Electrochemical and sonochemical advanced oxidation processes applied to tartrazine removal. Influence of operational conditions and aqueous matrix.

Tartrazine degradation was investigated by electrochemical and sonochemical oxidation processes. Anodic oxidation was carried out using boron-doped diamond (BDD) electrodes. The influence of current density and dye initial concentration on the removal of tartrazine from water was analyzed. The experimental results indicate that total removal of tartrazine was obtained, and Chemical Oxygen Demand (COD) and Total Organic Carbon (TOC) removals of up to 94.4% and 72.8% were achieved, respectively. To optimize the process, the pollutant removal percentage, the kinetic rate constant, and the TOC removal efficiency were chosen as target variables. Moreover, sonochemical oxidation experiments at a high-frequency range of cavitation (up to 1 MHz) were performed to establish the influence of three different operating variables, namely ultrasound frequency (0.5-1.1 MHz), ultrasound power (2.0-26.6 W ⋅L-1), and pulse-stop ratio (5:1-1:1). The process was also analyzed in terms of kinetics and energy costs. The kinetics resulted to be three times faster for the electrochemical process. However, the calculated energy costs were very similar, at least at long treatment times. Finally, the influence of three aqueous matrices was investigated. According to the experimental results, the natural occurrence of chloride and/or nitrate ions in water strongly conditions the rate of the process, although at least 90% of tartrazine removal was achieved within the first 50 min of treatment.

Guía de recomendación ACCHED-SCHGE para el funcionamiento de las unidades de endoscopia durante el brote de coronavirus (COVID-19) / Guideline recommendations ACHED-SCHGE for the endoscopy units during the Coronavirus outbreak (COVID-19)

The outbreak of COVID-19 disease has recently spread from its original place in Wuhan, Hubei province, China, to the entire world, and has been declared to be a pandemic by the World Health Organization in March 2020. All countries in America, in particular Chile, show an important increase in COVID-19 cases and deaths. The clinical manifestations of COVID-19 are a broad spectrum, from asymptomatic mild disease, to severe respiratory failure, shock, multiorgan dysfunction and death. Thus, high clinical suspicion and appropriate structure risk stratification are needed. Health care teams in endoscopy units, are at an increased risk of infection by COVID-19 from inhalation of droplets, mucosae contact, probably contamination due to contact with stools. Endoscopic aerosolized associated infections have also been reported. Different societies' recommendations, have recently placed digestive endoscopy (especially upper) among the high risk aerosol generating procedures (AGPs). In addition, live virus has been found in patient stools. On top of this, the infected health professionals may transmit the infection to their patients. Health care infection prevention and control (HCIPC), has been shown to be effective in assuring the safety of both health care personnel and patients. This is not limited to the correct use of personal protective equipment (PPE), but is based on a clear, detailed and well communicated HCIPC strategy, risk stratification, use of PPE, and careful interventions in patients with moderate and high risk of COVID-19. A conscientious approach regarding limited resources is important, as the simultaneous outbreak in all countries heavily affects the availability of health supplies. The Chilean Gastroenterology Society (SChGE) and Digestive Endoscopy Association of Chile (ACHED) are joining to provide continued updated guidance in order to assure the highest level of protection against COVID-19, for both patients and health care workers. This guideline will be updated online as needed.

El brote de la enfermedad denominada COVID-19, se ha extendido desde su origen en Wuhan, provincia de Hubei, China, a todo el mundo. La Organización Mundial de la Salud lo declaró pandemia en marzo de 2020. Todos los países de América, en especial Chile, presentan incremento de casos y fallecidos. Las manifestaciones clínicas de COVID-19 van desde una enfermedad leve, hasta insuficiencia respiratoria severa, shock, disfunción orgánica y muerte. Se necesita una alta sospecha clínica y una adecuada estratificación del riesgo. El equipo de salud en las unidades de endoscopia, tiene un mayor riesgo de COVID-19 que otras unidades clínicas y de apoyo diagnóstico, dada la mayor exposición a inhalación de gotas, contacto posible con mucosas y contaminación por contacto con deposiciones. Recomendaciones de diferentes sociedades colocan la endoscopia digestiva (especialmente la esofagogastroscopia o endoscopia digestiva alta, EDA) entre los procedimientos generadores de aerosoles (PGA) de alto riesgo. Además, se han encontrado virus viables en las deposiciones de los pacientes. Potencialmente, los profesionales de la salud infectados podrían contagiar a los pacientes. Se ha demostrado que la prevención y control de infecciones asociadas a la atención de salud (IAAS), son efectivos para garantizar la seguridad tanto del personal de salud, como de los pacientes. Esto no es solamente el correcto uso del equipo de protección personal (EPP), sino que se basa en una clara estrategia de IAAS, bien comunicada, con estratificación de riesgo, uso de EPP e intervenciones correctas en pacientes con riesgo moderado y alto. Es relevante un enfoque sobre los limitados recursos, dado la simultaneidad del brote en todos los países, que afecta la disponibilidad de insumos. La Sociedad Chilena de Gastroenterología (SChGE) y la Asociación Chilena de Endoscopia Digestiva (ACHED) publican esta guía actualizada para apoyar las buenas prácticas contra COVID-19, tanto para pacientes como para el equipo de salud. Esta guía podrá tener actualizaciones según avance la información disponible.

Selecting and improving activated homogeneous catalytic processes for pollutant removal. Kinetics, mineralization and optimization.

The degradation of a model pollutant, tartrazine, very used in food industry and usually present in WWTPs effluents and surface waters, was investigated by nine activated homogeneous catalytic processes, namely, Fe3+/H2O2, Fe2+/H2O2, UV/H2O2, UV/S2O82-, UV/Fe2+/H2O2, UV/Fe3+/H2O2, UV, VIS/Fe3+/H2O2, and VIS/Fe3+/H2O2/C2O42-. In order to compare the mineralization and oxidation ability of each process, the removal of dye, chemical oxygen demand (COD) and total organic carbon (TOC) were analyzed, as well as the overall kinetic rate constant. Also, the different oxidation path-ways (direct photolysis and/or oxidation by free radicals) were estimated for each system. After the comparison, the Fenton process, which had the highest mineralization values, was tested in luminous and dark phases using designed experiments, and the influences of all operating variables were studied by RSM.

Trasplante pulmonar en pacientes con fibrosis pulmonar: experiencia del Instituto Nacional del Tórax / Lung transplantation in pulmonary fibrosis: an experience from National Institute of Thorax, Chile

Resumen La fibrosis pulmonar es una enfermedad progresiva y de mal pronóstico por lo que el trasplante pulmonar sigue siendo una opción para pacientes bien seleccionados. Objetivo: Evaluar resultados y sobrevida de pacientes con fibrosis pulmonar trasplantados a 8 años de inicio del programa de trasplante. Métodos: Estudio descriptivo de trasplantados de pulmón por fibrosis pulmonar desde agosto de 2010 a julio de 2018. Resultados: De un total de 76 trasplantes, un 68,4% han sido en pacientes con fibrosis pulmonar. La principal indicación fue fibrosis pulmonar idiopática (75%). El puntaje de priorización pulmonar (LAS) promedio fue de 53 y un 32% cumplía con criterios de urgencia. La edad promedio fue 55 años, y se usó técnica unipulmonar en un 98%. La principal complicación quirúrgica fue la estenosis bronquial (7,6%). De las complicaciones médicas precoces destacaron 26 episodios infecciosos y 6 rechazos celulares agudos. La principal complicación tardía fue la disfunción crónica de injerto. Los resultados funcionales promedio pre trasplante, a 1 y 3 años fueron: CVF de 49%, 71% y 70% del valor teórico. Un 40% ha fallecido en el período de seguimiento. La principal causa de mortalidad el primer año post trasplante fueron las infecciones. La sobrevida a 1, 3 y 5 años fue de 86,2%, 65,2% y 59,8% respectivamente. Conclusiones: En trasplante monopulmonar es una opción de tratamiento en estos pacientes, con una sobrevida de 59% a 5 años. Un tercio se trasplanta con criterios de urgencia, siendo las infecciones la principal complicación precoz y la disfunción crónica de injerto la complicación tardía más frecuente.

Pulmonary fibrosis is a progressive disease with a bad prognosis. This situation makes rise lung transplant as a therapeutic option among carefully selected patients. Objective: Evaluate the results and survival rates of patients with pulmonary fibrosis that were transplanted through an 8 years period of follow-up, from the beginning of our transplant program. Methods: Descriptive study of the transplanted patients diagnosed with pulmonary fibrosis from august 2010 to july 2018. Results: Out of 76 transplants, 68.4% were due to pulmonary fibrosis, among these, the main diagnosis was idiopathic pulmonary fibrosis (75%). The average lung allocation score (LAS) was 53 and 32% of them had urgency criteria. Patients ' age averaged 55 years-old and 98% of them underwent a single lung transplant. Early medical complications were seen in 26 patients with infectious episodes and 6 with acute rejection. The main late complication was chronic allograft dysfunction. The main surgical complication was bronchial stenosis (7.6%). In comparison to its base line reference values FVC means pre transplant and 1 and 3 years post-transplant were 49%, 70% and 71% respectively. A 40% of patients died during follow up period. Infections were the main cause of mortality during the first year. Survival rates at 1st 3rd and 5th year were 86,2%; 65.2% and 59.8% respectively. Conclusions: Single lung transplant is a therapeutic option for patients with interstitial lung disease with a 59% survival rate in 5 years, 1/3 fulfilled urgency criteria at the transplant time. The infections were the main early complication and chronic graft dysfunction was the main late complication.

Compromiso de seno cavernoso como presentación de cáncer anaplásico de tiroides / Cavernous sinus involvement as presentation of anaplastic thyroid cancer

Anaplastic thyroid cancer is an uncommon malignant tumor, usually fatal, primarily affecting older adults and doesn't have effective systemic therapy. The median survival is less than 6 months from diagnosis. Brain metastases are low frequency and reach 18 percent. We present the case of a patient with papillary carcinoma of the thyroid who takes an aggressive form, becoming anaplastic carcinoma, with involvement of the central nervous system (CNS) manifested by paralysis of the cranial nerve IV, which is rare clinical condition.

Trasplante pulmonar en pacientes portadores de fibrosis pulmonar: caracterización de una cohorte de 87 pacientes / Lung transplantation in 87 patients with idiopathic pulmonary fibrosis

Pulmonary fibrosis is a progressive disease. Lung transplantation is the only effective therapy for a group of patients. Objective: To evaluate results of lung transplantation for fibrosis up to a 5 years of follow up. Methodology: Retrospective review of clinical records of patients subjected to lung transplantation from Clínica Las Condes and Instituto Nacional del Tórax. Demographic data, type of transplant, baseline and post-transplant spirometry and 6 min walked distance (6MWT), early and late complications and long-term survival rate were analyzed. Results: From 1999 to 2015, 87patients with pulmonary fibrosis were transplanted, in average they were 56 years old, 56% were male, 89% of patients were subjected to a single lung transplant. 16% of them were in urgency. Baseline and 1-3-5 years for FVC were 49-73-83 and 78% of the reference values and for 6MWT were 280, 485, 531 and 468 meters respectively. Predominant complications < 1 year post-transplant were: acute rejection (30%) and infections (42%). Complications after 1 year of transplantation were chronic graft dysfunction (DCI) 57% and neoplasms (15%). The main causes of mortality > 1 year were DCI (45%) and neoplasms (11%). The estimated 1, 3 and 5 year survival rate were 84, 71 and 58% respectively. Conclusions: Lung transplantation in patients with pulmonary fibrosis improves their quality of life and survival rate. The monopulmonary technique is efficient in the long term. Acute rejection and infection were the most common early complications and chronic graft dysfunction was the prevalent long-term complication.

La Fibrosis pulmonar es una enfermedad progresiva y el trasplante constituye una terapia efectiva para un grupo de pacientes. Objetivo: Evaluar los resultados del trasplante pulmonar por fibrosis a 5 años. Metodología: Revisión retrospectiva de registros de trasplante pulmonar de la Clínica Las Condes e Instituto Nacional del Tórax. Se analizaron datos demográficos, tipo de trasplante, función pulmonar basal y post-trasplante, complicaciones precoces y tardías y sobrevida a largo plazo. Resultados: Entre 1999 y 2015 ambos centros trasplantaron 87 pacientes por fibrosis pulmonar. Los pacientes tenían una edad promedio de 56 años, 56% eran del género masculino y se usó técnica monopulmonar en 89% de ellos. 16% de los pacientes se encontraba en urgencia. Los resultados espirométricos y la distancia caminada en 6 minutos (T6 min) basales y a 1- 3 - 5 años fueron: CVF 49- 73- 83 y 78% del valor teórico y T6 min fue 280, 485, 531 y 468 metros respectivamente. Complicaciones predominantes < 1 año fueron: rechazo agudo 30% e infecciones 42%. Complicaciones > 1 año fueron: disfunción crónica del injerto (DCI) 57% y neoplasias 15%. Las causas de mortalidad > 1 año fueron DCI 45% y neoplasias 11%. La sobrevida estimada a uno, 3 y 5 años fue 84, 71 y 58% respectivamente. Conclusiones: El trasplante en pacientes con fibrosis pulmonar, permite mejorar la calidad de vida y sobrevida de estos pacientes. La técnica monopulmonar es eficiente a largo plazo. En las complicaciones precoces predominaron el rechazo agudo e infecciones y a largo plazo la DCI.

Aspectos relevantes en la realización de la endoscopia digestiva: propuestas basadas en la evidencia. Curso ACHED 2013 / Relevant aspects of digestive endoscopy. Evidence-based suggestions. Chilean Association of Digestive Endoscopy (ACHED), Course 2013

Digestive endoscopy is a complex tool for diagnosis and treatment, with continuous development both in technical aspects and in their application for the different pathologies where this technique is required. Therefore, a continuous education program is necessary for the practitioner using this technique. With the purpose of reaching an agreement between different aspects of the performance of these procedures and also generating proposals for its application that are useful for the physicians of this area of expertise, during 2013 the Chilean Association of Digestive Endoscopy (ACHED) developed a workshop called ‘Relevant aspects of digestive endoscopy. Evidence-based suggestions’. This workshop was attended by gastroenterologists and trainee practitioners, who worked in groups during a period of two months where they reviewed available evidence to answer several questions relating to milestones and lesions that need to be described in upper gastrointestinal endoscopy, the preparation of the GI endoscopy report, technical aspects and quality measures in colonoscopy. This review resulted in proposals that were analyzed and agreed on in the form of recommendations presented for further analysis and discussion amongst endoscopic teams in our country.

La endoscopia digestiva es una herramienta de diagnóstico y tratamiento médico compleja, en continuo desarrollo tanto en lo técnico como en los conceptos de manejo de las patologías en las que se utiliza.Por lo tanto, es deseable una estrategia de formación continua del profesional que la realiza. Con el objetivode consensuar diferentes aspectos en la realización de estos procedimientos y generar propuestas de manejoque sean de utilidad para todos los médicos involucrados en esta especialidad, la Asociación Chilenade Endoscopia Digestiva (ACHED) realizó durante el año 2013 un curso taller denominado “Aspectosrelevantes en la realización de la endoscopia digestiva. Propuestas basadas en la evidencia”. Este cursoconvocó a gastroenterólogos y médicos en formación de la especialidad que conformaron grupos de trabajoque durante 2 meses revisaron la evidencia disponible para responder diversas preguntas en relación a los hitos y lesiones a describir en endoscopia digestiva alta (EDA), la realización del informe en EDA, aspectos técnicos y medidores de calidad en colonoscopia. La revisión les permitió generar propuestas que fuerondiscutidas y consensuadas en recomendaciones que se proponen para su discusión por los equipos endoscópicos de nuestro país.

Trasplante de microbiota fecal en paciente con colitis ulcerosa e infección refractaria por: revisión de la literatura a partir de un caso clínico / Fecal microbiota transplantation in patient with ulcerative colitis and refractory infection due to: review of the literature based on a clinical case

Infection (CDI) is increasing both in the hospital environment as in the outpatient setting, and is associated with prior use of antibiotics, hospitalizations and inflammatory bowel disease (IBD), among others. It is also characterized by a high rate of recurrence with the usual antibiotic treatment, which increases with greater number of episodes, reaching up to 65 percent. In this context, the transplantation of fecal microbiota (FMT) emerges as recurrent CDI therapy, achieving success rates exceeding 90 percent, including in IBD patients, with minimum rates of recurrence. To achieve such efficiency, the colonization by the donated microbiota in the recipient is critical. The role of FMT is still unclear in IBD therapy not associated with CDI. Although there are great differences in the methodology of FMT, the process has been standardized even creating banks of frozen fecal samples, without reducing its effectiveness. FMT is a safe procedure, without serious adverse events, and accepted by the potential beneficiary population. There are few reported cases of refractory CDI management with FMT. Since 2012, the FMT in CDI and IBD publications have increased significantly, but in our country there are only few reports of this therapeutic strategy. We present a patient with ulcerative colitis and conventional antimicrobial management resistant CDI, which was successfully treated with FMT in a public hospital in Chile.

La infección por Clostridium difficile (ICD) está en aumento tanto en el ambiente hospitalario como ambulatorio, y se asocia a uso previo de antibióticos, hospitalización y enfermedades inflamatorias intestinales (EII), entre otros. Se caracteriza además por su alta tasa de recurrencia con el tratamiento antimicrobiano habitual, que aumenta con el mayor número de episodios alcanzando hasta 65 por ciento. En este contexto, el trasplante de microbiota fecal (TMF) surge como terapia para la ICD recurrente, logrando tasas de éxito superiores a 90 por ciento, incluyendo pacientes con EII, con mínimas tasas de recurrencia. Para lograr esa eficacia, la colonización por la microbiota donada en el receptor es fundamental. Aún no está claro el rol del TMF en la terapia de EII no asociada a ICD. Aunque existe gran heterogeneidad en la metodología del TMF, el proceso se ha ido estandarizando incluso hasta llegar a la creación de bancos de muestra fecal congelada, sin disminuir su efectividad. El TMF es un procedimiento seguro, sin eventos adversos graves y aceptado por la población potencialmente beneficiaria de él. Existen pocos casos publicados de manejo de ICD refractaria con TMF. Desde el 2012 el número de publicaciones sobre TMF en ICD y en EII ha aumentado considerablemente, sin embargo, en nuestro país los reportes sobre esta estrategia terapéutica son escasos. Presentamos el caso de un paciente con colitis ulcerosa e ICD refractaria al manejo antimicrobiano habitual, que se trató exitosamente con TMF en un hospital público de Chile.

Frecuencia y factores asociados a daño hepático inducido por medicamentos en tratamiento antituberculosis / Frequency and factors associated with DILI in antituberculosis treatment

Introduction: Potentially hepatotoxic drugs are used in tuberculosis treatment. The incidence range of drug-induced liver injury (DILI) varies from 0.6 to 33 percent. Adverse reactions can be asymptomatic; therefore periodical liver tests are required. Multiple risk factors are described, such as age and HIV infection, among others. Objective: To determine risk factors associated to DILI and secondary lethality in patients receiving anti-tuberculosis drugs. Materials and Methods: The database from the Servicio de Salud Metropolitano Central de Chile was used. 1,249 patients were analyzed from 2003 to 2008 to determine DILI’s frequency and time of appearance. Multivariate binominal regression was used to study possible risks associated to hepatotoxicity. Results: 2,8 percent of our patients presented DILI (n = 35), three of them died from this cause (8.5 percent). Association between DILI and HIV infection and extrapulmonary tuberculosis was observed (p < 0.01). DILI was present in 50 percent of our patients before the 23rd day. Conclusions: We propose a more exhaustive control of the liver function in patients with DILI risk factors, including HIV carriers and extrapulmonary tuberculosis.

Introducción: El tratamiento antituberculosis incluye drogas hepatotóxicas, estimándose una incidencia de daño hepático inducido por medicamentos (DHIM) entre 0,6 y 33 por ciento. Puede ser asintomático, debiendo evaluarse periódicamente con perfil hepático. Se han descrito múltiples factores de riesgo, como mayor edad e infección por VIH, entre otros. Objetivo: Determinar factores asociados al desarrollo de DHIM y letalidad secundaria a tratamiento antituberculosis. Materiales y Métodos: Base de datos del Programa de Tratamiento antituberculosis del Servicio de Salud Metropolitano Central de Chile. Se analizaron 1.249 pacientes entre 2003 y 2008. Se determinó frecuencia y tiempo de aparición de DHIM. Se estudiaron posibles factores asociados a hepatotoxicidad mediante regresión binomial. Resultados: se diagnosticó DHIM en 2,8 por ciento de los pacientes (n = 35), falleciendo 3 de ellos por esta causa (8,5 por ciento). Se observó asociación entre DHIM con ser portador de VIH (+) y tuberculosis extrapulmonar (p < 0,01). Aparición de DHIM antes del día 23 en 50 por ciento de los casos. Conclusión: Sugerimos un control más exhaustivo del perfil hepático en pacientes con factores de riesgo, entre los cuales deben considerarse los portadores de VIH y tuberculosis extrapulmonar.

Terapia ocupacional precoz e intensiva en la prevención del delirium en adultos mayores ingresados a unidades de paciente crítico: ensayo clínico randomizado: resultados preliminares / Early and intensive occupational therapy in prevention of delirium in older adults admitted to critical patient unit: randomized clinical trial: prelimary results

Objetivo: comparar la eficacia de la prevención no farmacológica estándar (PnFE) versus la prevención no farmacológica reforzada (PnFR), consistente en prevención no farmacológica estándar más terapia ocupacional (TO) precoz e intensiva, en la incidencia del delirium en adultos mayores (AM) ingresados a unidad de pacientes críticos (UPC). Diseño: ensayo clínico randomizado, en UPC del Hospital Clínico de la Universidad de Chile (HCUCH). Sujetos: 70 pacientes de edad igual o superior a 60 años, ingresados al HCUCH entre abril y octubre del 2011, con necesidad de ingreso a UPC para monitorización, hospitalización por enfermedad aguda/crónica descompensada, con consentimiento del paciente o familiar y sin presencia de delirium al ingreso ni deterioro cognitivo previo al estudio. Materiales y métodos: PnFE (grupo control) consiste en: reorientación, movilización precoz, corrección de déficit sensoriales, manejo ambiental, protocolo de sueño y reducción de fármacos anticolinérgicos, versus PnFR (grupo experimental), que considera las siguientes áreas de intervención de TO: estimulación polisensorial, posicionamiento, estimulación cognitiva, entrenamiento en actividades de la vida diaria básica, estimulación motora de extremidades superiores y participación familiar; durante 5 días, dos veces al día. Se evaluó la presencia del delirium, con el CAM dos veces al día durante 5 días, y la severidad de éste con DRS; previo al alta se evaluó, independencia funcional con FIM, estado cognitivo con MMSE y fuerza de garra con dinamómetro de Jamar. Resultados: la PnFR de TO se asocia a menor incidencia de delirium, afectando al 16,1 por ciento del grupo con prevención no farmacológica estándar versus un 3,1 por ciento del con prevención no farmacológica reforzada, así como a menos días de hospitalización (20,6 días versus 10,4 p=.009). La independencia funcional al alta se mantiene en aspectos cognitivos (32,5 versus 32,9) mientras que en aspectos motores aumenta...

Objective: to compare the efficacy of standard non pharmacological prevention of delirium versus intensified prevention of delirium (standard prevention plus early and intensive occupational therapy) in the incidence of delirium in older adults (OA) admitted to critical patient unit (CPU). Desing: randomized control trial, blinded to outcome evaluator, in the CPU of Hospital Clínico Universidad de Chile. Subjects: 70 patients aged 60 years or older, admitted to CPU between April and October of 2011, with need for admission to CPU for monitoring, acute or decompensated chronic illness, without cognitive impairment and consent by patient or family member. Materials and methods: standard prevention group consisted in: reorienting, early mobilization, correction of sensory deficit, environmental management, protocol of sleep and reduction of drugs, and intensified prevention based on standard measured plus early and intensive Occupational therapy: multisensory stimulation, positioning, cognitive stimulation, training in activities of daily living, motor stimulation of the upper extremities and family participation, twice a day for 5 days. Delirium was evaluated (twice a day for 5 days) with CAM and severity with DRS. Primary outcome was delirium incidence, and secondarily were functional independence (FIM), cognitive status (MMSE) and strength of grip with jamar dynamometer at leaving. Results: early intervention and intensive occupational therapy is associated with lower incidence of delirium, affecting 16.1 percent of non-pharmacological standard prevention group and 3.1 percent of intensified prevention group, as well as fewer days of hospitalization (20, 6 days versus 10,4, p= 0,009). The functional independence at leaving keeps in cognitive (32.5 versus 32.9) and is increases significantly in motor aspects (46.5 versus 58.3 l, P =. 03). Conclusion: standard prevention plus early intensive intervention of occupational therapy is effective in...

99mTc-MAG3 diuretic renography in children: a comparison between F0 and F+20.

The aim of this work was to compare the quality of renal drainage obtained with two well-described procedures of diuretic renography (F+20 and F0 tests). We selected 36 clinically stable children, aged 10 days to 17 years, with unilateral (25) or bilateral (11) hydronephrosis, in whom both F+20 and F0 tests were successively performed. In all cases, a late image (PM) was acquired after micturition and after changing the position of the patient. The following parameters were calculated: the time to the maximum of the basic renogram (Tmax); and the normalized residual activity (NORA) and output efficiency (OE) at the end of the 20 min renogram, at the end of the furosemide test (35 min) and on the PM image. In F+20, the renal drainage was better on the PM image than at the end of the diuretic renogram, whereas, in F0, the renal drainage was better on the PM image than at the end of the 20 min diuretic renogram. When comparing F0 and F+20, both OE and NORA parameters revealed slightly better drainage at the end of the 20 min F0 renogram than at the end of the 35 min F+20 diuretic renogram. The drainage obtained on the late post-voiding image was comparable for both F0 and F+20 tests. In conclusion, the quality of drainage obtained during the F+20 and F0 procedures can easily be compared using both OE and NORA. A very similar quality of drainage was reached for both procedures when considering only the PM image. This PM view remains mandatory irrespective of the timing of the furosemide injection and despite the use of tracers with a high extraction rate.

Influence of early furosemide injection on the split renal function.

The split renal function, obtained using Technetium 99m mercaptoacetyltriglycine renography, is currently considered as a robust, accurate and reproducible parameter, provided that it is calculated at a time when no escape of the tracer from the kidney has occurred. The question arises as to whether the simultaneous administration of furosemide with the tracer (F0 test) might accelerate the escape of the tracer, resulting in an underestimation of the split renal function. From a large database, we selected 36 clinically stable children in whom both F0 and F+20 (administration of furosemide 20 min after the tracer) diuretic renography had been performed. In all cases, the F+20 test preceded the F0 test. The mean interval between the two tests was 17 months. The split renal function was calculated on the basis of the 1-2 min background-corrected renal activity using the integral method, slope method and Rutland-Patlak plot. In order to evaluate the effect on the split renal function of an early escape of the tracer, the patients were analysed according to the T(max) value of the renogram for both the F0 and F+20 tests. For the F+20 test, all T(max) values were more than 3 min. For the F0 test, the T(max) value was more than 3 min in 53 kidneys and less than 3 min in 19 kidneys (unilateral in all 19 patients). For the F0 test, for the kidneys with a T(max) value of less than 3 min, there was a tendency to underestimate the split renal function, taking as reference the split renal function observed in the F+20 test. This observation, however, was only statistically significant for the slope method (P=0.03). There was a tendency for lower values with the Rutland-Patlak plot (P=0.07), but, for the integral method, no difference was observed (P=0.5). In conclusion, the simultaneous administration of furosemide with the tracer induces an early acceleration of renal transit. This should be taken into account when calculating the split renal function, for example by favouring the integral method.

Contribución del neuropéptido Y a la fisiología de la co-transmisión simpática humana: estudios en biopsias de vena safena / Neuropeptide Y contribution to the physiology of human sympathetic cotransmission: studies in saphenous vein biopsies

Background: It is known that the sympathetic varicosities co-store and co-release norepinephrine (NE) together with adenosine S-triphosphate (ATP) and neuropeptide Y (NPY). Aim: To describe the chemical characterisation of stored and released NPY from the varicosities of sympathetic nerve terminals surrounding segments of the human saphenous vein, and the vasomotor activity of rings electrically depolarized or contracted by the exogenous application of the co-transmitters. Material and methods: Saphenous vein tissues were obtained from patients undergoing elective cardiac revascularization surgery. Results: The chromatographic profile of NPY extracted from biopsies is identical to a chemical standard of human NPY. Upon electrical depolarisation of the perivascular sympathetic nerve terminals, we demonstrated the release of NPY to the superfusion media, which did not exceed a 1percent of its stored content. The release of the peptide is sensitive to guanethidine, and to extracellular calcium, suggesting that the mechanism of its release is exocytotic in nature. The electrically evoked release of NPY is dependent on the frequency and duration of the electrical pulses. Phenoxybenzamine reduces the electrically evoked release of NPY. Exogenous application of NE and ATP contract saphenous vein rings; the simultaneous application of NE plus ATP causes a synergic response, effect which is further potentiated by the joint co-application of 10 nM NPY. Conclusions: Present results highlight the role of NPY as a sympathetic co-transmitter in the regulation of human vascular tone

[Bone scintigraphy in prostatic cancer. Correlation with clinical and laboratory features and with survival]. / Cintigrafía ósea en pacientes con cáncer de próstata: correlación con aspectos clínicos, de laboratorio y sobrevida.

BACKGROUND: The yield of bone scintigraphy is specially good in some types of neoplasia such as mammary and prostate carcinoma, whose metastases cause a marked osteoblastic reaction in bone. AIM: To assess the usefulness of bone scintigraphy in patients with prostate carcinoma. PATIENTS AND METHODS: A retrospective analysis of bone scintigrams performed to 79 patients with prostate carcinoma aged 56 to 83 years old, describing their relationship with prostate specific antigen and bone pain. The predictive value of bone scan, prostate specific antigen and clinical variables was analyzed using Kaplan Meier survival tables. RESULTS: Scintigraphy disclosed bone metastases in 22 patients (28%). The most frequently involved zones were pelvis (86%), rib cage (67%) and spine (57%). The association with pain was low specially for limbs, rib cage and skull. The better efficacy of prostate specific antigen for the prediction of bone metastases was obtained with a cutoff value of 50 ng/ml (sensitivity 72%, specificity 86%). With a cutoff value of 10 ng/ml, the negative predictive value was 100%. The only significant predictor of a lower patient survival was the presence of bone metastases on bone scintigraphy. CONCLUSIONS: In this series of patients, bone scintigraphy was an excellent diagnostic tool for bone metastases and had a survival prognostic value.

A 6-year clinical trial of methotrexate therapy in the treatment of ectopic pregnancy.

OBJECTIVE: Our aim was to assess the efficiency of methotrexate therapy for unruptured ectopic pregnancy. STUDY DESIGN: From November 1990 to December 1996, 60 patients diagnosed with unruptured ectopic pregnancies were treated by the Departamento de Ginecología y Obstetricia at the Hospital Virgen Macarena of Seville. Of these, 14 patients received an intrasacular injection of 15 mg of methotrexate, 45 were given an intramuscular dose of 50 mg/m2 and only one received the drug by both routes. RESULTS: Forty-six patients (76.7%) responded successfully to treatment. Of these, 10 had been given the drug intrasacularly (10/15, 66.7%), while 36 had received the drug intramuscularly (36/46, 78.3%). Twenty patients (33.3%) had minor side effects, the most frequent being mild abdominal pain. Falling levels of leukocytes on the third day after initiation of treatment may serve as a fairly accurate criterion to predict the patient's response to the treatment. CONCLUSION: Our data support the use of methotrexate therapy as a reliable alternative to surgical intervention in the treatment of unruptured ectopic pregnancy. Intramuscular administration, without laparoscopy, appears to be the most convenient route as it is easily implemented and has comparatively few complications.

[Rheumatoid arthritis. Therapeutic efficacy of methotrexate and its hepatotoxic effects]. / Artritis reumatoídea. Eficacia terapéutica del metotrexate y sus efectos hepatotoxicos.

The efficacy and toxicity (specially hepatic) of methotrexate in low doses (7.5 mg/week) was prospectively assessed in 21 patients with rheumatoid arthritis refractory to treatment with gold or penicillamine, during two years. Three patients were prematurely withdrawn from the protocol. A fast and significant improvement of RA was observed during the first six months, which tapered thereafter. Erythrocyte sedimentation rate decreased from 51.5 +/- 20.1 to 27.7 +/- 11.5 mm/h (p < 0.05). A rise in serum transaminases, always raising to less than twice the normal value, was observed in 75% of patients in some moment of the follow up. Hepatic scintigraphy did not show significant changes. Hepatic histological alterations were mild and no changes were observed after two years of treatment. The main secondary effects were moderate and transitory gastrointestinal and hematological disturbances. The prednisone dose was decreased from 6.8 +/- 2.6 to 4.8 +/- 1.9 mg/day at twelve months. There were no withdrawals due to drug toxicity. It is concluded that methotrexate proved to be efficacious in the treatment of rheumatoid arthritis refractory to conventional treatments. Its secondary effects, although frequent, were discrete and transitory and there were no changes in liver histology.