule or cyst formation in collagen gel culture: hepatocyte growth factor or inducers of intracellular cAMP formation, respectively. In gel culture, clone OR93.22.D6 forms cysts and responds with morphological transformation to both hepatocyte growth factor and prostaglandin E1, and is most typical of a previously described cell type except for its higher transepithelial electrical resistance. OR55.25.II20 forms tubules in culture, is unresponsive to hepatocyte growth factor, and forms prostaglandin-induced spherical cysts. OR55.28.V2 forms dense cell spheres under control conditions, is induced to form tubules by hepatocyte growth factor, and is unresponsive to prostaglandin. OR55.29 forms only cysts, and is the only clone to form domes in monolayer culture. Tubule formation induced by hepatocyte growth factor, in all clones except OR55.25.II20, is blocked by a neutralizing antibody. In defined medium, without hepatocyte growth factor or prostaglandin, OR55.25.II20 forms spontaneous tubules. This finding indicates that a tubulogenic serum factor is not responsible for the observed phenotype. Increasing prostaglandin concentrations lead to inhibition of tubule formation and increased cyst formation. This observation suggests that induction of intracellular cAMP formation negatively regulates tubule formation in these cells, and implies that cystogenesis may represent a "default pathway" for impaired tubulogenesis. These observations demonstrate that some facets of renal tubulogenesis may be independent of hepatocyte growth factor, and that care must be exercised when comparing biological studies utilizing different clones.

Cystic maldevelopment of the kidney.

Cystic maldevelopment of the kidney can occur when the normal processes of nephrogenesis are disrupted. The result is formation and enlargement of fluid-filled cysts instead of normal renal tubules. Several human disease states are associated with the development of renal cysts. Events triggered by genetic mutation or environmental insult probably lead to the combination of factors believed to stimulate cyst formation and enlargement, including epithelial hyperplasia, abnormal protein sorting, altered fluid transport, and abnormal extracellular matrix:cell interactions. A precise delineation of the cellular pathophysiology of renal cystic maldevelopment has the potential to do the following: (1) focus genetic investigation on specific "cystic" candidate genes; (2) provide models for the definitive identification of such candidate genes; and (3) provide key targets for immunotherapy or pharmacotherapy designed to prevent renal cyst formation and progressive enlargement.