Genotyping of Helicobacter pylori CagA/CagE strains in gastric mucosa and its association with gastric illness.

The aim of this work was associate the presence of the virulence factors of Helicobacter pylori, cagA/cagE, with gastric illness. We found evidence that indicate the contribution of these genotypes with the severity of gastric lesions in patients infected, principally in histological subtypes as atrophic gastritis, and metaplasia.

Neuromyelitis optica spectrum disorder: do patients positive and negative for anti-aquaporin-4 antibodies present distinct entities? A Colombian perspective.

INTRODUCTION: Neuromyelitis optica (NMO) is an inflammatory disease of the central nervous system characterised by attacks of optic neuritis and longitudinally extensive transverse myelitis. The discovery of anti-aquaporin-4 (anti-AQP4) antibodies and specific brain MRI findings as diagnostic biomarkers have enabled the recognition of a broader and more detailed clinical phenotype, known as neuromyelitis optica spectrum disorder (NMOSD). OBJECTIVE: This study aimed to determine the demographic and clinical characteristics of patients with NMO/NMOSD with and without seropositivity for anti-AQP4 antibodies, in 2 quaternary-level hospitals in Bogotá. METHODS: Our study included patients > 18 years of age and diagnosed with NMO/NMOSD and for whom imaging and serology results were available, assessed between 2013 and 2017 at the neurology departments of hospitals providing highly complex care. Demographic, clinical, and imaging data were gathered and compared in patients with and without seropositivity for anti-AQP4 antibodies. RESULTS: The sample included 35 patients with NMO/NMOSD; the median age of onset was 46.5 years (P25-P75, 34.2-54.0); most patients had sensory (n = 25) and motor manifestations (n = 26), and a concomitant autoimmune disease was identified in 6. Twenty patients were seropositive for anti-AQP4 antibodies. Only age and presence of optic nerve involvement showed statistically significant differences between groups (P = .03). CONCLUSIONS: Clinical, imaging, and laboratory variables showed no major differences between patients with and without anti-AQP4 antibodies, with the exception of age of onset and presence of optic nerve involvement (uni- or bilateral); these factors should be studied in greater detail in larger populations.

Tres versiones del "Ogtt Squeezer", un programa para evaluar de un vistazo la información metabólica de la curva de tolerancia a la glucosa / Three versions of the "Ogtt Squeezer", a program to evaluate ataglance the metabolic information of the oral glucose tolerance test

El diagnóstico clínico de resistencia insulínica (RI) es difícil, ya que el Clamp no es aplicable a la clínica. El así llamado "síndrome metabólico", un predictor clínico de la RI, no identifica alrededor de la mitad de los sujetos afectados. Previamente, definimos adecuadamente (Análisis ROC) los niveles de corte diagnóstico de los siguientes predictores bioquímicos: HOMA1, HOMA2, QUICKI e ISI-Composite, a través de analizar datos de 90 sujetos (53 no resistentes y 37 resistentes) que tenían una medición directa de su resistencia insulínica (Test de supresión pancreática, TSP, Test de Reaven) y también, una curva de tolerancia a la glucosa oral (CTG). Los puntos de corte obtenidos exhibieron un mucho mejor desempeño diagnóstico comparados con los puntos de corte convencionales. También encontramos un predictor nuevo, simple, económico y eficiente, el I0*G60. Definimos la "normalidad metabólica" de la CTG usando las medianas de los valores de varios parámetros en 312 sujetos con un G120 dentro de los 2 primeros terciles del grupo de normo-tolerantes a la glucosa (NGT, n=468; G120: 51-110 mg/dL, los con mejor función beta insular). A las medianas de la función beta insular y de la sensibilidad insulínica se les asignó un valor de un 100%. Se calculó el % relativo de función beta insular (%RFBI) y el % relativo de sensibilidad insulínica (%RSI) del resto de la cohorte (n=573) contra estos valores de referencia. El "OGTT Squeezer" se escribió en Excel. Las glicemias y las insulinemias de la CTG fueron las entradas del programa. Las salidas fueron: I0*G60, ISI-OL, QUICKI, and HOMA1 (predictores) y el índice insulinogénico, el índice de disposición, %RFBI y %RSI (parámetros). El programa también caracterizó la tolerancia glucídica de acuerdo a los criterios de la ADA 2003. El formato final del programa, HTML 5, facilita su uso. Desarrollamos tres versiones del programa: completa, abreviada y mínima.

Clinically, diagnosing insulin resistance (IR) is difficult since the Clamp is not applicable to clinical work. The so-called "Metabolic Syndrome", a clinical surrogate of IR, fails to identify around 50% of affected subjects. Previously, we properly defined (ROC Analysis) the diagnostic cut-offs of the following biochemical predictors: HOMA1, HOMA2, QUICKI, and ISI-Composite by analyzing data from 90 subjects (53 non-insulin-resistant and 37 insulin-resistant subjects) who had a direct measurement of insulin resistance (Pancreatic Suppression Test, PST, Reaven's Test), and also, an Oral Glucose Tolerance Test (OGTT). The resulting cut-offs exhibited much better performances compared with the conventional cut-offs. We also found a new, simple, inexpensive and efficient predictor, the I0*G60. We chose to define the "metabolic normalcy" of the OGTT by using the median values of several parameters in 312 NGT subjects with a G120 in the first 2 tertiles of the NGT group (n=468; G120: 51-110 mg/dL, those with the best beta-cell function). The median values of both Beta-Cell Function and Insulin Sensitivity of these subjects were assigned a 100% value. Both % Relative Beta-Cell Function (%RBCF) and % Relative Insulin Sensitivity (%RIS) of everyone else in the cohort (n=573) was calculated against these reference values. The "OGTT Squeezer" was written in Excel. The OGTT's glucose and insulin values served as the inputs of the program. The outputs were: I0*G60, ISI-OL, QUICKI, and HOMA1 (predictors), and Insulinogenic Index, Disposition Index, %RBCF, and %RIS (parameters). Moreover, the program characterized the OGTT according to the ADA 2003 criteria. The HTML 5 format of the program facilitates its use. We developed 3 versions of the program: complete, abbreviated, and minimal versions.

Neurofibromatosis segmentaria: Comunicación de dos casos / Segmental Neurofibromatosis: A report of two cases

Resumen La neurofibromatosis (NF) segmentaria, actualmente llamada NF mosaico, es una variante rara de neurofibromatosis, sin afectación sistémica y limitada a un segmento corporal. Los pacientes no presentan historia familiar de enfermedad. El cuadro clínico se caracteriza por manchas café con leche, neurofibromas o ambos. Se comunican dos casos de niñas con NF segmentaria solo con cambios pigmentarios,sin alteraciones sistémicas.

Abstract True segmental neurofibromatosis is an uncommon variant of neurofibromatosis, without systemic involvementand limited to a body segment. Patients don´t have family history of disease. The manifestations arecharacterized by café au lait spots, neurofibromas or both. We report two cases of girls with segmental NF with pigmentary changesonly, without systemic alterations.

Anticancer activity of two novel ruthenium compounds in gastric cancer cells.

AIMS: Ruthenium (II) complexes are promising anticancer molecules due its pharmacological properties and selectivity to cells tumor. The aim of this work was to study the cytotoxic activity, and apoptosis induction of two new ruthenium complexes on a human gastric cancer cell line. MAIN METHODS: Two ruthenium(II) complexes were synthesized: [(H2pbbzim)Ru(tpy-Ph-COOCH3)](Cl)2 (Ru-UCN1), and [(tpy)Ru(tpy-Ph-bzH)](Cl)2 (Ru-UCN3), and their anticancer capacity determined by cytotoxic assays, gene expression analysis, caspase activation and confocal microscopy. KEY FINDINGS: Ru-UCN3 is more notably cytotoxic than cisplatin in human gastric cancer cells AGS at 24 h, while Ru-UCN1 is more active against gastric cancer cells than cisplatin at 48 h. The complexes induce apoptosis as shown by RT-qPCR, protease activity, and confocal microscopy. Ru-UCN1 induces the overexpression of pro-apoptotic genes at 3 and 6 h, whereas Ru-UCN3 induces overexpression of these genes at 12 and 24 h. Ru-UCN1 treatment shows a strong activation of caspases 3/7 at 24 h, which was not observed for Ru-UCN3 treatment in the same timeframe. SIGNIFICANCE: Taken together, this data suggests that Ru-UCN1 and to a lesser extent, Ru-UCN3, may be interesting anticancer agents for gastric cancer.

Choroidal metastasis as a presenting manifestation of a lung adenocarcinoma with response to afatinib. / Metástasis coroidea como signo de presentación de un adenocarcinoma de pulmón con respuesta a afatinib.

CASE REPORT: We present the case of a 55-year-old man with a non-small cell lung adenocarcinoma, who presented with choroidal metastasis. The patient showed a decrease in visual acuity. His evaluation revealed unilateral choroidal metastasis secondary to carcinoma of the lung. The patient received afatinib with complete regression of choroidal metastasis after one year follow-up. DISCUSSION: Choroidal metastasis may be the initial sign of lung cancer. This case highlights the importance of a thorough systemic evaluation in patients with choroidal tumours. Afatinib was effective against choroidal metastasis of a lung adenocarcinoma with EFGR mutation.

Surgical treatment of renal-cell carcinoma in elderly people. / Tratamiento quirúrgico del carcinoma de células renales en personas de edad avanzada.

OBJECTIVE: To describe the oncological characteristics and evolution of patients 65 years or older who underwent surgery for renal-cell carcinoma (RCC). METHODS: We reviewed our prospectively maintained database of patients with RCC treated surgically. Those ≥ 65 years old were selected. We analyzed clinical and pathological characteristics as well as oncological and functional outcomes. Overall survival (OS) was estimated with the Kaplan-Meier method. Multivariate Cox-proportional hazards model was used to determine predictors of OS. RESULTS: A total of 156 elderly patients with mean age 72.0±5.5 years (range 65-92) and median follow-up of 33 months were included. Surgical approach was open radical nephrectomy in 114 (73.5%), laparoscopic radical nephrectomy in 13 (8.4%), open partial nephrectomy in 23 (14.2%) and laparoscopic partial nephrectomy in 6 (3.9%). Pathological stage was: Stage I, 71 (45.5%); Stage II, 27 (17.3%); Stage III, 48 (30.8%); and Stage IV, 10 (6.4%). Lastly, 51 (32.6%) patients died, 22 (43.1%) from cancer. The 5-year OS according to pathological stage was 77.6%, 71.9%, 45.1% and 11.7% for stage I, II, III and IV, respectively (P<.001). On multivariate analysis, pathological stage independently predicted OS (HR 1.96, 95% CI [1.36-2.84], P=.0003). CONCLUSIONS: The surgical management of RCC appears to be safe in properly selected patients 65 years or older. Pathological stage predicts survival in this population.

Nfkb1 is a haploinsufficient DNA damage-specific tumor suppressor.

NF-κB proteins play a central and subunit-specific role in the response to DNA damage. Previous work identified p50/NF-κB1 as being necessary for cytotoxicity in response to DNA alkylation damage. Given the importance of damage-induced cell death for the maintenance of genomic stability, we examined whether Nfkb1 acts as a tumor suppressor in the setting of alkylation damage. Hprt mutation analysis demonstrates that Nfkb1(-/-) cells accumulate more alkylator-induced, but not ionizing radiation (IR)-induced, mutations than similarly treated wild-type cells. Subsequent in vivo tumor induction studies reveal that following alkylator treatment, but not IR, Nfkb1(-/-) mice develop more lymphomas than similarly treated Nfkb1(+/+) animals. Heterozygous mice develop lymphomas at an intermediate rate and retain functional p50 in their tumors, indicating that Nfkb1 acts in a haploinsufficient manner. Analysis of human cancers, including therapy-related myeloid neoplasms, demonstrates that NFKB1 mRNA expression is downregulated compared with control samples in multiple hematological malignancies. These data indicate that Nfkb1 is a haploinsufficient, pathway-specific tumor suppressor that prevents the development of hematologic malignancy in the setting of alkylation damage.

Trends in laryngeal cancer incidence in a health area between 2007 and 2013.

OBJECTIVE: Our aim was to study the trend between 2007 and 2013 in the incidence of larynx cancer in a health district of 300,000 inhabitants. MATERIAL AND METHOD: With information from the hospital cancer registry for the reference health area, we calculated the incidence and subsequently performed a joinpoint regression using specific software. RESULTS: We found a statistically-significant downward trend with an annual percentage change of -10.83 LC 95% (-16.85, -4.40) between 2007 and 2013. CONCLUSIONS: We found that the tendency of incidence in larynx cancer decreased, mainly in males, where the results were statistically significant. These results should encourage continuing prevention of smoking and alcohol consumption.

Transient GUS gene expression in cassava (Manihot esculenta Crantz) using Agrobacterium tumefaciens leaf infiltration / Expresión transitoria del gen GUS en yuca (Manihot esculenta Crantz) utilizando infiltración con Agrobacterium tumefaciens

Objective. Assess transient gene expression of GUS in cassava (Manihot esculenta Crantz) leaves using Agrobacterium tumefaciens infiltration. Materials and methods. A. tumefaciens strains GV3101 and AGL1 containing pCAMBIA1305.2 were used to evaluate transient gene expression of β-glucuronidase (GUS). A. tumefaciens infiltration (agroinfiltration) was made using both leaves from in vitro and 1 month old greenhouse plants. Leaves were incubated in X-GLUC buffer, stained and photographed to detect GUS activity. Results. Agroinfiltration assays showed GUS transient expression in leaves of cassava varieties widely cultivated in the north coast and eastern savannah, MCOL2215 (Venezuelan) and CM6438-14 (Vergara), respectively. A. tumefaciens agressive strain AGL1 showed high efficiency inducing GUS expression in cassava leaves. Conclusions. We recommend using A. tumefaciens agressive strain AGL1 for agroinfiltration to assess transient expression in cassava leaves.

Objetivo. Evaluar la expresión transitoria del gen GUS en hojas de yuca (Manihot esculenta Crantz) por medio de infiltración con Agrobacterium tumefaciens. Materiales y métodos. Se utilizaron las cepas GV3101 y AGL1 de A. tumefaciens conteniendo el plásmido pCAMBIA1305.2, para evaluar la expresión transitoria del gen GUS. La infiltración de A. tumefaciens (agroinfiltración) se realizó tanto en hojas de plantas "in Vitro" como de plantas adultas de 1 mes. Las hojas se incubaron en tampón X-GLUC, se destiñeron y se fotografiaron para detectar la actividad de la enzima β-glucuronidasa (GUS). Resultados. Los ensayos de agroinfiltración en hoja muestraron la expresión transitoria del gen GUS en variedades cultivadas en la costa norte y en los llanos orientales, MCOL2215 (Venezolana) y CM6438-14 (Vergara) respectivamente, tanto en plantas "in Vitro" como en plantas adultas. La cepa hipervirulenta de A. tumefaciens AGL1 mostró una mayor eficiencia para la expresión transitoria en hojas de yuca. Conclusiones. Se recomienda utilizar la cepa AGL1 para evaluar la expresión transitoria de genes de interés por agroinfiltración en hojas de yuca.

Hand-assisted laparoscopic versus open donor nephrectomy: a retrospective comparison of perioperative and functional results in a tertiary care center in Mexico.

BACKGROUND: Laparoscopic nephrectomy for living donors is the current procedure of choice. Hand-assisted laparoscopic donor nephrectomy (HALDN) is the variation of this technique currently used in our institution. Though the advantages and disadvantages have been described for this procedure, the graft function compared with open surgery has been shown to be equal. We compared the outcomes of patients undergoing the former standard open donor nephrectomy (ODN) versus the current HALDN technique. METHODS: In this retrospective, comparative, and analytic study we reviewed our institutional database of renal transplantation procedures from January 2005 to April 2011 for perioperative variables and 1-year follow-up data. Donor renal function was evaluated with serum creatinine concentrations and estimated glomerular filtration rates with the Chronic Kidney Disease-Epidemiology formula. Complications were reported with the Clavien-Dindo classification. RESULTS: The 190 consecutive donors included 99 ODN and 91 HALDN, who did not show baseline differences. ODN had a shorter mean operative time (217 ± 57.5 vs 270 ± 60.1 minutes) and shorter warm ischemia time (2.12 ± 1.4 vs 4.62 ± 2.7 minutes). HALDN had less operative blood loss (274.4 ± 198.1 vs 202.99 ± 157.1 mL) and shorter in-hospital stay (5.58 ± 2.2 vs 4.23 ± 1.8 days). There were no significant differences in 30-day surgical complications or transfusion requirements. No graft loss was reported. No difference in renal function was observed between the groups at days 1-2 or months 1, 6, or 12 after nephrectomy. CONCLUSIONS: Laparoscopic surgery has replaced conventional open surgery for living renal donors. HALDN is a safe and successful procedure compared with ODN. It is now the procedure of choice in our institution.

Natural history of pyuria and microhematuria after prostate surgery.

OBJECTIVE: Urinalysis alterations are common after prostatic surgery. However, time to normalization has not been established. Presence of pyuria and microhematuria can lead to unnecessary diagnostic procedures. The objective of this study is to determine the time to normalization for both parameters. MATERIAL AND METHODS: We reviewed medical records of patients who underwent prostatic surgery without infectious complications during follow-up. We included patients who underwent transurethral resection of the prostate (TURP) with either monopolar or bipolar energy, or open prostatectomy (OP). Kaplan-Meier curves were used to determine the time of persistence of both parameters. ANOVA was used to compare the 3 groups according to the type of surgery. We analyzed the impact of preoperative use of 5-α-reductase inhibitors, and searched for a correlation between the weight of resected tissue and persistence of both parameters. RESULTS: 85 patients were analyzed: 44 underwent monopolar TURP, 27 bipolar TURP, and 14 OP. Persistence of pyuria was significantly longer than microhematuria with a median of 274 days vs. 176 days. Neither the use of monopolar or bipolar energy, nor the use of preoperative 5α-reductase inhibitors affected the persistence time. We found a positive correlation between the resected tissue weight and the persistence of leukocyturia after endoscopic surgery: 23 g was the best cut-off point. CONCLUSIONS: Pyuria persists longer than microhematuria regardless of the type of surgery. There is a correlation between the resected tissue weight and the persistence of pyuria. The presence of pyuria and microhematuria after prostatic surgery is not always a pathological finding.

Performance of computed tomographic urography for the detection of bladder tumors in patients with microscopic hematuria.

OBJECTIVE: Our objective was to evaluate the sensitivity, specificity, predictive value, and accuracy of computed tomographic urography for the detection of bladder tumors in patients with microscopic hematuria. MATERIAL AND METHODS: Patients with microscopic hematuria initially evaluated with computed tomography and cystoscopy from January 2006 to December 2009 were evaluated. Computed tomography detecting a bladder lesion suspicious of malignancy was considered positive. Cystoscopy was classified as positive when a lesion requiring biopsy or resection was found. Performance characteristics of computed tomography were determined by comparing with cystoscopic and pathological findings. RESULTS: A total of 112 patients were eligible for analysis. Seven tumors were found on cystoscopy; of these, 2 were correctly diagnosed by computed tomography and 5 were missed. An additional case was considered erroneously positive. The results are a sensitivity of 29%, specificity of 99%, positive predictive value of 67%, negative predictive value of 95%, and accuracy of 95%. CONCLUSIONS: Although computed tomography has a high specificity its sensitivity is limited. For this reason conventional cystoscopy should be considered the standard for bladder evaluation of patients with microscopic hematuria.

Estimation of bladder cancer projections in Spain.

INTRODUCTION: One of the most frequent cancers in the world is bladder cancer that affects, according to some authors, 5.4 million persons in the most developed countries. Our study has aimed to estimate the impact projections of this disease in Spain between 2007 and 2022. MATERIAL AND METHODS: Mortality data for bladder cancer mortality was used International Classification of Diseases 10th revision (ICD-10 C67), and the population data from 1998 to 2007. The data were obtained from the National Institute of Statistics (INE). Relative survival was obtained form the EUROCARE study. The projections of incidence, prevalence, and mortality were estimated using the statistical program Mortality-Incidence Analysis MODel (MIAMOD) and after the joinpoint regression that calculates the Annual Percentage of Change (APC). RESULTS: Between the years 1998 and 2022, it is foreseen that there will be a decrease in prevalence in the men, from 156.93 (adjusted rate AR=128.71) to 132.99 (AR=84.68) cases per 100,000 inhabitants/year in the year 2022. The incidence rate would decrease from 30.2 (AR=24.93) to 24.87 (AR=15.88) and mortality from 14.96 (AR=12.25) to 12.08 (AR=7.67). In women, an increase is expected in prevalence from 21.18 (AR=13.23) to 35.6 (AR=21.46) cases per 100.000 inhabitants/year. The incidence of 4.8 (AR=2.91) in 1998 to 7.79 (AR=4.69), Mortality will increase from 2.25 (AR=1.32) to 3.37 (AR=1.89) between the years 1998 and 2022. In men, the APCs found for prevalence, incidence and mortality were, respectively, 0.69 (95% CI%:-6.9/8.9); 0.69 (95% CI:-6.9/8.95) and -4.18 (95% CI:-11.32/3.51), these not being statistically significant. In women, the APC for prevalence was -4.44 (95% CI:-13.4/5.44). from 19.24 (95% CI:8.93/30.52).and from -3.28 (95% CI:-20.26/17.20) for mortality. CONCLUSIONS: This cancer should be monitored and in turn prevented based on the controllable risk factors, especially in women.

[Estimation of the projections of incidence rates, prevalence and mortality due to prostate cancer in Aragon (Spain)]. / Estimación de las proyecciones de las tasas de incidencia, prevalencia y mortalidad por cáncer de próstata en Aragón (España).

OBJECTIVE: The purpose of this study was to project prostate cancer prevalence, incidence rates and mortality over a 15-year period going from 2008 to 2022 for the Aragon region of Spain. METHODS: The projections were calculated using the MIAMOD PROGRAM. All-cause mortality due to prostate cancer for the baseline period of 1998 to 2007 was obtained from the Spanish National Institute of Statistics. RESULTS: The prostate cancer incidence rates for the period 2008 to 2022 per 100,000 persons are projected to decrease from 47.57 to 26.68/100,000 (adjusted rates 24.9 to 12.93). Mortality will decrease from 21.89 to 11.73 (adjusted rates 10.89 to 5.83) and prevalence from 277.07 cases/ 100,000 per year to 125.09 (adjusted rates 165.54 to 63.41). CONCLUSIONS: These projections indicate that the prostate cancer incidence and its mortality rate will decrease in Aragon (Spain).

Mycobacterium tuberculosis 38-kDa lipoprotein is apoptogenic for human monocyte-derived macrophages.

Mycobacterium tuberculosis is the main aetiologic agent of tuberculosis, a disease of great concern in less-developed regions. Apoptosis is a conspicuous event in macrophages infected in vitro with mycobacteria, a phenomenon also observed in vivo in granulomas of patients with tuberculosis. To determine its significance, it is important to define the mycobacterial moieties involved and how they cause apoptosis. Here we show that the 38-kDa lipoprotein induces macrophage caspase-dependent apoptosis involving TNF-alpha and FasL and, interestingly, with the upregulation of cell-death receptors TNFR1, TNFR2 and Fas. A role for the Toll-like receptor 2 was also demonstrated. In conclusion, the ability to induce apoptosis of host cells is another property of the 38-kDa lipoprotein, a molecule that has focused attention for being an immunodominant antigen that participates in phosphate transport.

Utilidad de los bloqueos anestésicos en patología de columna vertebral en el Hospital Universitario Clínica San Rafael / Use fullness of anesthetic blocks in pathology of the spine in the Hospital Universitario Clínica San Rafael / Utilidade dos bloqueios anestésicos em patologia de coluna vertebral no Hospital Universitario Clínica San Rafael

Los bloqueos peridurales y facetarios han sido controvertidos por su utilidad en el manejo del dolor en pacientes con patología de columna vertebral, utilizándose actualmente como último recurso. Para el presente trabajo de recolectaron, entre enero de 2005 y enero de 2006, en el Hospital Universitario Clínica San Rafael de Bogotá, 50 pacientes, que según su patología se dividieron en tres grupos. Mientras que al primero, que incluyó 34 pacientes con hernia discal y al segundo, con nueve pacientes con canal lumbar estrecho se les realizó bloqueo peridural, al tercer grupo, con siete pacientes con enfermedad facetaria, se le aplicó bloqueo facetario. Para determinar la utilidad de los bloqueos se evaluó la mejoría del dolor, el regreso a la actividad laboral, la utilización de analgésicos adyuvantes y la necesidad de algún tipo de procedimiento quirúrgico de acuerdo a la patología presentada. El porcentaje de mejoría del dolor para los distintos grupos fue del 71,5% para los pacientes con enfermedad facetaria, del 77,7% para los pacientes con canal lumbar estrecho y del 65% para los pacientes con hernia discal lumbar. El porcentaje de regreso a la actividad laboral en los tres grupos fue similar, con un 85,7% para los pacientes con enfermedad facetaria, 67% para los pacientes con canal lumbar estrecho y 73,5% para los pacientes con hernia discal. La terapia analgésica adyuvante fue requerida por 42,9% de los pacientes con enfermedad facetaria, por el 55,5% de los pacientes con canal lumbar estrecho y por el 29,5% de los pacientes con hernia discal. La cirugía debió realizarse al 11% del grupo con canal estrecho, al 14% del grupo con hernia discal y no se necesitó en ninguno paciente con enfermedad facetaria. Teniendo en cuenta la efectividad de los bloqueos facetarios para aliviar el dolor en pacientes con enfermedad facetaria y de los bloqueos peridurales para los pacientes con canal lumbar estrecho y hernia discal lumbar, con una mejoría del dolor superior al 50% en los tres grupos, con una tasa de regreso al trabajo alta y con una disminución en la necesidad de cirugía, se propone la realización de estos bloqueos, antes de recurrir a procedimientos invasivos...

The usefulness of peridural and facet blocks has been controversial in the management of pain in patients with pathology of the spine, being used only as a last resort. For this work we collected 50 patients between January 2005 and January 2006 at the Hospital Universitario Clínica San Rafael de Bogotá. There were separated in 3 groups based on their pathology. The first group included 34 patients with a herniated disc and the second group 9 patients with a narrow lumbar canal who received epidural block, and the third group with facet disease received a facet block. To determine the result of the blocks, we evaluated the improvement in the pain, the return to laboral activity, the use of adjuvant analgesics and the need for surgical intervention. The pain improvement was 71,5% for those patients with facet disease, 77.7% for those patients with a narrow canal and 65% for those with a herniated disc. The percentage of return to laboral activity was similar in the three groups, 85,7% for patients with facet disease, 67% for patients with a narrow canal and 73,5% for patients with a herniated disc. Adjuvant analgesics were required by 42,9% of the patients with facet disease, 55,5% of the patients with a narrow lumbar canal and 29,5% of the patients with a herniated disc. Surgery was necessary in 11% of the patients with a narrow canal and 14% of the patients with a herniated disc. Patients with facet disease did not require surgery. In view of the efficacy of the blocks above 50% for all of the measured parameters, it is proposed that the blocks should always be attempted prior to the use of more invasive methods...

Os bloqueios peridurais e facetarias foram discutidos por sua utilidade no manejo da dor em pacientes com patologia de coluna vertebral, utilizando-se atualmente como último recurso. Para o presente trabalho de coletaram, entre janeiro de 2005 e janeiro de 2006, no Hospital Universitário Clínica San Rafael de Bogotá, 50 pacientes, que segundo sua patologia se dividiram em três grupos. Enquanto ao primeiro, que incluiu 34 pacientes com hérnia discal e ao segundo, com nove pacientes com canal lombar estreito se lhes realizou bloqueio peridural, ao terceiro grupo, com sete pacientes com doença facetaria, se lhe aplicou bloqueio facetaria. Para determinar a utilidade dos bloqueios se avaliou a melhoria da dor, o regresso à atividade trabalhista, a utilização de analgésicos adjuvantes e a necessidade de algum tipo de procedimento cirúrgico de acordo à patologia apresentada. A percentagem de melhoria da dor para os diferentes grupos foi do 71,5% para os pacientes com doença facetaria, do 77,7% para os pacientes com canal lombar estreito e do 65% para os pacientes com hérnia discal lombar. A percentagem de regresso à atividade trabalhista nos três grupos foi similar, com um 85,7% para os pacientes com doença facetaria, 67% para os pacientes com canal lombar estreito e 73,5% para os pacientes com hérnia discal. A terapia analgésica adjuvante foi requerida por 42,9% dos pacientes com doença facetaria, pelo 55,5% dos pacientes com canal lombar estreito e pelo 29,5% dos pacientes com hérnia discal. A cirurgia deveu realizar-se aos 11% do grupo com canal estreito, ao 14% do grupo com hérnia discal e não se precisou em nenhum paciente com doença facetaria. Tendo em conta a efetividade dos bloqueios facetarias para aliviar a dor em pacientes com doença facetaria e dos bloqueios peridurais para os pacientes com canal lombar estreito e hérnia discal lombar, com uma melhoria da dor superior ao 50% nos três grupos, com uma taxa de regresso ao trabalho alta e com uma diminuição na necessidade de cirurgia, propõe-se a realização destes bloqueios, antes de recorrer a procedimentos invasivos...

Principios físicos básicos del ultrasonido / Basic physics of ultrasound

El ultrasonido es una técnica de imagen sencilla, no invasiva y accesible que permite la evaluación del sistema musculoesquelético en tiempo real, con la ventaja de examinar las articulaciones en forma dinámica; adicionalmente, con la ayuda del Doppler de poder y de color, se pueden evaluar los fenómenos inflamatorios locales, sin someter al paciente a radiación ionizante. Tiene como desventaja ser dependiente del operador, el cual debe tener un amplio conocimiento de los principios físicos del ultrasonido, estar familiarizado con la ecotextura de los tejidos y de la anatomía musculoesquelética. Además es importante que sepa reconocer los fenómenos sonográficos que pueden presentarse como confusores, denominados artefactos. Este cúmulo de conocimientos es deseable para el especialista en padecimientos musculoesqueléticos, para que pueda interpretar adecuadamente los estudios ecográficos, reconocer los artefactos y así evitar diagnósticos erróneos y procedimientos innecesarios. En una serie de tres artículos se analizan los principios físicos básicos de la ecografía, la sonoanatomía del sistema musculoesquelético y los artefactos más comunes encontrados en ecografía. En esta primera entrega analizaremos los principios físicos básicos involucrados en la producción de imágenes ecográficas.

Ultrasonography is a simple, non invasive and accessible imaging technique that allows the evaluation of a variety of musculoskeletal structures in real time. It has the advantage of dynamic assessment of joints, tendons and muscles; furthermore, the presence of an underlying inflammatory phenomenon can be evaluated with power or color Doppler techniques in the same session without radiation exposure. However, it is an operator dependant technique that needs a in-depth knowledge of basic principles of ultrasound, musculoskeletal anatomy and ecostructure. Additionally, it is important to identify and recognize the presence of ultrasound artifacts that can be image confusors. A basic knowledge of ultrasound physics, as well as, sonoanatomy and ultrasound artifacts recognition is essential to understand ultrasound images. This knowledge diminishes the possibilities of misdiagnoses and unnecessary procedures. In a series of three papers, we will analyze the basic principles of ultrasound, musculoskeletal sonoanatomy and finally ultrasonographic artifacts. In the present paper we review the basic physical and technical principles behind ultrasound images.