Correlation between proximal serrated polyp detection and clinically significant serrated polyps: inter-endoscopist variability.

INTRODUCTION AND AIMS: The adenoma detection rate (ADR) is the most important quality indicator for the prevention of colorectal cancer but serrated polyps are also precursor lesions of the disease. The aim of our study was to compare the detection rate of proximal serrated polyps (PSPs) and that of clinically significant serrated polyps (CSSPs) between endoscopists and analyze the relation of those parameters to the ADR. METHODS: An observational, prospective, cross-sectional study was conducted on all patients that underwent colonoscopy at the Policlínico Peruano Japonés within the time frame of July 2015 and August 2016. The ADR and PSP and CSSP detection rates between endoscopists were compared through multivariate logistic regression and the association between those parameters was calculated through the Pearson correlation coefficient. RESULTS: The study included 15 endoscopists and 1,378 colonoscopies. The PSP detection rate ranged from 1.8-17% between endoscopists and had an almost perfect correlation with the CSSP detection rate (p = 0.922), as well as strongly correlating with the ADR (p = 0.769). CONCLUSIONS: There was great variability in the PSP detection rate between endoscopists. It also had an almost perfect correlation with the CSSP detection rate and strongly correlated with the ADR. Those results suggest a high CSSP miss rate at endoscopy and a low PSP detection rate.

Correlation between proximal serrated polyp detection and clinically significant serrated polyps: inter-endoscopist variability. / Correlación entre la detección de pólipos serratos proximales y pólipos serratos clínicamente significativos: variabilidad interendoscopista.

INTRODUCTION AND AIMS: The adenoma detection rate (ADR) is the most important quality indicator for the prevention of colorectal cancer but serrated polyps are also precursor lesions of the disease. The aim of our study was to compare the detection rate of proximal serrated polyps (PSPs) and that of clinically significant serrated polyps (CSSPs) between endoscopists and analyze the relation of those parameters to the ADR. METHODS: An observational, prospective, cross-sectional study was conducted on all patients that underwent colonoscopy at the Policlínico Peruano Japonés within the time frame of July 2015 and August 2016. The ADR and PSP and CSSP detection rates between endoscopists were compared through multivariate logistic regression and the association between those parameters was calculated through the Pearson correlation coefficient. RESULTS: The study included 15 endoscopists and 1,378 colonoscopies. The PSP detection rate ranged from 1.8-17% between endoscopists and had an almost perfect correlation with the CSSP detection rate (p = 0.922), as well as strongly correlating with the ADR (p = 0.769). CONCLUSIONS: There was great variability in the PSP detection rate between endoscopists. It also had an almost perfect correlation with the CSSP detection rate and strongly correlated with the ADR. Those results suggest a high CSSP miss rate at endoscopy and a low PSP detection rate.

Detection of periodontal pathogens in mothers of preterm birth and/or low weight.

BACKGROUND: The present study aims to estimate the possible relationship between periodontal pathogens in the oral cavity and the birth of Preterm Birth (PTB) and/or Low Birth Weight (LBW). MATERIAL AND METHODS: It's a case- control study with the subgengival biofilm samples were collected from four sites up deeper until 48 hours postpartum and were processes by Polymerase Chain Reaction (PCR) for presence the periodontal pathogens Prevotella intermedia (Pi), Fusobacterium nucleatum (Fn), Porphyromonas gingivalis (Pg), Treponema denticola (Td), Tannerella forsythia (Tf) e Aggregatibacter actinomycetemcomitans (Aa). The mothers were divided into case grup (babies weighing < 2500g and/or gestational age < 37 weeks) and control group (babies weighing ≥ 2500g and gestational age ≥ 37 weeks). Chi-square test and the measure of association obtained by Odds Ratio (OR) were used to estimate the association between the variables. RESULTS: Microbial analyses results showed no significant association between PTB and LBW with most periodontal pathogens in the oral cavity, even with association with the clinical presence of periodontitis. CONCLUSIONS: given the high presence of periodontal pathogens in the biofilm subgengival of recent mothers, it is suggested that the findings of this research serve as the basis for future studies on the pathophysiology involved in the relationship between periodontitis and PTB and/or LBW.

Associations between patellofemoral joint cartilage T1ρ and T2 and knee flexion moment and impulse during gait in individuals with and without patellofemoral joint osteoarthritis.

OBJECTIVE: This study aimed to investigate the associations between patellofemoral cartilage T1ρ and T2 relaxation times and knee flexion moment (KFM) and KFM impulse during gait. METHOD: Knee magnetic resonance (MR) images were obtained from 99 subjects with and without patellofemoral joint (PFJ) osteoarthritis (OA), using fast spin-echo, T1ρ and T2 relaxation time sequences. Patellar and trochlear cartilage relaxation times were computed for the whole cartilage, and superficial and deep layers (laminar analysis). Subjects also underwent three-dimensional (3D) gait analysis. Peak KFM and KFM impulse were calculated during the stance phase. Linear regressions were used to examine whether cartilage relaxation times were associated with knee kinetics during walking while adjusting age, sex, body mass index (BMI) and walking speed. RESULTS: Higher peak KFM and KFM impulse were significantly related to higher T1ρ and T2 relaxation times of the trochlear and patellar cartilage, with standardized regression coefficients ranging from 0.21 to 0.28. Laminar analysis showed that overall the superficial layer of patellofemoral cartilage showed stronger associations with knee kinetics. Subgroup analysis revealed that in subjects with PFJ OA, every standard deviation change in knee kinetics was related to greater increases in PFJ cartilage T1ρ and T2 (standardized coefficients: 0.29 to 0.41). Conversely, in subjects without OA, weaker relationships were observed between knee kinetics and PFJ cartilage T1ρ and T2. CONCLUSIONS: Our findings suggest that increased peak KFM and KFM impulse were related to worse cartilage health at the PFJ. This association is more prominent in superficial layer cartilage and cartilage with morphological lesions.

Factors related to advanced colorectal neoplasm at the Policlínico Peruano Japonés.

BACKGROUND: Identifying persons at high risk for advanced colorectal neoplasia can aid in the prevention of colon cancer. Previous studies have shown that some patients can present with proximal advanced neoplasia with no distal findings. AIMS: To determine the factors related to advanced neoplasia and advanced proximal colorectal neoplasia in a Latin American population. MATERIAL AND METHODS: A prospective, cross-sectional, observational, analytic study was conducted. It included patients that underwent colonoscopy at the Policlínico Peruano Japonés within the time frame of January and July 2012. Advanced neoplasia was defined as the presence of lesions ≥ 10mm with a villous component, high-grade dysplasia, or carcinoma. The splenic flexure was the limit between the proximal and distal colon. RESULTS: A total of 846 patients were included in the study. Advanced neoplasia was detected in 108 patients (12.8%) and advanced proximal neoplasia in 55 patients (6.7%), 42 (76.4%) of whom had no neoplasia in the distal colon. Factors related to advanced neoplasia found in the multivariate analysis were age, at the intervals of 50-59 (p=0.019), 60-69 (p=0.016), and ≥ 70 years (0.002) and male sex (p=0.003). In the evaluation of advanced proximal neoplasia, the multivariate analysis identified the 60-69 year age interval (p=0.039) and advanced distal neoplasia (p=0.028) as factors related to advanced proximal disease. The ROC curve established the age cut-off point at 60 years for initially performing colonoscopy, rather than sigmoidoscopy. CONCLUSIONS: Age and sex are related to advanced neoplasia, whereas age and advanced distal neoplasia are related to advanced proximal neoplasia.

Response of knee cartilage T1rho and T2 relaxation times to in vivo mechanical loading in individuals with and without knee osteoarthritis.

OBJECTIVE: The objective of this study was to evaluate the effects of mechanical loading on knee articular cartilage T1ρ and T2 relaxation times in patients with and without osteoarthritis (OA). DESIGN: Magnetic resonance (MR) images were acquired from 137 subjects with and without knee OA under two conditions: unloaded and loaded at 50% body weight. Three sequences were acquired: a high-resolution 3D-CUBE, a T1ρ relaxation time, and a T2 relaxation time sequences. Cartilage regions of interest included: medial and lateral femur (MF, LF); medial and lateral tibia (MT, LT), laminar analysis (superficial and deep layers), and subcompartments. Changes in relaxation times in response to loading were evaluated. RESULTS: In response to loading, we observed significant reductions in T1ρ relaxation times in the MT and LT. In both the MF and LF, loading resulted in significant decreases in the superficial layer and significant increases in the deep layer of the cartilage for T1ρ and T2. All subcompartments of the MT and LT showed significant reduction in T1ρ relaxation times. Reductions were larger for subjects with OA (range: 13-19% change) when compared to healthy controls (range: 3-13% change). CONCLUSIONS: Loading of the cartilage resulted in significant changes in relaxation times in the femur and tibia, with novel findings regarding laminar and subcompartmental variations. In general, changes in relaxation times with loading were larger in the OA group suggesting that the collagen-proteoglycan matrix of subjects with OA is less capable of retaining water, and may reflect a reduced ability to dissipate loads.

[Choledocolithiasis predictors in high-risk population subjected to endoscopic retrograde pancreatocholangiography at "Hospital Nacional Arzobispo Loayza"]. / Predictores de coledocolitiasis en población de alto riesgo sometida a pancreatocolangiografía retrógrada endoscópica en el Hospital Arzobispo Loayza.

INTRODUCTION: The choledocholithiasis is a frequent complication of gallstone disease. The endoscopic retrograde cholangiopancreatography (ERCP) is suitable for its diagnosis and treatment. That approach has both significative morbility and mortality so others methods of diagnosis have been proposed such as intraoperatorycholangiography (IOC) and magnetic resonance cholangiography (MRC), reserving ERCP only for therapy purpose. OBJECTIVES: Verify the utility of choledocholithiasis predictors described in literature MATERIAL AND METHODS: This study is a correlational observational transversal prospective approach. It was performed at the Arzobispo Loayza Hospital from August 2004 to January 2005. Many clinical, biochemical and ecographyc predictors of choledocholithiasis were analyzed in 151 patient underwent to ERCP. In all peopleunder study and analyzing separately patients underwent to cholecystectomy or not previous to ERCP, it was identified some risk factors for choledocholithiasis by means of both univariate and multivariate analysis. RESULTS: The univariate analysis showed a relationships among age, icterus, cholangytis, direct bilirrubin, amylase, lactic deshidrogenasa, ductal dilatation (>8 mm) and choledocholithiasis. In all groups, the multivariate analysis determined that ductal dilatation by ecography was the unique predictor for choledocholithiasis in the group of patients postoperated. CONCLUSIONS: None single indicator was able to predict with accuracy the choledocholithiasis. However, the parameters described in the literature are useful in our country.

Predictores de coledocolitiasis en población de alto riesgo sometida a pancreatocolangiografía retrógrada endoscópica en el Hospital Arzobispo Loayza / Predicting of choledocholithiasis in population of high risk submissive an endoscopic retrograde cholangiopancreatography in yhe Hospital Arzobispo Loayza

Introducción: La coledocolitiasis es una complicación frecuente de la litiasis vesicular. La pancreatocolangiografía retrógrada endoscópica (PCRE) es el "gold Standard" para su diagnóstico y tratamiento, sin embargo debido a su significativa morbilidad y mortalidad, otros métodos diagnósticos han sido planteados, tales como la colangiografía intraoperatoria (CIO) y la colangioresonancia (CRMN), reservado a la PCRE sólo para fines terapéuticos. Objetivo: Verificar la utilidad de los predoctores de coledocolitiasis descritos en la literatura. Material y Método: Estudio correlacional, observacional, transversal prospectivo que se realizó entre agosto del 2004 y enero del 2005 en el Hospital Arzobispo Loayza. Conocidos criterios clínicos, bioquímicos y ecográficos predictores de coledocolitiasis fueron analizados en 151 pacientes sometidos a PCRE. Usando análisis univariado y multivariado, se identificaron los factores de riesgo para coledocolitiasis, en el total de pacientes del estudio, así como en los pacientes colecistectomizados o no antes de la PCRE. Resultados: El análisis univariado en el total de pacientes encontró que la edad, ictericia, colangitis, biblirrubina directa, amilasa, deshidrogenada láctica (DHL), dilatación del colédoco (>8mm) y coledocolitiasis por ecografía, estuvieron asociados con coledocolitiasis. Cuando se evaluó por separado, el análisis multivariado en los tres grupos se encontró que sólo la dilatación del colédoco por ecografía fue el único predictor de coledocolitiasis en el grupo de pacientes post-operados. Conclusiones: Ningún indicador único es capaz de predecir, con total exactitud, la presencia de coledocolitiasis. Pero los parámetros descritos en la literatura, son de utilidad en nuestro medio.

Introducction: The choledocholithiasis is a frequent complication of gallstone disease. The endoscopic retrograde cholangiopancreatography (ERCP) is suitable for its diagnosis and treatment. That approach has both significative morbility and mortality so others methods of diagnosis have been proposed such as intraoperatorycholangiography (IOC) and magnetic resonance cholangiography (MRC), reserving ERCP only for therapy purpose.OBJETIVES: Verify the utility of choledocholithiasis predictors described in literature MATERIAL AND METHODS: This study is a correlational observational transversal prospective approach. It was performed at the Arzobispo Loayza Hospital from August 2004 to January 2005. Many clinical, biochemical and ecographyc predictorsof choledocholithiasis were analyzed in 151 patient underwent to ERCP. In all people under study and analyzing separately patients underwent to cholecystectomy or not previous to ERCP, it was identified some risk factors for choledocholithiasis by means of both univariate and multivariate analysis.RESULTS: The univariate analysis showed a relationships among age, icterus, cholangytis, direct bilirrubin, amylase, lactic deshidrogenasa, ductal dilatation (minor 8mm) and choledocholithiasis. In all groups, the multivariate analysis determined that ductal dilatation by ecography was the unique predictor for choledocholithiasisin the group of patients postoperated.CONCLUSIONS: None single indicator was able to predict with accuracy thecholedocholithiasis. However, the parameters described in the literature are useful in our country.

Acute and topic anti-edematogenic fractions isolated from the seeds of Pterodon pubescens.

We previously demonstrated that alcoholic extracts from Pterodon pubescens Benth. (Sucupira branca, Leguminosae) seeds exhibit anti-arthritic activity. In the present work we show that the oleaginous extract obtained from P. pubescens seeds (OEP) exhibits acute or topic anti-edematogenic activity when tested in carrageenan-induced paw edema or in croton oil-induced ear edema assays, respectively. Four fractions were obtained from OEP by sequential liquid-liquid extraction. The anti-edematogenic properties were predominant in the hexanic fraction, which was further fractionated by HPLC, yielding three sub-fractions (PF1.1, PF1.2 and PF1.3). PF1.1 and PF1.3 showed potent acute and topic anti-edematogenic activity. The PF1.2 sub-fraction, although not active in the carrageenan assay, exhibited a potent anti-edematogenic activity in the croton oil-induced ear edema. This sub-fraction shows a maximum efficacy similar to indometacin in a lower dose. The PF1.1 sub-fraction presented a complex mixture containing furane diterpene derivatives of vouacapan. PF1.2 consists of a single substance, geranylgeraniol, as determined by GC/MS and NMR, while PF1.3 contains farnesol.

Congenital absence of lacrimal puncta and salivary glands: report of a Brazilian family and review.

Congenital absence of the salivary glands and lacrimal puncta is a rare autosomal-dominant disorder with variable expressivity. Only a few instances of this condition have been reported. We present the first Brazilian observation of this syndrome and a review of the literature.

Estudo comparativo das diferenças entre as estratégias dinâmica e normal com o perímetro Octopus 1-2-3 / Comparative study of the differences between dynamic and normal strategies with Octopus 1-2-3

Objetivo: Analisar os resultados de um estudo comparativo entre as estratégias dinâmica e normal utilizando o perímetro Octopus 1-2-3. Métodos: Utilizando o Octopus 1-2-3 nas estratégias dinâmica e normal foi realizada a perimetria automatizada em 24 pacientes glaucomatosos (8homens e 16 mulheres) com uma média de intervalo de 2 exames de 6 meses. Todos pacientes já haviam sido previamente sunmetidos a pelo menos um exame de perimetria automatizada no Octopus 1-2-3. Os dados comparados, para ambos os olhos, foram: a idade do paciente, número de estimulos, sensibilidade média (MS), defeito médio (MD), perda focalizada (LV), flutuaçäo em curto prazo (SF) e o fator de confiabilidade (RF). Na análise estatística, utilizando o teste t pareado, somente os campos visuais com RF menor que 10 foram incluídos. O nível de significância fi igual a 5 (por cento) (p<0,05). Resultados: Näo houve diferença estatisticamente significativa entre as duas estratégias em relaçäo a idade, LV, SF e RF. Entretanto, houve diferença estatisticamente significativa na duraçäo do teste, número de estímulos, MS MD. A estratégia dinâmica mostrou uma sensibilidade difusa maior e um menor defeito médio quando comparada à estratégia normal. Conclusöes: Nossos resultados indicam que os valores dos limiares medidos pela estratégia dinâmica estäo em concordância com os valores obtidos utilizando a estratégia normal nos pacientes portadores ou suspeitos de glaucoma, cujos campos visuais estäo normais ou limítrofes. Estes resultados também confirmam a reduçäo na duraçäo do exame. Também sugerem que, quando comparamos campos visuais realizados com a estratégia dinâmica com aqueles realizados com a estratégia normal, é necessária cautela em relaçäo aos valores do MS e MD

An evaluation of methylated collagen as a substitute for vitreous and aqueous humor.

PURPOSE: To evaluate ocular tolerance of methylated collagen gel injected intravitreally and into the anterior chamber. METHODS: Methylated collagen (type I/III) was tested in New Zealand white rabbits. Vitreous cavity: After pars plana vitrectomy, methylated collagen gel was injected intravitreally. The eyes were examined clinically; electroretinogram recordings were made before and after surgery. Vitreous samples were taken for immunological analysis for the presence of the injected collagen. The rabbits were sacrificed 6 months after surgery; the retina was evaluated by light microscopy. Anterior chamber: In another group of rabbits, methylated collagen gel (0.2 ml, 0.1 ml, or 0.05 ml) was injected into the anterior chamber after paracentesis. The eyes were examined with a slit lamp; intraocular pressure was measured postinjection. The rabbits were sacrificed after 4 months; the corneas were evaluated histologically. RESULTS: Vitreous cavity: The fundus view was clear for 6 months after intravitreal injection. Scotopic and photopic electroretinograms were normal in 6/7 eyes; one eye experienced a mild decrease one month postoperatively. No abnormal changes were found in the retinal histology. Anterior chamber: Some corneas were hazy and edematous around the injection site for one week. The injected collagen appeared in bundles, patches, and little pieces in the anterior chamber with precipitates on the corneal endothelium, pupillary margin, and the anterior capsule of the lens. The collagen diminished gradually, without causing permanent opacity. Histologically, the corneal endothelium in the eye which received 0.2 ml collagen showed a mild distention of the mitochondriae and vesicle formation between endothelial cells under transmission electron microscope. CONCLUSION: Methylated collagen gel was tolerated by the eye after intravitreal injection. Localized temporary clinical and mild ultrastructural corneal changes were observed after anterior chamber injection.

Toxicity and efficacy of intravitreal injection of spartanamicin B in the treatment of Candida endophthalmitis.

AIMS/BACKGROUND: We evaluated the retinal toxicity of spartanamicin B and its efficacy in a rabbit model of Candidal endophthalmitis. METHODS: Toxicity. Fourteen albino rabbit eyes were injected intravitreally with spartanamicin B (1, 2, 5, 10, 25, 50, and 100 microg); 2 eyes received the vehicle alone. Efficacy. Ten rabbit eyes were inoculated with 3000 Candida organisms which caused endophthalmitis in 24 hours. Eight eyes were treated with intravitreal spartanamicin B in doses of 1, 2, 5, or 10 microg/0.1 ml; 2 untreated eyes served as controls. RESULTS: Toxicity. The eyes injected with < or =10 microg and the control group eyes exhibited no clinical, histological, or electroretinographic evidence of retinal toxicity. Doses >10 microg caused vitritis. Efficacy. Clinical examination of the treated eyes showed a gradual improvement over 3-6 days; mild opacities remained until day 14. Results of cultures performed 15 days after infection were negative in all treated eyes. CONCLUSIONS: Intravitreally injected spartanamicin B (10 microg) is nontoxic to the retina, effective against C. albicans in the endophthalmitis model in the rabbit eye and caused no discernible histological changes in the retina.

The management of giant retinal tears using perfluoroperhydrophenanthrene. A multicenter case series. Vitreon Collaborative Study Group.

OBJECTIVE: The purpose of the study was to determine the predictors of success and evaluate the use of perfluoroperhydrophenanthrene as an intraoperative and postoperative tool in the management of giant retinal tears in a multicentered collaborative study. DESIGN: Multicentered prospective case series. PARTICIPANTS: Twenty-three centers consecutively enrolled 162 eyes of 161 patients with retinal tears 90 degrees or greater in circumferential extent. INTERVENTION: Perfluoroperhydrophenanthrene was used as an intraoperative surgical adjunct in all cases and left after surgery in 16 eyes (9.9%). MAIN OUTCOME MEASURES: Retinal reattachment and visual acuity. RESULTS: Intraoperative reattachment was achieved in 158 eyes (97.5%); 147 eyes (90.7%) remained attached at their most recent follow-up. Seventy-nine eyes (48.8%) experienced an improvement in their visual acuity, 26 eyes (16.0%) remained unchanged, and 57 (35.2%) worsened. Recurrent retinal detachment occurred in 80 patients (49.4%). Other significant postoperative complications included cataract formation in 20 (39.2%) of 51 eyes, macular pucker in 12 (7.4%), corneal decompensation in 10 (6.2%), and hypotony (intraocular pressure equal to or less than 5 mmHg) in 9 (5.6%). A chi-square analysis of preoperative characteristics showed that hypotony (P = 0.007), macular detachment (P = 0.020), a history of cataract extraction (P = 0.003), poor visual acuity (P = 0.000), giant tear extent greater than 180 degrees (P = 0.004), and higher grade proliferative vitreoretinopathy (P = 0.000) all predicted a poor visual outcome. Vitreon (Vitrophage, Inc., Lyons, IL) was left in 16 eyes (9.9%) for an extended postoperative retinal tamponade for between 3 and 1034 days (mean, 87.2 days). The Vitreon was well tolerated, and these eyes experienced a similar outcome and rate of retinal reattachment to the rest of the group. CONCLUSIONS: Vitreon is a safe and useful adjunct to pars plana vitrectomy in the management of giant retinal tears and may, additionally, be the perfluorocarbon liquid that can be used most safely as a temporary postoperative tool for extended retinal tamponade, reinforcing its role as a useful adjunct in the management of these complex retinal detachments.