Characteristics of fingertip injuries and proposal of a treatment algorithm from a hand surgery referral center in Mexico City.

BACKGROUND: Fingertips are the most commonly injured anatomical structures in the upper extremity. The aim of this work is to present our experience in the management of fingertip injuries. METHODS: All patients with fingertip injuries managed by Plastic and Reconstructive Surgery Division of Hospital General “Dr Manuel Gea Gonzalez” in Mexico from July 2010 to June 2015 were included; their demographic characteristics were described, as well as patterns of injury and management. RESULTS: A total of 1,265 patients were included in the study, 75% were males. The mean age of presentation was 20.5 ± 16.46 years; the age group most commonly affected was younger than 15 years (46.7%). Right and left-sided injuries were almost equally prevalent (51 vs. 49%). The most commonly injured fingers were the third (27.2%), and second (25.8%). Eighty-seven percent of the patients presented with single-digit injuries. Fingertip amputations were the most common type of injury with 620 cases (49%), followed by simple fingertip lacerations (574 cases, 45%), and nail bed injuries in 71 cases (5.6%). Surgical management was necessary in 95.8% of the cases. CONCLUSIONS: Fingertip injuries remain the most common reason for consultation in hand emergencies. A structured approach for their treatment is necessary to obtain the best clinical outcomes.

Adipocyte accumulation in corpus cavernosum: First clinical evidence and pathophysiological implications in erectile dysfunction. / Acumulación de adipocitos en el cuerpo cavernoso: primera evidencia clínica e implicaciones fisiopatológicas en la disfunción eréctil.

OBJECTIVES: Animal models have shown that erectile dysfunction is associated with adipocyte accumulation under tunica albugínea, which could be involved in venous leakage and loss of penile rigidity. In the current sudy, we compared the histology of the penile sub-albuginean region of drug-refractory erectile dysfunction patients undergoing penile prosthesis implantation with potent patients with Peyronie's disease undergoing curvature correction procedures. MATERIALS AND METHODS: Seventeen refractory erectile dysfunction patients and fourteen potent patients with Peyronie's disease were recruited. Sub-albuginean tissue samples were taken in each surgery. An expert uropathologist analysed each section. A bivariate analysis was performed. Multivariate logistic regression was used to calculate adjusted odds ratios; P value<.05 was considered significant. RESULTS: Eleven patients (11/17) in the case group presented cavernous fat cell accumulation, while only one patient (1/14) in the control group presented this finding (P<.05). Adjusted odds ratio for erectile dysfunction was 40.72; 95% CI 2.28-727.29 (P=.012). CONCLUSIONS: Different studies have shown that androgen disruption could be involved in penile structural changes, leading to trabecular smooth muscle apoptosis and trans or de-differentiation into adipocytes. This is the first prospective study in humans to report an association between erectile dysfunction and sub-albuginean adipocyte accumulation. Venous leakage secondary to this phenomenon could be a factor in the pathophysiology of erectile dysfunction, especially in patients that do not respond to medical therapy.

Merkel cell carcinoma of the eyelid. A series of 5 cases and review of the literature.

OBJECTIVE: Presentation of 5 clinical cases of Merkel cell carcinoma of the eyelid, highlighting the clinical, histopathological, management, and monitoring features. Review of related literature. METHODS: Retrospective review of clinical records and telephone interview of the 5 patients treated for Merkel cell carcinoma between 2006 and 2013, in the Orbit and Oculoplastic Department, Clinical Hospital of the University of Chile. RESULTS: Five patients (2 men, 3 women); 79.2 years (range 64-94 years), with a mean onset of 10 weeks (range 5-16 weeks), tumour size reaching a mean of 2.5×2×2.1cm at the time of surgery. Described as a nodular mass, exophytic, solid, reddish coloured. With no infiltrated lymph nodes or metastases in the first match. Staging as T2N0M0, after the first surgery with oncological criteria. Two lymph node recurrences detected during monitoring. Distant metastasis was found in one patient. The histopathological diagnosis was confirmed by immunohistochemical study of the biopsy. The surgical strategy was full excision, control of surgical margins in the intraoperative period, and eyelid reconstruction with Hughes flap, Cutler/Beard flap or primary closure, depending on the case. CONCLUSIONS: Early diagnosis, wide excision of the tumour with intraoperative control of clear margins with conventional or Mohs surgery, and proper eyelid reconstruction are adequate for a good survival in elderly patients with this eyelid tumour. The study of sentinel lymph node biopsy in primary intervention is recommended; with subsequent radiotherapy to decrease the recurrence and increase survival.

Proapoptotic effect of endocannabinoids in prostate cancer cells.

In the early stages, prostate cancer is androgen­ dependent; therefore, medical castration has shown significant results during the initial stages of this pathology. Despite this early effect, advanced prostate cancer is resilient to such treatment. Recent evidence shows that derivatives of Cannabis sativa and its analogs may exert a protective effect against different types of oncologic pathologies. The purpose of the present study was to detect the presence of cannabinoid receptors (CB1 and CB2) on cancer cells with a prostatic origin and to evaluate the effect of the in vitro use of synthetic analogs. In order to do this, we used a commercial cell line and primary cultures derived from prostate cancer and benign prostatic hyperplasia. The presence of the CB1 and CB2 receptors was determined by immunohistochemistry where we showed a higher expression of these receptors in later stages of the disease (samples with a high Gleason score). Later, treatments were conducted using anandamide, 2-arachidonoyl glycerol and a synthetic analog of anandamide, methanandamide. Using the MTT assay, we proved that the treatments produced a cell growth inhibitory effect on all the different prostate cancer cultures. This effect was demonstrated to be dose-dependent. The use of a specific CB1 receptor blocker (SR141716) confirmed that this effect was produced primarily from the activation of the CB1 receptor. In order to understand the MTT assay results, we determined cell cycle distribution by flow cytometry, which showed no variation at the different cell cycle stages in all the cultures after treatment. Treatment with endocannabinoids resulted in an increase in the percentage of apoptotic cells as determined by Annexin V assays and caused an increase in the levels of activated caspase-3 and a reduction in the levels of Bcl-2 confirming that the reduction in cell viability noted in the MTT assay was caused by the activation of the apoptotic pathway. Finally, we observed that endocannabinoid treatment activated the Erk pathway and at the same time, produced a decrease in the activation levels of the Akt pathway. Based on these results, we suggest that endocannabinoids may be a beneficial option for the treatment of prostate cancer that has become nonresponsive to common therapies.

Modulación del metabolismo de esfingolípidos en cáncer de vejiga como una potencial estrategia para optimizar resultados de terapias intravesicales para tumores de vejiga no musculoinvasores / Modulation of sphingolipid metabolism in bladder cancer as a potential strategy to optimize outcomes of intravesical therapies for non-muscle invasive bladder cancers

El cáncer de vejiga representa un problema de salud pública importante a nivel mundial. En Chile su relevancia es aún mayor en la región de Antofagasta. Este cáncer se caracteriza por una alta tasa de recurrencia, por lo que los pacientes requieren un seguimiento estricto que afecta su calidad de vida e implica elevados costos para los sistemas de salud. Esto explica la necesidad de optimizar los tratamientos actuales (quimioterapia e inmunoterapia con BCG intravesical) para reducir las tasas de recurrencia y progresión. Los esfingolípidos son lípidos bioactivos que a nivel celular cumplen funciones relacionadas con la regulación del crecimiento, proliferación, migración, invasión, resistencia a drogas y apoptosis. La evidencia disponible a la fecha sobre el rol de los esfingolípidos en cáncer de vejiga es escasa, pero sugiere que en este cáncer existe un metabolismo esfingolipídico desplazado hacia la reducción de los niveles intracelulares de ceramida y esfingosina (esfingolípidos pro-apoptóticos) y aumento de esfingosina 1-fosfato (esfingolípido anti-apoptótico). La manipulación del metabolismo esfingolipídico para invertir esta relación se propone en esta revisión como una estrategia que podría ayudar a optimizar el efecto de las terapias disponibles actualmente para reducir las recurrencias y progresiones de los tumores de vejiga no músculo-invasores...

Bladder cancer is an important health problem worldwide. In Chile it has particular relevance in the region of Antofagasta. This cancer is characterized by a high recurrence rate, for which patients need a strict follow up that impairs their quality of life and determines increased costs for health care systems. These facts explain the necessity of optimizing the actual treatments (chemotherapy and BCG immunotherapy) for reducing the rates of recurrence and progression. Sphingolipids are bioactive lipids that at a cellular level have roles related to the regulation of growth, proliferation, migration, invasiveness, drug resistance and apoptosis. To date, the available evidence about the role of sphingolipids in bladder cancer is scarce, but suggests that in this cancer there is a sphingolipid metabolism shifted towards a reduction of the intracellular levels of ceramide and sphingosine (pro-apoptotic sphingolipids) and an increase of sphingosine 1-phosphate (anti-apoptotic sphingolipid). In this review we propose that the manipulation of the sphingolipid metabolism to invert this balance can contribute to optimize the effect of the actual therapies to reduce the rates of recurrence and progression of non-muscle invasive bladder cancers...

Esfingosina-1-fosfato y cánceres urológicos: identificando potenciales blancos terapéuticos en su etabolismo y señalización / Sphingosine-1-phosphate and urological cancers: identifying potential therapeutic targets in its metabolism and signalling

Los lípidos no sólo son moléculas estructurales de las membranas. Hay numerosos ejemplos de lípidos que median acciones fisiológicas dentro de las células. Específicamente, esfingolípidos como ceramida, esfingosina y esfingosina-1-fosfato (S1P) han sido involucrados en el control del crecimiento celular, la proliferación y la migración, todo lo cual se ha relacionado con el cáncer.Los efectos pro-apoptóticos de la ceramida y la esfingosina son revertidos por S1P. Por lo tanto, el destino de la célula puede ser modulada mediante el cambio de la proporción de estos esfingolípidos (el modelo reóstato). S1P promueve la proliferación celular, el crecimiento, la supervivencia, la migración, invasión y resistencia fármacos y radiación, en parte a través de receptores de membrana (S1PR1-5). La sobreexpresión de enzimas productoras de S1P y el aumento de los niveles de S1P se ha descrito en muchos tipos de cáncer, incluyendo cánceres urológicos. Por lo tanto, se pueden identificar posibles objetivos terapéuticos en el metabolismo y las vías de señalización de los esfingolípidos, cuya relevancia clínica debe ser determinada en futuros estudios.

Lipids are not only structural molecules of the membranes. There are numerous examples of lipids mediating physiologic actions within the cells. Specifically, sphingolipids like ceramide, sphingosine and sphingosine-1-phosphate (S1P) have been described to be involved in the control of cell growth, proliferation and migration, all of which has been linked to cancer. The pro-apoptotic effects of ceramide and sphingosine are opposed by S1P. Therefore, the fate of the cell can be modulated by changing the ratio of these sphingolipids (the rheostat model). S1P promotes cell proliferation, growth, survival, migration, invasion and resistance to drugs and radiation, in part mediated by S1P membrane receptors (S1PR1-5). Overexpression of S1P producing enzymes and increased S1P levels has been described in many cancers, including urological cancers. Therefore, potential therapeutic targets can be recognized in the metabolism and signaling pathways of sphingolipids and their clinical relevance have to be determined in future studies.

Enamel roughness and depth profile after phosphoric acid etching of healthy and fluorotic enamel.

BACKGROUND: Dental fluorosis requires aesthetic treatment to improve appearance and etching of enamel surfaces with phosphoric acid is a key step for adhesive restorations. The aim of this study was to evaluate surface roughness and a depth profile in healthy and fluorotic enamel before and after phosphoric acid etching at 15, 30 and 60 seconds. METHODS: One hundred and sixty enamel samples from third molars with no fluorosis to severe fluorosis were evaluated by atomic force microscopy. RESULTS: Healthy enamel showed a statistically significant difference (p < 0.05) between mean surface roughness at 15 seconds (180.3 nm), 30 seconds (260.9 nm) and 60 seconds (346.5 nm); depth profiles revealed a significant difference for the 60 second treatment (4240.2 nm). For mild fluorosis, there was a statistically significant difference (p < 0.05) between mean surface roughness for 30 second (307.8 nm) and 60 second (346.6 nm) treatments; differences in depth profiles were statistically significant at 15 seconds (2546.7 nm), 30 seconds (3884.2 nm) and 60 seconds (3612.1 nm). For moderate fluorosis, a statistically significant difference (p < 0.05) was observed for surface roughness for 30 second (324.5 nm) and 60 second (396.6 nm) treatments. CONCLUSIONS: Surface roughness and depth profile analyses revealed that the best etching results were obtained at 15 seconds for the no fluorosis and mild fluorosis groups, and at 30 seconds for the moderate fluorosis group. Increasing the etching time for severe fluorosis decreased surface roughness and the depth profile, which suggests less micromechanical enamel retention for adhesive bonding applications.

Arsenic-related DNA copy-number alterations in lung squamous cell carcinomas.

BACKGROUND: Lung squamous cell carcinomas (SqCCs) occur at higher rates following arsenic exposure. Somatic DNA copy-number alterations (CNAs) are understood to be critical drivers in several tumour types. We have assembled a rare panel of lung tumours from a population with chronic arsenic exposure, including SqCC tumours from patients with no smoking history. METHODS: Fifty-two lung SqCCs were analysed by whole-genome tiling-set array comparative genomic hybridisation. Twenty-two were derived from arsenic-exposed patients from Northern Chile (10 never smokers and 12 smokers). Thirty additional cases were obtained for comparison from North American smokers without arsenic exposure. Twenty-two blood samples from healthy individuals from Northern Chile were examined to identify germline DNA copy-number variations (CNVs) that could be excluded from analysis. RESULTS: We identified multiple CNAs associated with arsenic exposure. These alterations were not attributable to either smoking status or CNVs. DNA losses at chromosomes 1q21.1, 7p22.3, 9q12, and 19q13.31 represented the most recurrent events. An arsenic-associated gain at 19q13.33 contains genes previously identified as oncogene candidates. CONCLUSIONS: Our results provide a comprehensive approach to molecular characteristics of the arsenic-exposed lung cancer genome and the non-smoking lung SqCC genome. The distinct and recurrent arsenic-related alterations suggest that this group of tumours may be considered as a separate disease subclass.

Efecto de la concentración de hidróxido de calcio y tiempo de cocción del grano de maíz (Zea mays L) nixtamalizado, sobre las características fisicoquímicas y reológicas del nixtamal / Effect of calcium hydroxide concentration and cooking time of corn grain (Zea mays L) nixtamalized, over physicochemical and rheological nixtamal characteristics

Se evaluó el efecto de la concentración de hidróxido de calcio (Ca(OH)2) y tiempo de cocción del grano de maíz sobre las propiedades fisicoquímicas y reológicas durante la nixtamalización tradicional. Se observó que a mayor concentración de Ca(OH)2 y mayor tiempo de cocción del grano, la temperatura de gelatinización aumentó significativamente. El maíz nixtamalizado con 2 g/100g de Ca(OH)2 y 60 min de tiempo de cocción, presentó mayor absorción de calcio, 0.152 g/100g, mostrando un aumento significativo respecto a la concentración inicial (500 g/100g). Todas las muestras presentaron un patrón de difracción de rayos X de almidón tipo A, con diferencias en la intensidad de la difracción. La viscosidad aparente del nixtamal disminuyó considerablemente al utilizar condiciones de procesamiento más altas. Se encontró que la capacidad de retención de agua aumentó con la temperatura.

The effect of calcium hydroxide (Ca(OH)2) concentration and cooking time on physicochemical and pasting properties of maize, during traditional nixtamalization was evaluated. It was observed that the higher the Ca(OH)2 concentration and cooking time the higher the gelatinization temperature. Grain samples treated with 2 g/100g of Ca(OH)2 and 60 min of cooking time presented higher calcium absorption (0.152 g/100g) showing a significant increment (500 g/100g). Results of X-ray diffraction showed that all the samples had X-ray diffraction pattern of starch type A, showing differences in the intensity of the diffraction as indicated by the percentage of cristallinity. The apparent viscosity of the nixtamal considerably decreased when the processes conditions were higher. Water retention capacity increased with temperature.

[Effect of calcium hydroxide concentration and cooking time of corn grain (Zea mays L.) nixtamalized, over physicochemical and rheological nixtamal characteristics]. / Efecto de la concentración de hidr6xido de calcio y tiempo de cocción del grano de maíz (Zea mays L.) nixtamalizado, sobre las caracteristicas fisicoquímicas y reológicas del nixtamal.

The effect of calcium hydroxide (Ca(OH)2) concentration and cooking time on physicochemical and pasting properties of maize, during traditional nixtamalization was evaluated. It was observed that the higher the Ca(OH)2 concentration and cooking time the higher the gelatinization temperature. Grain samples treated with 2 g/100 g of Ca(OH)2 and 60 min of cooking time presented higher calcium absorption (0.152 g/100 g) showing a significant increment (approximately 500 g/100 g). Results of X-ray diffraction showed that all the samples had X-ray diffraction pattern of starch type A, showing differences in the intensity of the diffraction as indicated by the percentage of cristallinity. The apparent viscosity of the nixtamal considerably decreased when the processes conditions were higher. Water retention capacity increased with temperature.

Systemic vasculitis associated with Fasciola hepatica infection.

We report the case of a 50-year-old man who presented with systemic vasculitis associated with Fasciola hepatica infection. The patient presented with severe skin, kidney, spleen, ophthalmic, and neurological compromise. An immunological examination for primary vasculitis was negative and other infections were discounted by microbiological and serological analyses. The patient was treated with steroids without clinical response. The Fasciola hepatica infection was confirmed by the presence of specific immunoglobulin G (IgG) serum antibodies detected by a quantitative enzyme-linked immunosorbent assay (ELISA) with an optical density (OD) of 0.483 OD units (normal value<0.170 OD units) and a high-titre complement fixation (1/80 dilution). The patient received treatment with triclabendazole and all symptoms and systemic manifestations resolved within weeks. Hence, this previously unreported vasculitis-associated infection, if identified opportunely, can be treated and cured.

Lesión subendocárdica debida a intoxicación aguda por monóxido de carbono: a propósito de un caso / Lesion due subendocárdica to sharp intoxication for monoxide of carbon: purpose a case

La toxicosis o intoxicación por monóxido de carbono, se debe a la hipoxia tisular originada por el desplazamiento de oxígeno de la hemoglobina, la cual tiene consecuencias funcionales importantes en los sistemas y órganos que requieran un abastecimiento continuo de oxígeno como cerebro y corazón. Es común la intoxicación aguda y crónica por monóxido de carbono y aunque las manifestaciones clínicas dominantes corresponden al sistema nervioso central, con frecuencia hay anormalidades cardíacas que en ocasiones son mortales. La toxicidad cardíaca es resultado de la hipoxia miocárdica y del efecto tóxico directo del gas sobre las mitocondrias del corazón. La afección miocárdica aparece de inmediato o varios días después de la exposición al monóxido de carbono. Son frecuentes las palpitaciones, la taquicardia, sinusal y diversas arritmias como extrasístoles y fibrilación auricular. En los enfermos con cardiopatía isquémica, puede precipitar angina de pecho e infarto del miocardio. Son muy frecuentes las anomalías del segmento ST y de la onda T en el electrocardiograma de superficie. Aquí reportamos el caso de un paciente, de 45 años, quien presentó signos de isquemia miocárdica, del tipo lesión subendocárdica antero lateral, en relación con intoxicación accidental con monóxido de carbono

Prostatectomía radical en el tratamiento del cáncer prostático localizado / Radical retropubic prostatectomy in the treatment of localized prostate cancer

La prostatectomía radical retropúbica (PRR) es una de las alternativas efectivas en el manejo del cáncer prostático (CP) localizado, que compite con la braquiterapia y radioterapia externa. En la actualidad, se ha establecido como una técnica segura, reproducible y de riesgos perioperatorios cada vez menores. Se comunica nuestra experiencia en el manejo quirúrgico del cáncer prostático mediante la PRR, analizando las características clínico-patológicas, así como la evolución de la enfermedad posterior a la cirugía.Análisis retrospectivo descriptivo de 155 pacientes (P) sometidos a PRR entre los años 1993-2002 en nuestro servicio, con un seguimiento promedio de 32,3 meses y una edad promedio de 62,7 años (rango 41-75). Se utilizó arbitrariamente como punto de corte para definir recidiva post cirugía, un APE mayoro igual a 0,4 ng/ml. En 73 pacientes (47,1 por ciento) se diagnosticó el CP sólo por APE alterado, 81 pacientes (52,2 porciento), presentaron tacto rectal sospechoso. El 96,1 porciento de los P tenían enfermedad clínicamente órgano confinada. El APE preoperatorio promedio fue de 11,1 ng/ml (0,74-50), con un 61,9 porciento de los P (96) con APE< 10 ng/ml. La etapificación patológica fue: pT2a 51 porciento, pT2b 13,5 porciento, pT3a 21,3 por ciento y pT3b 14,2 porciento. En la biopsia de la pieza operatoria, un 7,2 por ciento tuvo score de Gleason (SG) 2-4, un 83,9 porciento SG de 5-7, un 7,9 por ciento SG 8-10. No hubocomplicaciones graves perioperatorias en la serie. Un P (0,65 porciento) falleció 1 mes post cirugía por infarto al miocardio. La sobrevida libre de enfermedad a 3 años, según estadío clínico, se presenta en curvas de actuarialidad. El tiempo de recidiva bioquímica en los diferentes estadíos fue de 21,4, 17 y 9,2 meses para los estadíos pT2, pT3a y pT3b respectivamente. La mortalidad cáncer específica en la serie fue de 2,6 porciento (4P), con un seguimiento promedio de 69,2 meses a la fecha de muerte, y todos ellos estadío pT3b.La PRR es una alternativa de tratamiento segura y ausente de complicaciones graves en nuestra serie.Los resultados de sobrevida libre de enfermedad, resultan atractivos sólo cuando la intervención es realizada en estadíos precoces.

Efficacy of sublingual nifedipine in the acute treatment of systemic hypertension.

The effects of sublingual nifedipine, a calcium antagonist vasodilator, were assessed in 43 patients with moderate to severe hypertension in an emergency room setting. Following a no-response placebo treatment period, the patients with supine diastolic blood pressure of less than 110 mm Hg (group A, n equals 17) received 10 mg of sublingual nifedipine, and the patients with supine diastolic blood pressure of much greater than or equal to 110 mm Hg (group B, n equals 26) received a 20-mg sublingual dose. In group A, systolic blood pressure decreased from 172.4 plus or minus 18.6 mm Hg to 140.0 plus or minus 14.6 mm Hg; diastolic pressure from 108.8 plus or minus 3.3 mm Hg to 87.6 plus or minus 9.9 mm Hg (P less than 0.001)., In group B, systolic blood pressure decreased from 203.8 plus or minus 22.1 mm Hg to 160.0 plus or minus 23.6 mm Hg; diastolic pressure from 127.7 plus or minus 11.3 mm Hg to 96.7 plus or minus 14.1 mm Hg (P less than 0.001). Heart rate increased significantly only in the 20-mg dose group, from 76 plus or minus 2 to 89 plus or minus 6 beats/min (P less than 0.005). Th effects of sublingual nifedipine were seen in one to five minutes, and the maximal effect in 20 to 30 minutes, with return to placebo baseline in four to five hours. Adverse reactions were minimal in both treatment groups. Nifedipine is an effective and safe hypotensive drug in the rapid management of moderate to severe hypertension and seems to be an effective nonparenteral agent for treatment of hypertensive emergencies.