Clinical accuracy of a non-contact infrared skin thermometer in paediatric practice.

BACKGROUND: Rectal thermometry is considered the most reliable method for measuring the temperature in the paediatric population. Recently, a new non-contact skin infrared thermometer for children was introduced in the market with excellent acceptance by parents. METHODS: A prospective, analytical, cross-sectional study was designed in order to assess the effectiveness of the infrared non-contact thermometer (Thermofocus) in comparison with two other known methods used to measure body temperature. Children aged 1 to 48 months were included from the emergency room and inpatient unit. All patients selected were assessed with three different thermometers: (1) non-contact infrared thermometer (Thermofocus); (2) temporal artery thermometer (Exergen); and (3) rectal glass mercury thermometer. RESULTS: Four hundred and thirty-four patients were eligible to complete the study. One hundred and sixty-seven were identified with fever. The mean age of the patients studied was 14.6 ± 10.7 months. Both devices were strongly correlated with the rectal temperature: r = 0.950 for Exergen and r = 0.952 for Thermofocus. The mean difference in temperature between the rectal temperature and the non-contact thermometer was 0.029 ± 0.01 °C (P < 0.001), while the mean difference between the temporal artery thermometer and the rectal temperature was -0.20 ± 0.27 °C (P < 0.001). The sensitivity and specificity for the non-contact thermometer is 97%. The negative predictive value is 99%, which is especially important to rule out fever and avoid unnecessary laboratory work-up. CONCLUSIONS: The non-contact infrared thermometer is a reliable, comfortable and accurate option for measurement of temperature and is very useful for the screening of fever in the paediatric population. More studies are recommended to support the evidence found in this study and compare its accuracy with more complex devices.

[First case of sacral neuromodulation for treatment of urinary and fecal incontinence in Mexico. Case report.]. / Primer caso de neuromodulación sacrapara el tratamiento de la incontinenciaurinaria y fecal en México. Informe de caso.

Sacral neuromodulation is a new treatment for urinary and fecal incontinence that has demonstrated good therapeutic results. This treatment modality has shown not only to reduce urinary dysfunction symptoms and urinary and fecal incontinence but improve quality of life scores as well. We present a 73 years old female patient with severe fecal and urinary incontinence with major quality of life impact. She was referred after failure of different surgical and conservative therapeutic approaches. Her evaluation met inclusion criteria for sacral neuromodulation treatment. Acute sacral nerve evaluation (PNE) proved to be therapeutic in the patient as measured by at least a 50 percent improvement in her symptoms so a permanent implant (Medtronic InterStim System) was placed. After the implant there was a significant improvement in urinary and fecal functional scores. Fecal Incontinence Severity Index improved from 34 to 8 and Urinary Sandvik's Severity Index from very severe urinary incontinence to minor urinary incontinence after the placement of the implant. Using standard quality of life questionnaires, she improved in the areas of lifestyle,coping and behavior and her experience with depression and self-perception.

Prevalence of insulin resistance and its association with metabolic syndrome criteria among Bolivian children and adolescents with obesity.

BACKGROUND: Obesity is a one of the most common nutritional disorder worldwide, clearly associated with the metabolic syndrome, condition with implications for the development of many chronic diseases. In the poorest countries of Latin America, malnourishment is still the most prevalent nutritional problem, but obesity is emerging in alarming rates over the last 10 years without a predictable association with metabolic syndrome. The objective of our study was to determine the association between insulin-resistance and components of the metabolic syndrome in a group of Bolivian obese children and adolescents. The second objective was determining the relation of acanthosis nigricans and insulin-resistance. METHODS: We studied 61 obese children and adolescents aged between 5 and 18 years old. All children underwent an oral glucose tolerance test and fasting blood sample was also obtained to measure insulin, HDL, LDL and triglycerides serum level. The diagnosis of metabolic syndrome was defined according to National Cholesterol Education Program-Adult Treatment Panel (NCEP-ATP III) criteria adapted for children. RESULTS: Metabolic syndrome was found in 36% of the children, with a higher rate among males (40%) than females (32.2%) (p = 0.599). The prevalence of each of the components was 8.2% in impaired glucose tolerance, 42.6% for high triglyceride level, 55.7% for low levels of high-density lipoprotein cholesterol, and 24.5% for high blood pressure. Insulin resistance (HOMA-IR > 3.5) was found in 39.4% of the children, with a higher rate in males (50%) than females (29%). A strong correlation was found between insulin resistance and high blood pressure (p = 0.0148) and high triglycerides (p = 0.002). No statistical significance was found between the presence of acanthosis nigricans and insulin resistance. CONCLUSION: Metabolic syndrome has a prevalence of 36% in children and adolescent population in the study. Insulin resistance was very common among children with obesity with a significant association with high blood pressure and high triglycerides presence.

GETAWAY descriptors to predicting A(2A) adenosine receptors agonists.

The GEometry, Topology and Atom-Weights AssemblY approach has been applied to the study of the A(2A) adenosine receptors agonist effect of 29 adenosine analogues: N(6)-arylcarbamoyl, 2-arylalkynyl-N(6)-arylcarbamoyl, and N(6)-carboxamido derivatives. A model able to describe more than 77% of the variance in the experimental activity was developed with the use of the mentioned approach. In contrast, no one of four different approaches, including the use of Topological, Galvez Topological Charges indexes, Geometrical and WHIM descriptors were able to explain more than 70% of the variance in the mentioned property with the same number of variables in the equation.

Pyridazine derivatives. XI: Antihypertensive activity of 3-hydrazinocycloheptyl[1,2-c]pyridazine and its hydrazone derivatives.

3-Hydrazinocycloheptyl[1,2-c]pyridazine (4) and its hydrazone derivatives 3-[N1-(isopropylidene)]hydrazinocycloheptyl[1,2-c]pyridazine [correction of hydrazinocyclohexyl] (5) and 3-[N1-(isobutylidene)]hydrazinocycloheptyl[1,2-c]pyridazine (6) were prepared, and their activity against genetic, neurogenically-induced, and deoxycorticosterone acetate -NaCl-induced hypertension was found to be at least as great as that of hydralazine. The results of studying vasorelaxation of rat aorta by 4 and hydralazine suggest that both these compounds owe their antihypertensive activity to direct relaxation of vascular smooth muscle.

AM1 theoretical study, synthesis and biological evaluation of some benzofuran analogues of anti-inflammatory arylalkanoic acids.

Using the semi-empirical quantum-mechanical method AM1, the molecular geometries of the arylalkanoic acids, indomethacin, naproxen and ibuprofen, were optimized and their frontier orbital charge distributions evaluated. Then, these molecular parameters were compared in order to identify structure-activity relationships and, on the basis of these, four benzofuran-3-acetic acids were designed as potential non-steroidal anti-inflammatory agents, and rapidly synthesized by a novel and easily generalized route. Notwithstanding the structural similarities between the synthesized compounds and the anti-inflammatory arylalkanoic acids, these compounds did not appreciably inhibit human platelet cyclooxygenase in vitro.

A model of suture-induced urolithiasis with urographic control in the bladder of the rat.

The characteristics of a model of urolithiasis in the bladder of male Wistar rats were evaluated. Two techniques were compared: one knot of suture material through the bladder wall, or 15-throw knots inside the bladder. Rats were randomly assigned to one of six groups, according to the technique and suture material used (polyester, silk, or chromic catgut). An excretory urogram was performed at days 30, 60, and 90. At the moment of positive radiographic diagnosis, animals were sacrificed and stones were obtained. All rats were sacrificed at day 90 regardless of the x-ray results. Variables evaluated were average days to a positive urogram, average weight of all uroliths, and percentage of animals developing urolithiasis throughout the study. There were no statistical differences between groups for the average weight of stones, which ranged from 0.008 to 1.502 g for individual cases. All three materials were more lithogenic with the 15-throw knot inside technique. No significant differences were detected for lithogenesis criteria between suture materials. X-ray dispersion spectroscopy evidenced calcium phosphate composition of two stones from chromic catgut, and magnesium phosphate composition of two stones from chromic catgut, two from silk, and two from polyester. Neo-epithelization over the suture was confirmed microscopically in bladders with the one-throw technique. We conclude that (1) this is an effective model of urolithiasis, with predictability in time, composition, and amount of stone formation; (2) the presence of more suture material inside the bladder is more lithogenic; and (3) excretory urograms are highly sensitive and specific for the noninvasive diagnosis of bladder urolithiasis.

Who is publishing in Theriogenology and on what subjects?

An analysis of 503 articles published in the journal Theriogenology in 1984, 1987 and 1990 was conducted to identify research trends and researchers publishing in the journal. A 30.5% increase in the number of papers published was found for 1990. During the 3 yr period studied, the United States and Canada accounted for 63.1% of the total number of articles published, followed by European countries with 14.3%, and by Asia with 12.0%. At least 1 paper was published from 41 countries. The United States, at the top of the list, increased its share from 16% in 1984 to 21% in 1990. The number of papers from Japan increased significantly while the percentage of participation from Europe declined. The female animal was the sole subject of 63.2% of the articles, and cattle were the most researched species, appearing in 44.3% of the studies. Although the estrous cycle was the most studied reproductive event in all 3 yr, there was also a trend for the popularity of this topic to decrease in favor of the subject fertilization. The number of authors per paper increased significantly over the years analyzed, as did the number of studies carried out in international cooperation. Institutes of higher education were represented in almost 70% of the papers, followed by research institutes (12.8%). The present analysis confirms the central role that the journal Theriogenology plays in the world-wide communication of research results in animal reproduction.

Resolution of racemic mixtures of carbocyclic analogues of nucleosides and assignment of their absolute configuration.

Racemic trans-6-chloro-9-[2-(hydroxymethyl)cyclopentyl]purine was resolved using HPLC with a chiral column. The absolute configurations of the enantiomers were determined by NMR studies of their (R)- and (S)-methoxyphenylacetates.

Synthesis and structural study of pyrimidyl carbocyclic analogues of nucleosides based on cyclopentene rings.

A series of 1,2-disubstituted carbonucleoside analogues of pyrimidine and 5-halopyrimidines with the unsaturated carbocycle cyclopentene was synthesized. AIM theory was applied to analyse the conformational and electronic effects of 5-halogenation.

Purine derivatives of 1,2-disubstituted cyclohexane analogues of nucleosides.

Starting from (+/-)-cis-2-hydroxymethylcyclohexylamine, a series of cyclohexane-derived cis-1,2-disubstituted carbonucleoside analogues with a 6- or 2,6-purine or 8-azapurine base were synthesized. The antiviral and antitumoral in vitro effects of the new compounds were evaluated.

Synthesis of carbocyclic analogues of MECA and NECA 1,2-disubstituted as potential adenosine receptor agonists.

A new class of 1,2-disubstituted carbocyclic nucleosides of MECA and NECA analogues was synthesized in good yield starting from (+/-) 6-azabicyclo[3.2.0]heptan-7-one.

[Sphincter-preserving surgery in rectal cancer]. / Cirugía preservadora de esfínter para cáncer de recto.

BACKGROUND: Surgical treatment for rectal cancer in the medium and lower third was traditionally abdominoperineal resection, but the possibility of sphincter preserving procedures has been emphasized in the last decades. PURPOSE: This review article was performed in order to discuss and analyze the surgical procedures available for treatment of rectal cancer. RESULTS: Surgical treatment of rectal cancer has changed due to a better understanding of the biological behavior of the tumor, improvement in diagnostic tests to stage the disease, and the development of better surgical techniques (surgical staplers) with the consequent increase in the possibility of sphincter-saving procedures. Adjuvant therapy has played a major role for improving the patient's prognosis. Even with all these improvements, the final outcome has not been changed in the last 15 years, and prospective studies are necessary to clarify the polemic issues still in debate: the development of better prognostic factors, more sensitive staging tests, the role of the complete mesorectal excision and pelvic lymphadenectomy, the adequacy of laparoscopic techniques in malignant disease, and the finding of the ideal scheme of adjuvant therapy. CONCLUSION: Significant progress has been made in the treatment of rectal cancer, but there are still important issues to be solved.

[Fistulotomy vs fistulectomy. Ultrasonographic evaluation of lesion of the anal sphincter function]. / Fistulotomía vs fistulectomía. Valoración ultrasonográfica de lesión al mecanismo de esfínter anal.

OBJECTIVE: To determine the extension of the lesion implicated on the mechanism of the anal sphincter with endoanal ultrasound in patients with simple fistulae, managed with fistulotomy versus fistulectomy. SITE: Central Military Hospital. Colon and Rectum Service. DESIGN OF STUDY: A prospective, comparative, descriptive and longitudinal study was performed. METHODS: A total of 40 patients with anal simple fistula were studied from march 1997 to march 1998. They were divided in two randomized groups: group A (n = 20) patients treated with fistulectomy, and group B (n = 20) patients managed with fistulotomy. Endoanal ultrasound was practice at the time of the diagnosis and six weeks later to identify integrity of both internal and external anal sphincter, and to register them in separate form. RESULTS: There were no significant differences in sex and age distribution, nor in type of fistula. The average of internal anal sphincter lesion in inter-sphincteric fistulae treated with fistulotomy was 8.5 mm versus 9.08 with fistulectomy (p > 0.05). The average of internal and external anal sphincter lesion in trans-sphincteric fistulae managed with fistulotomy was 9.25 mm versus 11.38 with fistulectomy (p < 0.05). The global analysis showed that the average of the lesion in the sphincter, mechanism was larger in the fistulectomy versus fistulotomy (p < 0.05). CONCLUSION: The major muscular injury made to the sphincter mechanism is caused mainly by the fistulectomy in comparison with the conventional fistulotomy.

[Laparoscopically created stomas]. / Estomas por laparoscopia.

PURPOSE: The aim of this paper is to present the results obtained in five cases with a stoma created by the laparoscopic approach. PATIENTS AND METHOD: Analysis of five patients who required a stoma as treatment for their diseases or as a complementary management of another medical problem from March 1999 to May 1999. There were three women and two men. Mean age was 43 years (range 20-59 years). Two women had a rectovaginal fistula secondary to radiation proctitis, another woman presented an infected sacral wound, one man suffered a sphincteric lesion that required sphincteroplasty, and the other man had Fournier's gangrene. Surgical technique included the use of two ports, one at the umbilicus for the camera and the other at the site previously chosen for the stoma. RESULTS: Mean surgical time was 30 min (range 20-40 min), transoperative bleeding was meaningless; all stomas began to function during the first 24 h after the procedure. One patient began oral intake on the first day, three patients on the second day, and one patient was intubated in the intensive care unit and for this reason was unable to eat. All stomas achieved the objective sought and there were no complications related to the procedure. CONCLUSIONS: Stoma creation by the laparoscopic approach may offer advantages over the open-surgery technique.

[Primary melanoma of the esophagus. Unusual case with Barrett's esophagus]. / Melanoma primario en el esófago. Caso inusual con esófago de Barrett.

OBJECTIVE: To present a rare entity of difficult preoperative diagnosis. BACKGROUND: Primary malignant melanoma of the esophagus represents 0.1% of all malignant tumors in this organ. It has been described in association with esophageal melanocytosis and melanosis with a clinic behavior similar to other neoplasm in the esophagus, but is more aggressive and fatal. By endoscopy, it usually appears as a vegetant, non-obstructive lesion, with dark pigmentation in the melanotic variant, the sole evidence that suggests the diagnosis prior to microscopic examination. Clinical exclusion of metastasis melanoma as a possibility is obligatory. METHODS: We reviewed clinical, imagenologic, endoscopic, and anatomopathological aspects of an ulcerovegetant neoplasm on the esophago-gastric junction, surgically resected, in a 65 years-old man with progressive dysphagia, who was without tumoral relapse during 18 months after surgery. RESULTS: The tumoral mass was an anaplastic cell tumor with very scant melanic pigmentation and diffuses stain for HMB-45 antigen and S100 protein, considering it to be a primary malignant melanoma. The neighboring mucous membrane showed a typical Barrett's esophagus and melanocytic hyperplasia. CONCLUSIONS: 1) Endoscopy may suggest the possibility of esophagus melanoma when there is a vegetate, non-obstructive, pigmented tumor. 2) Immunohistochemistry confirms the entity if HMB-45 antigen and S100 protein are detected in the tumoral cells, while the negative results for keratin and leukocytic common antigen (LCA) eliminate carcinoma and lymphoma as possible diagnoses. 3) In our case, the presence of Barrett's esophagus is exceptional, because it has not been described previously in the literature reviewed.

[Simulators in anesthesiology]. / Simuladores en anestesia.

The work of an anesthesiologist and that of a flight pilot share certain attributes. As pilots use simulators to obtain risk-free practice in recognizing and controlling situations that might lead to disaster, simulation programs are now emerging as a new way to learn and train anesthesiology is being conceived as a new task that integrates scientific knowledge and human factors. Simulators have been introduced into teaching and training programs as a powerful tools that allow anesthesiologists to learn, practice and train in a multitude of situations without putting human life at risk. Experience is limited so far, but acceptance has been high and simulators seem to accelerate the acquisition of skills and knowledge, although their effect on performance in critical situations has not been proven yet. Two types have been applied in anesthesiology: computer screen and mannequin. The usefulness of simulators ranges from training for situations that require the systematic application of protocols and the understanding of new drugs being introduced into clinical practice to the practice of how to use resources for managing anesthetic emergencies. It is still too early to use simulators for certifying and evaluating clinical performance, as further studies are needed to identify the type of events that reflect typical situations and to determine which procedures should be evaluated.

Chronic obstructive pulmonary disease. Are the times changing?

Chronic obstructive pulmonary disease (COPD) is one of the most prevalent diseases and a major cause of morbidity and mortality in Spain. Currently, COPD is considered a treatable disease with an inflammatory origin that is frequently associated with other diseases. The prevalence of comorbidity is clearly increased in patients with COPD, irrespective of other confounding variables such as smoking. Current treatments have been proven to slow the loss of lung function, decrease the number of exacerbations and improve health-related quality of life and survival. New advances regarding the classics and more recent phenotypes such as patients with frequent exacerbations or COPD with associated comorbidity should allow for more individualized treatment while advances in genetic research and inflammatory mechanisms of the disease will help us to increase our knowledge of the disease and the development of new treatments.

Prevalence of thoracic vertebral fractures in Spanish patients hospitalized in Internal Medicine Departments. Assessment of the clinical inertia. (PREFRAMI study).

PURPOSE: To study the prevalence of vertebral fractures (VF), the associated risk factors and the degree of diagnosis and prescription upon discharge in a series of hospitalized medical patients ≥50 years of age. METHODS: A cross-sectional, multicentre and observational study in which a prevalence cut-off was carried out concerning patients admitted to six Internal Medicine departments in Malaga (Spain). The main variables were the existence of a fracture in the spine lateral x-ray, the inclusion of the diagnosis of a fracture in the discharge report, and the establishment of anti-osteoporotic treatment at discharge. RESULTS: 254 patients were included (mean age 66.4±14.9 years). The prevalence of VF was of 14.2% (36 cases). Patients with VF presented with a higher mean age, compared to those without VF (70.14 vs. 65.7 years) (p=0.035). The means contrast for the FRAX index variable (major osteoporotic and hip fracture), grouping according to the presence of VF, did not show any statistical significance (p=0.369 and p=0.788, respectively). Only in 8.3% of the discharge reports of patients with VF had the diagnosis of VF and/or osteoporosis been recorded and the prescription of anti-osteoporotic drugs been included. CONCLUSIONS: A high prevalence of asymptomatic VF is verified in medical inpatients ≥50 years of age. The FRAX index did not turn out to be predictive of the presence of VF in this population. There is an underdiagnosis of osteoporotic VF in the coding at hospital discharge. Action protocols are necessary to avoid clinical inactivity regarding this entity.