[Effect of the resection margin and the extrarectal spread on the recurrence following 2 types of surgical procedures in rectal cancer]. / Influencia del margen de sección y de la diseminación extrarrectal en la recidiva después de dos tipos de intervenciones por cáncer de recto.

A prospective unrandomized clinical study was conducted to determine the incidence of local recurrences after radical surgery and to ascertain whether the anterior resection could be an effective approach in cases of the tumours of the rectum, also in presence of the unsatisfied distal clearance and the extraparietal spread. For this purpose the length of the rectum below the tumor, mesorectum included, was cut in little cubes of 1 square cm and 10 microslices/cm at random were histologically examined to locate the intramural diffusion and extraparietal spread. Sixty-one patients undergoing curative surgery for rectal cancer entered the trial. Thirty-seven of them have been operated on by anterior resections (AR) and twenty-four by abdominal-perineal amputation. Thirteen local recurrences (21.3%) have been recorded during a five-year follow-up: 9 after AR and 4 after Miles operation. Nine relapses were among the cases with distal clearance less than 3 cm an eight of these have undergone anterior resections. No recurrence was seen in cases with distal clearance greater than 5 cm. Spread was found in 11 (18%) patients. Five recurrences were recorded all belonging to the group with anterior resection. No statistical difference exists between conservative surgical procedure and abdominal-perineal operation. We have been able to demonstrate only the direct relationship between relapse and Dukes C stage after curative rectal surgery.

A reconfigurable, wearable, wireless ECG system.

New emerging concepts as "wireless hospital", "mobile healthcare" or "wearable telemonitoring" require the development of bio-signal acquisition devices to be easily integrated into the clinical routine. In this work, we present a new system for Electrocardiogram (ECG) acquisition and its processing, with wireless transmission on demand (either the complete ECG or only one alarm message, just in case a pathological heart rate detected). Size and power consumption are optimized in order to provide mobility and comfort to the patient. We have designed a modular hardware system and an autonomous platform based on a Field-Programmable Gate Array (FPGA) for developing and debugging. The modular approach allows to redesign the system in an easy way. Its adaptation to a new biomedical signal would only need small changes on it. The hardware system is composed of three layers that can be plugged/unplugged: communication layer, processing layer and sensor layer. In addition, we also present a general purpose end-user application developed for mobile phones or Personal Digital Assistant devices (PDAs).

[Pyomyositis in AIDS]. / Piomiositis en SIDA.

We describe two cases of pyomyositis in two patients with acquired immunodeficiency syndrome. Neither of the two cases had previous history of predisposing factors and both patients began with fever and pain at the site of the lesions. Aspiration by punction was required in addition to the antimicrobial therapy.

[Cytomegalovirus colitis simulating neoplasm in a patient with HIV infection]. / Colitis por citomegalovirus que simula una neoplasia en paciente con infección por HIV.

AIM: Cytomegalovirus colitis occurs in at least 5-10% of patients with AIDS. The most usual form of clinical presentation is that of a chronic picture of diarrhea, fever and abdominal pain in a patient with AIDS with a CD4 lymphocyte count lower than 100/mm3, although it can be the diagnostic index for AIDS up to in 25% of the cases. METHODS: Cytomegalovirus colitis in a patient with AIDS was diagnosed by endoscopy and colonic biopsy. The clinical was diagnosed by endoscopy and colonic biopsy. The clinical picture consisted of abdominal pain, without the findings of fever and diarrhea described in almost 80% and 100% respectively of the cases published in the literature. The barium enema carried out showed a stenotic appearance, like serviette ring, in the ascending colon, which suggested neoplasia of the colon. RESULTS: Induction therapy with ganciclovir was effective. However, the patient was readmitted one year later for chorioretinitis due to cytomegalovirus, without any evidence of gastro-intestinal involvement. CONCLUSIONS: Although unusual, cytomegalovirus colitis can be present with an abdominal clinical picture without diarrhea. Radiological and/or endoscopic pseudotumoral forms which this entity can adopt are often described. Endoscopy with digestive biopsy in essential for diagnosis. Therapy with ganciclovir can be effective although the reappearance of findings from cytomegalovirus can occur at another area, or as a gastrointestinal recurrence.

[Cryptococcal meningitis and AIDS. Clinical description of 10 patients]. / Meningitis criptocócica y SIDA. Descripción clínica de 10 pacientes.

We have studied 10 patients with cryptococcal meningitis and AIDS. Nine of them were intravenous drug users and four have been previously diagnosed of AIDS. In 60% of them cryptococcal meningitis was the first opportunistic infection, and as group represented only 6.3% of our 158 patients with AIDS on the same period. The most common symptoms were: malaise (100%), headache (80%), fever (60%), meningeal signs (50%). Two of them had focal neurological disease. CSF culture and serum cryptococcal antigen test were positive in 90%, the Indian ink in 77% and blood cultures in 30% of the cases, while indian ink preparation did it in 77%. MRI showed bilateral small lesions, deeply located, in 3 cases; it was also useful to prove optical tract lesions in a patient with blindness as a result of cryptococcal meningitis. We had treatment successes in 80% of the cases, all patients being treated with amphotericin B, alone in 4 and amphotericin B plus fluorocytosine in 6. Two patients died within the first 2 weeks. Maintenance therapy with fluconazole was effective and well tolerated, with 3 patients dying from causes other than cryptococcal meningitis. We recorded a survival rate over 12 months in 33% of patients.

Postoperative changes in serum interleukin-2 concentrations.

OBJECTIVE: To evaluate the postoperative changes in circulating interleukin-2 (IL-2) concentration according to the severity of the surgical injury and other postoperative variables that could influence IL-2 production. DESIGN: Prospective observational study. SETTING: University hospital, Italy. SUBJECTS: 43 patients about to undergo major operations (gastric and colo-rectal resection for cancer), intermediate operations (open cholecystectomy or mastectomy for cancer), and minor operations (hernia repair or breast lump); 24 healthy age and sex matched controls. MAIN OUTCOME MEASURES: Postoperative changes in serum concentrations of IL-2 after different degrees of surgery on the 1st, 3rd and 8th postoperative days correlated with changes in in vivo cellular mediated immunity (skin tests), duration of operation, blood transfusion or postoperative H2-blockers and antiprostaglandins. RESULTS: There were no significant variations in IL-2 serum concentrations postoperatively on ANOVA, and when the data were normalised, there were no significant changes in the median postoperative values after minor and intermediate operations. There was a slight but not significant increase in IL-2 concentrations after major operations. Neither blood transfusion nor duration of operation correlated with postoperative changes in IL-2, while postoperative antiprostaglandins and H2-blockers seemed to provide slight but not significant protection against a reduction in IL-2 concentrations. CONCLUSIONS: Circulating IL-2 does not necessarily correlate with reported in vitro postoperative production of IL-2 and therefore seems to be of little use in monitoring immunosuppression in surgical patients.

Fast-to-slow muscle conversion by chronic electrostimulation: effects on mitochondrial respiratory chain function with possible implications for the gracilis neosphincter procedure.

The effects of chronic, around the clock, low-frequency electrostimulation on the respiratory chain activity and cytochrome content of freshly isolated mitochondria were evaluated in rabbit skeletal muscle before and after 30 days of continuous or cyclical electrostimulation using a totally implantable system and a training programme now used in humans. The respiratory activity measured in state III increased strongly after electrostimulation. The efficiency of the respiratory chain increased significantly after electrostimulation but the activity of complex [(reduced nicotinamide adenine dinucleotide dehydrogenase) did not increase. The amount of cytochromes a and a3, b562, and c and c1 increased clearly after electrostimulation. The respiratory activity rate of mitochondria obtained after continuous electrostimulation was apparently higher than after cyclical electrostimulation. Chronic uninterrupted low-frequency electrostimulation, using a clinical training programme, induces an increase in mitochondrial respiratory chain activity in purified mitochondria of skeletal muscle. These changes are the basis of induced resistance to fatigue in fast-to-slow muscle conversion by chronic electrostimulation.