Characterization of inflammatory bowel disease in Colombia: Results of a national register. / Caracterización de la enfermedad inflamatoria intestinal en Colombia: resultados de un registro nacional.

AIM: To determine the clinical, sociodemographic, and treatment characteristics of inflammatory bowel disease (IBD) in a Colombian population register. METHODS: A descriptive, analytic, observational, cross-sectional, multicenter study on patients with IBD from 17 hospital centers in 9 Colombian cities was conducted. RESULTS: A total of 2,291 patients with IBD were documented, 1,813 (79.1%) of whom presented with ulcerative colitis (UC), 456 (19.9%) with Crohn's disease (CD), and 22 with IBD unclassified (0.9%). The UC/CD ratio was 3.9:1. A total of 18.5% of the patients with UC and 47.3% with CD received biologic therapy. Patients with extensive UC had greater biologic therapy use (OR = 2.78, 95% CI: 2.10-3.65, p = 0.000), a higher surgery rate (OR = 5.4, 95% CI: 3.5-8.3, p = 0.000), and greater frequency of hospitalization (OR = 4.34, 95% CI: 3.47-5.44, p = 0.000). Patients with severe UC had greater biologic therapy use (OR = 5.04, 95% CI: 3.75-6.78, p = 0.000), a higher surgery rate (OR = 8.64, 95% CI: 5.4-13.78, p = 0.000), and greater frequency of hospitalization (OR = 28.45, 95% CI: 19.9-40.7, p = 0.000). CD patients with inflammatory disease behavior (B1) presented with a lower frequency of hospitalization (OR = 0.12, 95% CI: 0.07-0.19, p = 0.000), a lower surgery rate (OR = 0.08, 95% CI: 0.043-0.15, p = 0.000), and less biologic therapy use (OR = 0.26, 95% CI: 0.17-0.41, p = 0.000). CONCLUSION: In Colombia, there is a predominance of UC over CD (3.9:1), as occurs in other Latin American countries. Patients with extensive UC, severe UC, or CD with noninflammatory disease behavior (B2, B3) have a worse prognosis.

IMD/ADM21-47, a factor that improves embryo quality.

Starting in vitro fertilization process with competent oocytes that may endure first cellular divisions is a critical step for obtaining an embryo. To obtain in vitro competent oocytes, culture conditions should emulate the in vivo microenvironment as close as possible. With the aim of improving the in vitro culture medium, the present study evaluated the IMD/ADM21-47 peptide as a factor that promotes oocyte competence and improves embryo quality in bovine systems. The culture supplemented with 153 µg/mL of IMD/ADM21-47 was correlated with the production of healthy oocytes in metaphase II (MII) stage in compacted cumulus-oocyte complexes (COC) with a decrease of BAX/BCL-2 to mRNA ratio and a reduction of late apoptosis by TUNEL in MII oocytes. In addition to this, treatment with IMD/ADM21-47 caused cAMPi level to be constant over time, and the cAMPi level kept increasing until 6 h. COC supplementation with 153 µg/mL of IMD/ADM21-47 increased the blastocyst production rate two-fold in comparison with control conditions. Only embryos from COC treatment with this peptide were capable of developing blastocysts in stage-6 grade I; compared with the control culture, it was the treatment with the greater number of blastocysts stage-5; these are characteristics of good quality blastocysts.

Isolation and characterization of yeasts from fermented apple bagasse as additives for ruminant feeding

Abstract Solid-state fermentation can be used to produce feeds for ruminants, which can provide an enriched population of yeasts to improve ruminal fermentation. Fermentation of apple bagasse was performed to obtain a yeast-rich product, with the objective of isolating, identifying, and characterizing yeast strains and testing their capability to enhance in vitro ruminal fermentation of fibrous feeds. Yeasts were isolated from apple bagasse fermented under in vitro conditions, using rumen liquor obtained from cannulated cows and alfalfa as a fibrous substrate. A total of 16 new yeast strains were isolated and identified by biochemical and molecular methods. The strains were designated Levazot, followed by the isolate number. Their fermentative capacity was assessed using an in vitro gas production method. Strain Levazot 15 (Candida norvegensis) showed the greatest increase in gas production (p < 0.05) compared with the yeast-free control and positively affected in vitro ruminal fermentation parameters of alfalfa and oat straw. Based on these results, it was concluded that the Levazot 15 yeast strain could be potentially used as an additive for ruminants consuming high-fiber diets. However, further studies of effects of these additives on rumen digestion, metabolism, and productive performance of ruminants are required.

Gross and histopathological observations of long-term catheterized vessels in experimental sheep.

Chronic indwelling central vessel catheters provide vascular access for compartmental infusion or sampling. However, complications with catheter patency during the postoperative and/or experimental period often arise. In order to identify physiological occurrences common with such complications, 10 multicatheterized sheep (61.8 +/- 7.8 kg BW), obtained from a previous nutrient flux study were used for gross and histopathological investigation. Catheters had been surgically placed in a hepatic portal vein (PVC), a hepatic vein (HVC), a distal mesenteric vein (MVC) and a mesenteric artery (MAC). In the previous study, catheters (PVC, HVC and MAC) were used to collect blood samples or infuse (MVC) p-aminohippurate. Catheters were maintained for a total of 58 days prior to necropsy. Histopathological findings indicated that catheter failures were associated with the following tissue responses: (i) thromboses with frequent focal vasculitis; (ii) euplastic tissues associated with extensive fibrosis; (iii) granulomas; (iv) neo-vascularization of the media; (v) calcification processes; and (vi) micro-abscesses. Additional studies are needed that address and incorporate improvement of catheter design and placement to minimize irritation of endothelium, improvement of catheter treatments and therapeutic regimes, and development and use of alternative anti-coagulants. A greater understanding of the mechanisms leading to failure will help researchers improve catheter performance and patency.

Actividad de 11 beta hidroxiesteroide dehidrogenasa tipo 2 en hipertensos chilenos / 11 B-hydroxysteroid dehydrogenase activity in patients with hypertension and low plasma renin activity

Background: Half of hypertensive patients with low plasma renin activity have a primary hyperaldosteronism. Among the remaining half, 11ß-hydroxysteroid dehydrogenase type 2 (11ßHSD2) deficiency plays an important role. This enzyme catalyzes the conversion of cortisol to cortisone, avoiding the interaction of cortisol with the mineralocorticoid receptor. If the enzyme fails, cortisol will stimulate sodium and water reabsorption and increase blood pressure. Aim: To determine biochemical alterations, suggestive of 11ßHSD2 deficiency, in low-renin hypertensive patients. Patients and Methods: Twenty eight hypertensive patients with a plasma renin activity of less than 0.5 ng/ml/h and with a plasma aldosterone of less than 5 ng/dl were studied. Twenty eight normotensive patients were studied as controls. Serum cortisol (RIA), cortisone (ELISA) and the serum cortisol/cortisone ratio were determined in all of them, between 9 and 10 AM. Measurements were confirmed by high pressure liquid chromatography. The serum cortisol/cortisone ratio was considered abnormal when its Ln (cortisol/cortisone) value was over 2 standard deviations of the mean. Results: Serum cortisol was higher in hypertensive subjects than in controls (11.1ñ3.3 and 9.2ñ2.8 µg/dl, respectively; p <0.05). No differences were observed in serum cortisone (3.4ñ1.3 and 3.7ñ1.2 µg/dl, respectively). Four hypertensive subjects had an abnormally high Ln (cortisol/cortisone) value (1.86; 1.73; 2.07 and 2.01, considering a normal value of less than 1.61). Conclusions: Four of 28 hypertensive subjects with low plasma renin activity and aldosterone had biochemical alterations suggestive of 11ßHSD2 deficiency

Bowel dysfunction in spina bifida--an American experience with the ACE procedure.

Fecal incontinence remains a detriment to improved quality of life in many patients with spina bifida. Previous methods of conservative management frequently prove to be inadequate, causing many patients to withdraw from the social mainstream. Recent descriptions of procedures to provide access to the proximal colon for antegrade colonic enemas (ACE procedure) have provided a new approach to managing fecal incontinence. We report here our experience with these procedures in 43 patients with spina bifida. The background, techniques and outcomes of these procedures are discussed and a plea is made to consider this approach in all patients who are hampered in their social or vocational progress because of neurogenic anorectal dysfunction.

Laparoscopic appendicostomy for management of fecal incontinence.

Fecal incontinence from any cause is a socially unacceptable condition and a major detriment to educational and psychosocial development in young people with certain disabilities. Recently several procedures have been described that allow antegrade colonic enemas in the treatment of this problem. We report here an additional method of establishing this proximal colon access, namely laparoscopic appendicostomy. Although not applicable to all patients, this procedure has been successful in a select group with excellent results, and we recommend its consideration when open surgery is not otherwise required.

Treatment of pediatric urolithiasis between 1984 and 1994.

PURPOSE: We report our experience with the management of pediatric urolithiasis during a 10-year period. Our aim was to assess the impact of new technology in the treatment of pediatric urolithiasis. MATERIALS AND METHODS: We retrospectively reviewed the records of all patients up to age 18 years in whom urolithiasis was treated from 1984 to 1994. In 37 cases 24-hour urine collections were available for metabolic evaluation. RESULTS: A total of 100 pediatric patients was treated for urolithiasis. Mean followup was 36 months. A total of 79 patients underwent 115 procedures for symptomatic urolithiasis and 21 were treated nonoperatively. In 42 patients structural anomalies of the urinary tract required additional management. Metabolic abnormalities in 48 patients included hypercalciuria in 19, defined as greater than 4 mg./kg./24 hours calcium by 24-hour urine collection. Only 24 of the 100 patients had no identifiable predisposing factors. Procedures included shock wave lithotripsy in 42 cases, basket extraction with or without ureteroscopy in 20, percutaneous nephrostolithotomy in 11 and litholapaxy in 12. Open surgery included cystolithotomy in 10 cases and other forms of open lithotomy in 15. Thus, open surgical removal was necessary in 1 of 5 cases. CONCLUSIONS: Compared to the traditional mode of stone treatment, fewer patients required open surgery. Our results indicate that a comprehensive approach to the care of pediatric patients with urolithiasis requires attention to metabolic and structural abnormalities.

Modified ASOPA procedure (Hodgson XX) achieves the goals of hypospadias repair.

Several vascularized island flap procedures have been described for the repair of severe hypospadias with chordee. The modified ASOPA (Hodgson XX) procedure, a variant of transverse island flap, employs an inner preputial skin tube for the neourethra while providing simultaneous skin coverage. Since 1988, more than 240 hypospadias repairs have been performed at the authors' institution, including 15 modified ASOPA procedures. All of the patients had proximal hypospadias with chordee. The follow-up of 12 of these patients showed a straight penis, free of chordee, with the meatus at the tip in 11 (92%). One patient had glanular separation and retraction of the meatus to a coronal position. No patient had a urethrocutaneous fistula or urethral diverticulum. Proximal anastomotic strictures were identified in three (25%) patients, which resolved with dilation in two and with internal urethrotomy in the other. The final cosmetic appearance was excellent for 11 patients. Based on these results, the authors conclude that the modified ASOPA procedure reliably achieves the goals of hypospadias repair: release of chordee, urethroplasty, scrotoplasty, and redistribution of skin coverage in one operation, with minimal morbidity.

Common sheath reimplantation yields excellent results in the treatment of vesicoureteral reflux in duplicated collecting systems.

PURPOSE: We evaluated our 10-year experience with the surgical treatment of vesicoureteral reflux in uncomplicated duplicated collecting systems. MATERIALS AND METHODS: Between 1984 and 1994, 54 refluxing renal units (8 bilateral) in 37 female and 9 male patients required surgery. Patient age ranged from 7 months to 17 years (average 4.9 at surgery). Postoperative followup (average 14.2 months) included voiding cystourethrography and renal sonography or excretory urography. RESULTS: Common sheath ureteral reimplantation via an intravesical approach was performed in 48 of the 54 refluxing renal units. Of the remaining 6 renal units detrussorrhaphy was performed in 4, and ureteroureterostomy combined with ureteral reimplantation and partial lower pole nephrectomy were done in 1 each. Two treated renal units had persistent postoperative vesicoureteral reflux, which resolved after subureteral polytetrafluoroethylene (Teflon) injection. No renal had postoperative hydronephrosis. Contralateral reflux was identified in 1 patient who underwent unilateral reimplantation. Our overall success rate was 96% for the surgical correction of vesicoureteral reflux in uncomplicated duplicated collecting systems. Common sheath reimplantation had a 98% success rate. CONCLUSIONS: Although a duplicated collecting system increases the risk for surgical treatment, the presence of a duplication anomaly does not adversely affect surgical outcome. Modifications of procedures commonly performed in the surgical treatment of single system reflux to accommodate common sheath reimplantation have excellent surgical results with minimal morbidity.

The Malone antegrade colonic enema enhances the quality of life in children undergoing urological incontinence procedures.

PURPOSE: Functional alterations of the gastrointestinal and genitourinary tracts, and physical limitations in children with spina bifida, imperforate anus and spinal cord injury challenge the ability to have independent fecal and urinary continence. Urologists have successfully helped these patients achieve urinary continence. We report our experience with the antegrade colonic enema procedure, which allows select individuals to achieve continence of stool, enhancing quality of life. MATERIALS AND METHODS: Since December 1992, 18 antegrade colonic enema procedures were performed in 12 female and 6 male patients 5 to 31 years old of whom 14 had spina bifida, 2 had imperforate anus and 2 had spinal cord injury. Simultaneous urological continence procedures were performed in 8 patients, including appendicovesicostomy in 4, augmentation cystoplasty in 2 and augmentation cystoplasty plus an ileal Mitrofanoff procedure in 2. Four patients previously underwent urological reconstruction. RESULTS: In 24 months of followup (average 6.6) all patients with a functioning stoma remained continent of stool and 17 were continent of urine. Complications related to the antegrade colonic enema procedure occurred in 4 children (22%) of whom 3 required further surgery. Three patients (17%) had minor stomal stenosis. CONCLUSIONS: The antegrade colonic enema procedure is easily performed and it should be considered for any child with significant physical limitations and/or refractory fecal incontinence before urological continence promoting procedures are done.

Vaginoplasty: combination therapy using labia minora flaps and lucite dilators--preliminary report.

The treatment of vaginal agenesis is varied. The combination of creating a vaginal cavity with local skin flaps, then progressively dilating to a functional size has been successful in the past. We describe a technique using tubularized labia minora vascularized flaps to create a deep vaginal pouch that is widened and elongated with lucite dilators. The new vagina has an epithelial lining of nonhair-bearing skin. Three teenage girls, 2 with the Mayer-Rokitansky syndrome and 1 with mixed gonadal dysgenesis, underwent this procedure without any postoperative complications. Since neither abdominal surgery nor skin grafting was required there were no extra scars, excessive neovaginal secretions or need for long-term splinting during the 1-year followup period. The patients have almost normal-appearing genitalia postoperatively and neovaginas averaging 2 cm. wide and 6.3 cm. deep before dilation. We recommend this procedure as first line treatment for teenage girls with vaginal agenesis.

Iron sulfate and feed pelleting to detoxify free gossypol in cottonseed diets for dairy cattle.

Thirty-two lactating cows were fed ad libitum diets with 1) 18.7% soybean meal, 2) diet 1 plus 500 ppm supplemental Fe from FeSO4.H2O, 3) 15% whole cottonseed, or 4) diet 3 plus 500 ppm Fe from FeSO4.H2O. Dry matter intakes were similar except for cows fed diet 2, which was lower. Cows fed whole cottonseed diets ingested 23 g/d of free gossypol per cow. Free gossypol apparently excreted was lower than its intake. Iron excretion was similar to Fe intake. Blood metabolites and productive performance did not differ among the diet groups. No signs of gossypol toxicity were observed. Twelve neonatal Holstein male calves were fed a commercial milk replacer for 4 wk, then were allowed ad libitum access to diets with 1) 27% soybean meal, 2) 50% whole cottonseed, or 3) diet 2 plus 500 ppm Fe from FeSO4.H2O. Dry matter intakes were similar but slightly lower for calves fed diet 3. Daily individual intakes of free gossypol from diets 2 and 3 were 2 g, which was lower than the expected 4 g due to an apparent effect of pelleting. Blood metabolites did not differ among the groups, and calves averaged about .6 kg of daily gain on these diets. A follow-up study showed that pelleting reduced free gossypol by as much as 70% in whole cottonseed and by 48% in cottonseed meal. Pelleting represents a mechanism to decrease the toxicity of gossypol in cottonseed products.

Captopril therapy of recurrent nephrolithiasis in a child with cystinuria.

Traditional and current therapies for cystinuria have been difficult for patients, only partially effective, or associated with substantial risk of serious side effects. We present a case of cystinuria that has been managed for 1 year on captopril, with elimination of recurrent nephrolithiasis and with no observable morbidity.