Utilidad clínica del Antígeno Carcinoembrionario (ACE), Tomografía convencional (TC) y PET-CT en el diagnóstico de adenocarcinoma colorrectal recidivante / Clinical utility of Carcinoembryonic Antigen (ACE), conventional tomography (CT) and PET-CT in the diagnosis of recurrent colorectal adenocarcinoma

Introduction: Colorectal cancer is one of the most prevalent tumors in the world. In the surveillance setting of recurrent colorectal cancer, laboratory test like carncinoembryonic antigen (CEA) and imaging tests like computed tomography (CT) and positron emission tomography (PET/CT) are available. We performed this study to establish the predictive accuracy of these tests to an early identification of recurrent colorectal cáncer. Materials and Methods: Thirty six patients at stages I , III and IV, after single metastasis resection of colorectal cáncer were identified. We assessed the utility of CEA, CT and PET-CT in the follow-up of these patients to improve the diagnosis of recurrent disease. Results: Of 36 studied patients, 27 /75%) had recurrence; the median age was 61 year-old and the median lap-time 16 months. The PET PET/CT scan obtained the following results: sensitivity 96.7%, specificity 88.9%, positive predictive value 96.3%, negative predictive value 88.9%, positive likekihood ratio 8.7 and negative likelihood ratio 0.04. Discusion: The best tool to make diagnosis of colorectal cancer and its recurrence is PET­CT, however, none of these tests could make the diagnosis by themselves. It has to be confirmed by histopathologic studies plus other exams.

Avances en la cirugía de la disrrafia espinal en el Instituto de Neurocirugía de Chile: el uso del neuromonitoreo mejora radicalmente los resultados quirúrgicos / Advances in spinal dysraphism surgery at the Institute of Neurosurgery of Chile: the use of neuromonitoring radically improves surgical outcomes

El objetivo del tratamiento quirúrgico de los pacientes aquejados de disrrafia espinal es mantener su función neurológica estable y óptima durante toda su vida, sin embargo, existe un riesgo importante implícito en la cirugía. Con el objeto de investigar el impacto del monitoreo electrofisiológico intraoperatorio (MIO) en la evolución postoperatoria de estos pacientes, el cirujano practicó electromiografía libre y estimulada como retroalimentación continua del procedimiento. Las patologías operadas fueron: lipomas del fillum, lipomas del cono medular y re-anclajes de pacientes portadores de mielomeningocele al nacer. En todas las patologías se comparó la evolución post-operatoria con grupos de pacientes operados sin MIO, con el objeto de comparar sus evoluciones. Se observaron diferencias significativas entre los tres grupos de pacientes el uso de MIO evita el deterioro motor y la aparición de vejiga neurogénica en pacientes operados de lipoma del cono, evita la inclusión de raíces nerviosas en la sección del Fillum y evita el deterioro motor y ayuda a mejorar la función vesical de pacientes que se operan por re-anclaje medular por mielomeningocele. Finalmente, fue posible aplicar esta técnica en recién nacidos con mielomeningocele bajo, desarrollándose un protocolo que evita de facto el deterioro motor y debería evitar la inclusión de piel durante la tunelización de la placoda. Los datos mostrados en el presente trabajo permiten afirmar que esta técnica, por primera vez desarrollada en el sistema público chileno, así aplicada mejora muy significativamente los resultados de la cirugía de disrrafia espinal.

Inulin determination for food labeling.

Inulin and oligofructose exhibit valuable nutritional and functional attributes, so they are used as supplements as soluble fiber or as macronutrient substitutes. As classic analytical methods for dietary fiber measurement are not effective, several specific methods have been proposed. These methods measure total fructans and are based on one or more enzymatic sample treatments and determination of released sugars. To determine inulin for labeling purposes, we developed an easy and rapid anion-exchange high-performance liquid chromatography (HPLC) method following water extraction of inulin. HPLC conditions included an Aminex HPX- 87C column (Bio-Rad), deionized water at 85 degrees C as the mobile phase and a refractive index detector. The tested foods included tailor-made food products containing known amounts of inulin and commercial products (cookies, milk, ice creams, cheese, and cereal bars). The average recovery was 97%, and the coefficient of variation ranged from 1.1 to 5% in the food matrixes. The obtained results showed that this method provides an easier, faster and cheaper alternative than previous techniques for determining inulin with enough accuracy and precision for routine labeling purposes by direct determination of inulin by HPLC with refractive index detection.

[In vitro analysis of the iron availability in fortified rice]. / Análisis in vitro de la disponibilidad del hierro en el arroz fortificado.

Cereals are rich in fiber but also in phytate which is considered the principal inhibitor of mineral availability. On this basis, iron availability of fortified rice, and the inhibitory effect of bran phytate was studied in: white rice fortified with electrolytic iron (ABF) from commercial origin; and mixtures of ABF plus 4.76% and 9.09% of rice bran (ABF2 and ABF3 respectively) to simulate brown rice. Samples were analysed before and after phytic acid hydrolysis with phytase: Dietary fiber and phytic acid were assessed according AOAC; iron availability, expressed as dialisable iron by the in vitro method of Kapsokefalou and Miller modified by Valencia et al.; iron content was assessed by AAS. Results showed that added bran depressed iron availability, 9.65%; 4.04% and 1.82% as expected (ABF, ABF2 and ABF3 respectively). After phytic acid hydrolysis iron availability reached 28.20%; 27.95% and 25.30% for the same samples. These values were not different. After phytic acid hydrolysis, fiber content of ABF2 and ABF3 were lower than before. However multiple regression analysis of the data showed that fiber had not influence on iron availability and that phytic acid would be the principal responsible of it. These results indicate that brown rice should have a higher level of iron fortification than in white rice or be combined with other foods that improve iron availability as meats, vegetables or fruits.

Literature review: sinus pericranii.

Sinus pericranii is a rare circumscribed fluctuating vascular swelling of the scalp that communicates with the intracranial venous system. It has been associated with other intracranial vascular malformations. The tumour is usually round, fluctuant, nonpulsatile, and disappears with compression. Its size increases during manoeuvers that increase the intracranial pressure. Approximately 100 cases were reported in the literature. The antecedents, different surgical procedures, differential diagnoses, and associated malformations were reviewed.

[Nutrient content in raw and processed foods derived from cereals and legumes. I: Centesimal composition and energetic value]. / Contenido de nutrientes en materias primas y productos procesados derivados de cereales y leguminosas. I: Composición centesimal y valor energético.

Proximate composition and metabolizable energy of raw and processed foods derived from cereals and legumes, were determined. Results can be used to revise the out of day national composition table, to incorporate data of ash, new data of dietary fiber obtained by an enzimatic hydrolysis method, asimilable carbohydrates and metabolizable energy. They also replace the composition of various foods which were compiled from foreing tables. Difference observed on values of lipids in those foods with low lipid content, are imputed to the solvents used in the extraction.

[Ultrasonography in spinal dysraphism and tethered cord]. / Ultrasonografía en la disrafia espinal y la médula anclada.

Spinal dysraphism is relatively common in children and includes a wide spectrum of congenital anomalies in the normal closure of the posterior elements of the spine. The prognosis will depend mostly on early diagnosis and treatment. Occult spinal dysraphism may present without external anomalies and the diagnosis could be suspected lately, when neurological symptoms are present and often irreversible. Occult spinal dysraphism is frequently associated to a tethered cord, most commonly secondary to the presence of a lipoma. Ultrasonography has been proven highly sensitive in the detection of intraspinal anomalies, especially in the diagnosis of tethered cord, in children under two years of age due to lack of ossification of the posterior elements of the spine. Today ultrasonography should be the examination of choice in all those patients in whom some kind of spinal dysraphism is suspected. We report our experience with three infants with occult spinal dysraphism in whom diagnosis was initially made by US and later on proved by either computed tomography, magnetic resonance or myelography. All of them had corrective surgery and neurological abnormalities were not detected afterwards.

Metastasis cerebral de tumor de Wilms / Cerebral metastases of wilms' tumor

Se presenta el caso de un niño de doce años de edad, portador de una metástasis cerebral de un tumor de Wilms descubierto y extirpado mediante nefrectomía a los cinco años, de edad. Posteriormente fue intervenido en 2 ocasiones por presentar metástasis pulmonares a los seis y siete años de edad, agregándose nuevamente radioterapia y adicionándose, quimioterapia. Su enfermedad se estabilizó, entonces por espacio de cuatro años y medio al cabo de los cuales aparece signología neurológica que motiva una exploración con Tomografía Axial Computada (TAC) de cráneo demostrándose, una lesión altamente sugerente de metástasis en la región parietal superior izquierda. La posterior craneotomía y remoción confirman histopatológicamente, la presencia de una metástasis cerebral del Tumor de Wilms original

Cloverleaf skull syndrome.

4 cases of cloverleaf skull syndrome are reported and analyzed after a brief review of the literature is presented. It is noted that reported cases of surgical management of this entity are extraordinarily rare. The rather characteristic displacement of intracranial contents suggests early onset of craniosynostosis (in intrauterine life) and that hydrocephalus is not an invariable complication present at the time of birth. Rather, it appears that the hydrocephalus is secondary to obliteration of the cortical subarachnoid spaces and the presence of a cranial ring. Total craniectomy proved to be a satisfactory treatment, one which was responsible for the reversal of hydrocephalus. Early detection and treatment of this rather rare malformation results in acceptable cosmetic and neurologic improvement.

Micro-abscesses and presumptive inflammatory nodules of the brain.

Sixteen cases of micro-abscesses and presumptive inflammatory nodules of the brain are analyzed. The increasing frequency of cortico-subcortical small nodular lesions diagnosed by CT scan, as well as the number of cases successfully treated with antibiotics, are stressed. In the authors opinion, initial antibiotic treatment with a high possibility of a cure is indicated in patients with a presumptive inflammatory cortico-subcortical nodular lesions diagnosed by CT scan.

Tumors of the optic pathways.Analysis of 12 cases.

Se analizan 12 pacientes portadores de gliomas de la via optica. Once pacientes fueron intervenidos; seis fueron sometidos a radioterapia. El analisis retrospectivo parece demostrar que el mejor metodo de manejar estos casos es mantenerlos en control seriado con T.A.C., examenes oftalmologicos y radiologia de los agujeros opticos. Las indicaciones quirurgicas quedan reservadas a tumores de un nervio optico con severo compromiso de vision, frente a un exoftalmo doloroso y el uso de derivativa externa por hidrocefalia.La craniotomia exploratoria se justifica en casos de diagnostico diferencial dudoso con otras lesiones benignas del area susceptible de reseccion quirurgica (v. gr. Craneofaringeomas). La radioterapia puede tener indicacion en casos seleccionados

Experiencia en el diagnostico antenatal de hidranencefalia y estudio ulterior de los recien nacidos. / Experience in antenatal diagnosis of hydranencephaly and farther study of the newborn infants

1. Se presentan y analizan cuatro casos de diagnostico antenatal de hidranencefalia, formulados entre aproximadamente 6.776 ecografias obstetricas practicadas en la Unidad de Ecografia de la Maternidad del Hospital Barros Luco-Trudeau, desde noviembre de 1979 a mayo de 1983. 2. Se estudia posteriormente a los cuatro recien nacidos mediante angiografia isotopica, ecotomografia, electroencefalografia, tomografia axial computadorizada y, en un caso, por la necropsia practicada. 3. En tres casos se comprueba el diagnostico de hidranencefalia, resultando el ultimo una hidrocefalia. 4. Se hace um analisis de las caracteristicas ecograficas, clinicas, anatomopatologicas y de laboratorio de los casos de hidranencefalia, y se efectuan alcances sobre la etiopatogenia, diagnostico, pronostico y tratamiento del cuadro.5. Se destacan algunos hechos del diagnostico diferencial, antenatal y postnatal, entre hidranencefalia e hidrocefalia, lo que tiene interes por las posibilidades quirurgicas, incluso in utero, de la ultima anomalia, con la consiguiente mejoria del pronostico

Gamma-encephalography in the diagnosis of subdural effusions in infancy and childhood.

The results of the use of gamma-encephalography (GEG) as a diagnostic tool in a group of 28 patients with subdural effusions and 46 membranes confirmed at surgery are presented. 27 patients were submitted to bilateral surgical expolorations and 1 was unilaterally explored. Positive GEG: membranes were present in 34, in 8 the test was nonconclusive and there were 4 false-negatives. Negative GEG: membranes were absent in 6, 1 case was nonconclusive and 2 were false-positive tests. Therefore, from 28 patients with 46 membranes the GEG was correct in two thirds of the cases, it was nonconclusive in 9 cases and the image did not confirm the surgical findings in 6 cases (false-positive or false-negative). The results suggest that the presence of a medium or thick membrane almost always results in a positive image, whereas the presence of a thin membrane leads to a nonconclusive result or in some cases a false-negative one. The general data from the literature correlates well with the present series.