Gastric adenocarcinoma burden, trends and survival in Cali, Colombia: A retrospective cohort study.

Background: Gastric adenocarcinoma (GA) has changed in recent decades. Cancer estimates are often calculated from population-based cancer registries, which lack valuable information to guide decision-making (clinical outcomes). We describe the trends in clinical practice for GA using a hospital-based cancer registry over a timespan of 15 years. Methods: A retrospective cohort study was conducted. Data were gathered from adults diagnosed and treated for GA at Fundación Valle del Lili (FVL), between 2000 and 2014, from the hospital's own cancer registry and crossed with Cali's Cancer Registry. Additional data were obtained directly from clinical records, pathology reports and the clinical laboratory. Patients younger than 18 years and those for whom limited information was available in the medical history were excluded. A survival analysis was conducted using Kaplan-Meier method. Results: A total of 500 patients met eligibility criteria. Median age was 64 years (IQR: 54-74 years), 39.8% were female, 22.2% were at an early stage, 32.2% had a locally advanced disease, and 29% a metastatic disease, 69% had intestinal subtype, 48.6% had a positive H. pylori test, 85.2% had a distal lesion, 62% underwent gastrectomy, 60.6% lymphadenectomy, and 40.6% received chemotherapy. Survival at 5 years for all cases was 39.9% (CI 95% 35.3-44.5). Survival decreased over time in all groups and was lower in age-groups <39 and 60-79 with either locally advanced or metastatic disease. Prognostic factors that were significant in the Cox proportional-hazards model were late stages of the tumor (locally advanced: HR=2.52; metastatic: HR=4.17), diffuse subtype (HR=1.40), gastrectomy (subtotal: HR=0.42; total: 0.44) and palliative chemotherapy (HR=0.61). Conclusions: The treatment of GA has changed in recent decades. GA survival was associated with clinical staging, diffuse subtype, gastrectomy and palliative chemotherapy. These findings must be interpreted in the context of a hospital-based study.

Síndrome sarcoidosis-linfoma. Presentación de 2 casos clínicos / Sarcoidosis-lymphoma syndrome. Presentation of 2 clinical cases

RESUMEN La combinación de sarcoidosis y linfoma (síndrome sarcoidosis-linfoma) es una asociación poco frecuente pero reconocida en el ámbito clínico. Algunas manifestaciones pueden ser comunes entre estas entidades, por lo que es un reto para el clínico diferenciar cada enfermedad por separado o si coexisten en un mismo individuo. En este último escenario, ni las manifestaciones clínicas ni los parámetros de laboratorio son específicos, por lo que es necesario un análisis minucioso de cada caso, apoyado de laboratorios, imágenes e histopatología para llegar a un diagnóstico certero. Se presentan 2 casos de síndrome sarcoidosis-linfoma y se analizan los aspectos clave en el diagnóstico de esta forma clínica.

ABSTRACT The combination of sarcoidosis and lymphoma (sarcoidosis-lymphoma syndrome) is a rare but recognised clinical condition. Some manifestations may be common among these conditions, making it a challenge for the clinician to differentiate each disease separately, or if they coexist in the same individual. In this latter scenario, neither the clinical manifestations nor the laboratory parameters are specific, so a meticulous analysis of each case is necessary, supported by laboratory and imaging tests, and histopathology in order to obtain an accurate diagnosis. Two cases of sarcoidosis-lymphoma syndrome are presented, and an analysis is presented on the key aspects in the diagnosis of this clinical condition.

Stump appendicitis, a case report and a review of the literature. Is it as uncommon as it is thought?

INTRODUCTION: Acute appendicitis (AA) is the most common cause of acute surgical abdomen. Complications from surgical appendectomy include intraabdominal abscess, bleeding, surgical site infections, ileus, and stump appendicitis (SA). This last one is one of the least common ones with a reported incidence of 1:50.000. METHODS: We present a case and review 132 cases of SA reported in the literature. Demographic and clinical characteristics were evaluated, as well as details of the surgical treatment. Categorical variables are presented as quantities and proportions, and continuous variables with median and interquartile range. Additionally, we calculate an incidence from 3 papers reported in the literature and our own. RESULTS: We analyzed 132 cases, 60.3 % were male with a median age at SA of 33 years. There was a wide range time interval between the episode of AA and SA from 1 day to 60 years. Initial open appendectomy was reported in 62 cases. From all the patients with SA 51 % reported complications. The median length of the appendiceal stump was 3 cm. The incidence of SA fluctuated between 0.22-1.37 in 1.000 cases of appendectomies. DISCUSSION: SA is usually underrated, and which are the risk factors for this condition are not clear. The data available suggest that a primary laparoscopic appendectomy is not related to SA, but the length of the stump left in the first surgery might be associated. The incidence of SA seems to be higher than the one reported of 1 in 50.000.

Impact of a Primary Care intervention on the colorectal cancer early detection programme. / Impacto de una intervención de Atención Primaria en el programa de detección precoz de cáncer colorrectal.

AIM: To assess the effectiveness of a telephonic interview performed by primary care professionals among non-participants in the first round of the colorectal cancer early detection programme in the basic urban health area Guineueta in Barcelona, Spain. PATIENTS AND METHODS: The Primary Healthcare Team of La Guineueta contacted people who did not respond to the invitation to the first round of the colorectal cancer early detection programme using a standardised telephone call protocol. We analysed the impact of the intervention based on participation and diagnosed disease. RESULTS: We made 3,327 phone calls to 2,343 people. After the intervention the participation rate was 54.9%, which meant an increase of 5.7% with respect to the participation in the usual protocol for the programme (49.2%). The intervention allowed 5cancers, 2high-risk neoplasms and 8low- and intermediate-risk lesions to be diagnosed. An average of 9phone calls was necessary to achieve the participation of one additional person. DISCUSSION: The telephonic intervention performed by primary care professionals has significantly increased the population participation rate and the detection of neoplasms with respect to the usual colorectal cancer early detection programme protocol.

Prevalencia de anemia en niños del proyecto EquiDar de la región de Azuay-Ecuador / Prevalence of anemia in children of EquiDar project in Azuay region, Ecuador

Introducción: La anemia y su erradicación es una prioridad de organizaciones de salud. La implementación de programas de suplementación nutricional para su disminución es realizada por diversas instituciones. Objetivo: Caracterizar la anemia en niños beneficiarios del proyecto EquiDar, Azuay-Ecuador. Métodos: Investigación con diseño no experimental, prospectivo, observacional, de corte descriptivo-asociativo y transversal, realizada en el período 2015-2016 en el Cantón Cuenca, Azuay- -Ecuador. La muestra probabilística correspondió a 1 091 niños beneficiarios del proyecto EquiDar. Se realizó biometría mediante equipo automatizado. Los índices hematológicos obtenidos se normalizaron según la altura. Los datos se procesaron con SPSS 23.0 mediante estadística descriptiva e inferencial para la comparación de medias y proporciones (H Kruskall Wallis, U de Mann Whitney y Ji-cuadrada). Resultados: La prevalencia de anemia fue de 23,96 por ciento con predomino en la edad preescolar y en zona rural de residencia. El incremento de la edad corrigió el padecimiento mediante asociación inversa. El principal tipo de anemia en la muestra fue de tipo normocítica hipocrómica, seguida de anemia macrocítica. El nivel de macrocitosis en la población fue alto (56 por ciento) en individuos anémicos y no anémicos sugiriendo la concurrencia de otras enfermedades como agente causante. Conclusiones: La prevalencia de anemia en la muestra es un problema moderado de salud pública influido por variables sociodemográficas. La reversión del fenómeno sobrepasa la dimensión nutricional, por lo que es necesario políticas con enfoque multifactorial que integren el área nutricional, educativa y de salud pública(AU)

Introduction: Anemia and its eradication is a priority of health organizations. The implementation of nutritional supplemental programs for its reduction is carried out by several institutions. Objective: To characterize anemia in the children who were beneficiaries of EquiDar project, in Azuay, Ecuador from 2015 to 2016. Methods: Prospective approach with non-experimental, observational, descriptive-associative and cross-sectional design carried out in the period 2015-2016 in Canton Cuenca, Azuay, Ecuador. The probabilistic sample corresponded to 1091 children who are benefit from EquiDar project. Biometry was performed using automated equipment. The hematologic indices obtained were normalized according to the height. Data were processed with SPSS 23.0 and using descriptive and inferential statistics with methods for the comparison of means and proportions (H Kruskall Wallis, Mann Whitney U and square-Ji). Results: The prevalence of anemia was 23.96 percent, predominantly in the preschool ages and in the rural areas. Increasing age corrects the condition by inverse association. The main type of anemia in the sample is hypocromic normocytic, followed by macrocytic anemia. The level of macrocytosis in the population was high (56 percent) in both anemic and non-anemic individuals, suggesting the concurrence of other pathologies as causative agent. Conclusions: The incidence of anemia in the sample is a moderate public health problem influenced by sociodemographic variables. The reversion of the phenomenon surpasses the nutritional dimension being necessary policies with multifactorial approach that integrate the nutritional, educative and public health areas(AU)

Disseminated histoplasmosis as a first clinical manifestation in a patient with small lymphocytic lymphoma: A case report

The small lymphocytic lymphoma is a mature B cell neoplasm with a broad spectrum of clinical presentations. Opportunistic infections that are not related to the treatment, even in advanced stages, have a low incidence rate. There are few case reports in the medical literature of patients who have not received immunosuppressive therapy and present with small lymphocytic lymphoma associated with disseminated histoplasmosis at diagnosis. A female 82-year-old patient was admitted due to an intermittent dry cough, asthenia, and adynamia that had persisted for one month. Multiple studies to detect infections and immuno-rheumatic conditions were performed and an extensive cervical, thoracic and peritoneal adenopathic syndrome was diagnosed. A flow cytometry and a cervical lymph node biopsy were performed reporting CD19+, CD20dim, CD5+, CD45+, CD23+, CD43neg, and CD10neg phenotypes with restriction in the light kappa chain compatible with a small lymphocytic lymphoma. Epithelioid granulomas without necrosis were observed in the lymph node histopathology and special colorations showed no microorganisms. The culture from the lymph node was positive for Histoplasma capsulatum. We initiated treatment with amphotericin B and itraconazole with an adequate response. In the absence of compliance with oncology treatment criteria, the patient was managed on a "watch and wait" basis. Opportunistic infections could be the initial clinical manifestation in patients with low-grade lymphoproliferative syndromes. This case report shows that they can develop even in the absence of chemotherapy.

Histoplasmosis diseminada como manifestación inicial del linfoma linfocítico de células pequeñas / Disseminated histoplasmosis as a first clinical manifestation in a patient with small lymphocytic lymphoma: A case report

RESUMEN El linfoma linfocítico de células pequeñas es una neoplasia de células B maduras con un amplio espectro de presentaciones clínicas. Las infecciones por gérmenes oportunistas no asociadas con el tratamiento, incluso en estadios avanzados de la enfermedad, tienen baja incidencia. Se han reportado muy pocos casos de pacientes con linfoma linfocítico de células pequeñas asociado a histoplasmosis diseminada que no habían recibido quimioterapia en el momento del diagnóstico. Se presenta el caso de una paciente de 82 años que fue hospitalizada por presentar tos seca intermitente, astenia y adinamia de un mes de evolución. Se le practicaron múltiples estudios para detectar infecciones o compromiso inmunológico o reumático, y se diagnosticó un síndrome adenopático extenso con compromiso cervical, torácico y retroperitoneal. En la citometría de flujo y en la biopsia de ganglio linfático cervical, se reportaron los fenotipos CD19+, CD20dim, CD5+, CD45+, CD23+, CD43neg y CD10neg, con restricción de la cadena ligera kappa, lo cual confirmó un linfoma linfocítico de células pequeñas. En la histopatología del ganglio, se observaron granulomas epitelioides sin necrosis, pero las coloraciones especiales no mostraron la presencia de microorganismos, en tanto que el cultivo del ganglio fue positivo para Histoplasma capsulatum. Se inició el tratamiento antifúngico con anfotericina B e itraconazol, y la paciente tuvo una adecuada evolución. Dado que no se cumplían los criterios para el tratamiento oncológico, se continuó con su observación mediante controles periódicos. Las infecciones oportunistas pueden ser la manifestación clínica inicial en pacientes con síndromes linfoproliferativos de bajo grado. Este caso demuestra que pueden desarrollarse, incluso, en ausencia de quimioterapia.

ABSTRACT The small lymphocytic lymphoma is a mature B cell neoplasm with a broad spectrum of clinical presentations. Opportunistic infections that are not related to the treatment, even in advanced stages, have a low incidence rate. There are few case reports in the medical literature of patients who have not received immunosuppressive therapy and present with small lymphocytic lymphoma associated with disseminated histoplasmosis at diagnosis. A female 82-year-old patient was admitted due to an intermittent dry cough, asthenia, and adynamia that had persisted for one month. Multiple studies to detect infections and immuno-rheumatic conditions were performed and an extensive cervical, thoracic and peritoneal adenopathic syndrome was diagnosed. A flow cytometry and a cervical lymph node biopsy were performed reporting CD19+, CD20dim, CD5+, CD45+, CD23+, CD43neg, and CD10neg phenotypes with restriction in the light kappa chain compatible with a small lymphocytic lymphoma. Epithelioid granulomas without necrosis were observed in the lymph node histopathology and special colorations showed no microorganisms. The culture from the lymph node was positive for Histoplasma capsulatum. We initiated treatment with amphotericin B and itraconazole with an adequate response. In the absence of compliance with oncology treatment criteria, the patient was managed on a "watch and wait" basis. Opportunistic infections could be the initial clinical manifestation in patients with low-grade lymphoproliferative syndromes. This case report shows that they can develop even in the absence of chemotherapy.

Espectro clínico de la enfermedad relacionada con IgG4 en Colombia / Clinical spectrum of IgG4-related disease in Colombia

RESUMEN La enfermedad relacionada con IgG4 es una condición inflamatoria sistémica, caracterizada por la infiltración de diversos órganos por complejos formados por células plasmáticas IgG4 positivas, asociadas con niveles elevados de IgG4 en el suero. El diagnóstico de esta enfermedad es complejo y los hallazgos clínicos no son patognomónicos. En esta serie de casos, describimos un amplio espectro clínico en 4 pacientes, en quienes, después de descartar otros diagnósticos, se confirmó la enfermedad relacionada con IgG4. A pesar de que esta enfermedad no es común, se debe considerar entre los diagnósticos diferenciales de enfermedades con afectación de múltiples órganos. Este reporte de pacientes con enfermedad relacionada con IgG4, en Colombia, resalta un amplio espectro de presentaciones clínicas, incluyendo estenosis subglótica, pancreatitis autoinmune, fibrosis retroperitoneal y compromiso sistémico.

ABSTRACT IgG4-related disease is an inflammatory systemic condition noted by the infiltration of different organs by IgG4-bearing plasma cells, as well as elevated serum IgG4 levels. Diagnosis of this condition is complex, and clinical findings are not particularly indicative. In this case series, a description is presented on 4 patients with a wide spectrum of clinical manifestations, in whom, after ruling out different options, a diagnosis of IgG4 related disease was confirmed. Despite this disease not being common, it should be considered among the options whenever multiple organs are affected. This report of patients with IgG4-related disease in Colombia highlights a wide spectrum of clinical presentations, including subglottic stenosis, autoimmune pancreatitis, retroperitoneal fibrosis, and systemic compromise.

Sequential rituximab and omalizumab for the treatment of eosinophilic granulomatosis with polyangiitis (Churg-Strauss syndrome).

Eosinophilic granulomatosis with polyangiitis (EGPA), formerly known as Churg-Strauss syndrome (CSS), is a small vessel vasculitis associated with eosinophilia and asthma. Clinical manifestations commonly seen in patients presenting with EGPA range from upper airway and lung involvement to neurological, cardiac, cutaneous, and renal manifestations. Treatment for severe presentations includes steroids, cyclophosphamide, plasmapheresis, and recently, rituximab. Rituximab is associated with a good response in the treatment of vasculitis, but a variable response for the control of allergic symptoms. Here, we report a 16-year-old female patient with severe EGPA (gastrointestinal and cutaneous vasculitis, rhinitis and asthma) refractory to conventional treatment. She was treated with rituximab, which enabled rapid control of the vasculitis component of the disease, but there was no response to rhinitis and asthma. Additionally, she developed severe bronchospasm during rituximab infusion. Sequential rituximab and omalizumab were initiated, leading to remission of all manifestations of vasculitis, rhinitis, and asthma, in addition to bronchospasm related to rituximab infusion.

Sclerosing Encapsulated Peritonitis: A devastating and infrequent disease complicating kidney transplantation, case report and literature review.

INTRODUCTION: Sclerosing Encapsulating Peritonitis (SEP) is a rare condition with an incidence of up to 3% and a mortality of up to 51% among peritoneal dialysis (PD) patients (Brown et al., Korte et al. and Kawanishi et al.). In the last ten years, the incidence of SEP in kidney transplant recipients has increased (Nakamoto, de Sousa et al. and Korte et al.). PRESENTATION OF CASE: A 31-year old male with a 15 years history of PD and later kidney retransplantation was admitted to the emergency service after experiencing several weeks of diffuse abdominal pain which had escalated to include vomiting and diarrhea during the 24h previous to admission. The patient underwent an exploratory laparotomy where severe peritoneal thickening was found, in addition to signs of chronic inflammation and blocked intestinal loops. Histopathologic findings were suggestive of sclerosing peritonitis. After two months of treatment in hospital, the patient presented an obstructed intestine, with a rigid and thickened peritoneum compromising all the intestinal loops. DISCUSSION: Despite being rare, SEP, represents a significant complication due to its high mortality and recurrence. It is insidious in its early stages and culminates in an intestinal obstruction (Fieren). Risk factors for its development in kidney transplant recipients include a history of prolonged treatment with PD and the use of calcineurin inhibitors as an immunosuppressive treatment (Korte et al.). CONCLUSION: Given the increase in the incidence of SEP in kidney transplant recipients, the clinician should be alert to the presence of this complication. A greater number of multi-centre studies are required to identify the risk factors for SEP that are inherent in renal transplant recipients.

[Renal biopsies during the second trimester of pregnancy: report of two cases]. / Biopsia renal en el segundo trimestre del embarazo: Dos casos clínicos.

Kidney biopsies were performed in two women during their 21st and 24th week of pregnancy. The first patient developed an abrupt nephrotic syndrome without hypertension or kidney failure. The pathological study disclosed diffuse podocyte alterations such as those observed in focal and segmental glomerulosclerosis, which had a good response to steroidal treatment. The second patient had a progressive renal failure associated with non-nephrotic proteinuria. The biopsy disclosed a fibrillary glomerulopathy.

Hiperparatiroidismo primario asociado a pancreatitis autoinmune, colangitis esclerosante y posible hipoglucemia autoinmune / Primary hyperparathyroidism associated with autoimmune pancreatitis, sclerosing cholangitis and probable autoimmune hypoglycemia

Se informa el caso de una mujer de 42 años quien desarrolla pancreatitis autoinmune, colangitis esclerosante y probable hipoglucemia autoinmune, asociada con hiperparatiroidismo primario. (Acta Med Colomb 2012; 37: 80-82).

Abstract We report the case of a 42 year old woman who developed autoimmune pancreatitis, sclerosing cholangitis and probable autoimmune hypoglycemia associated with primary hyperparathyroidism. (Acta Med Colomb 2012; 37: 80-82).

Determination of ethylene glycol dinitrate in dynamites using HPLC: application to the plastic explosive Goma-2 ECO.

In this study, a sequential extraction method using water and methanol to recover ethylene glycol dinitrate or nitroglycol (EGDN) contained in Goma-2 ECO dynamite was developed. After, an HPLC method was used for the determination of EGDN in the two extracted phases. The analytical method was validated by evaluating its selectivity, sensitivity, linearity, and linear working concentration range, limit of detection and quantitation, precision (as repeatability and intermediate precision), accuracy, and robustness, providing appropriate values (i.e. RSD values for precision about 6% and accuracy about 100%). Finally, the EGDN content of a sample of the Goma-2-ECO dynamite was determined obtaining a concentration of 30.29%, which is in accordance with the manufacturer's specifications for this dynamite (25.7-31.4%).

Asociación de los polimorfismos IL-1B-511 e IL-1RN y Helicobacter pylori CagA positivo con cáncer gástrico en una zona de riesgo alto en Colombia / Association of interleukin-1 genetic polymorphism and CagA positive Helicobacter pylori with gastric cancer in Colombia

Background: There is an association of interleukin (IL)1B polymorphism with gastric cancer risk. However systematic reviews of the existing evidence have shown that such association varies across populations with different genetic ancestry. Aim: To evaluate the association of IL-1B-511 and IL-1RN polymorphism and Helicobacter pylori IgG antibodies CagA, with gastric cancer in two Colombian cities located in a high risk area for gastric cancer. Material and Methods: A case-control study including 46 gastric cancer cases and 99 controls with non-atrophic gastritis from a high risk zone for gastric cancer. Polymorphism genotyping was carried out by polymerase chain reaction (PCR) and IgG CagA status by ELISA. Results: IgG CagA seropositive individuals had an increased gastric cancer risk (odds ratio (OR) = 11.56; 95 percent confidence intervals (CI) 2.62-50.91 in Tunja and OR = 19.66, 95 percentCI 0.98-395 in Bogotá). IL-1B-511TT carriers in Tunja had increased risk of gastric cancer (OR = 11.31; 95 percentCI 1.20-106.54)), while IL-1RN*2 alelle carriers in Bogotá showed an inverse association with gastric cancer risk (OR = 0.03; 95 percentCI 0.01-0.65). Conclusions: This study adds evidence to the positive association of Helicobacter pylori CagA positive strains with non-cardial gastric cancer etiology. There is a possible heterogeneity in the association of IL-1B gene polymorphism with cancer, in populations of similar ethnic background and settled in the same risk area.

[Association of interleukin-1 genetic polymorphism and CagA positive Helicobacter pylori with gastric cancer in Colombia]. / Asociación de los polimorfismos IL-1B-511 e IL-1RN y Helicobacter pylori CagA positivo con cáncer gástrico en una zona de riesgo alto en Colombia.

BACKGROUND: There is an association of interleukin (IL)1B polymorphism with gastric cancer risk. However systematic reviews of the existing evidence have shown that such association varies across populations with different genetic ancestry. AIM: To evaluate the association of IL-1B-511 and IL-1RN polymorphism and Helicobacter pylori IgG antibodies CagA, with gastric cancer in two Colombian cities located in a high risk area for gastric cancer. MATERIAL AND METHODS: A case-control study including 46 gastric cancer cases and 99 controls with non-atrophic gastritis from a high risk zone for gastric cancer. Polymorphism genotyping was carried out by polymerase chain reaction (PCR) and IgG CagA status by ELISA. RESULTS: IgG CagA seropositive individuals had an increased gastric cancer risk (odds ratio (OR) = 11.56; 95% confidence intervals (CI) 2.62-50.91 in Tunja and OR = 19.66, 95%CI 0.98-395 in Bogotá). IL-1B-511TT carriers in Tunja had increased risk of gastric cancer (OR = 11.31; 95%CI 1.20-106.54)), while IL-1RN*2 alelle carriers in Bogotá showed an inverse association with gastric cancer risk (OR = 0.03; 95%CI 0.01-0.65). CONCLUSIONS: This study adds evidence to the positive association of Helicobacter pylori CagA positive strains with non-cardial gastric cancer etiology. There is a possible heterogeneity in the association of IL-1B gene polymorphism with cancer, in populations of similar ethnic background and settled in the same risk area.

[Reproducibility of histopathologic diagnosis of precursor lesions of gastric carcinoma in three Latin American countries]. / Reproducibilidad del diagnóstico histopatológico de lesiones precursoras del carcinoma gástrico en tres países latinoamericanos.

OBJECTIVE: The aim was to evaluate the concordance in the diagnosis of precursor lesions of intestinal-type gastric carcinoma among observers with different levels of experience. MATERIAL AND METHODS: Gastric biopsies from 1 056 cases were studied: 341 from Colombia, 382 from Mexico, and 333 from Paraguay. Pathologists without experience (A) and with experience (B) in gastrointestinal pathology, as well as experts working in an international reference center (C) participated in the diagnosis of each case. RESULTS: The concordance (k) between pathologists with experience and those without was poor for the diagnosis of atrophic gastritis (k=0.04 to 0.12) and dysplasia (k=0.11 to 0.05), and good for the diagnosis of intestinal metaplasia (k=0.52 to 0.58). Supervision of pathologists without experience by those with experience remarkably improved the concordance in the diagnosis of atrophic gastritis (k=0.65) and intestinal metaplasia (k=0.91), and to a lesser degree, of dysplasia (k=0.28). The concordance among experts before and after the consensus meeting showed no variation in the diagnosis of atrophic gastritis (k=0.57); the concordance varied from good to excellent in the diagnosis of intestinal metaplasia (k=0.67 to 0.81) and from poor to good in that of dysplasia (k=0.18 to 0.66). CONCLUSION: The greatest differences arose in the diagnosis of chronic atrophic gastritis and dysplasia. The interobserver concordance depended on the experience of the observer and the consensus reading.

Reproducibilidad del diagnóstico histopatológico de lesiones precursoras del carcinoma gástrico en tres países latinoamericanos / Reproducibility of histopathologic diagnosis of precursor lesions of gastric carcinoma in three Latin American countries

Objetivo. Evaluar la concordancia en el diagnóstico de lesiones precursoras del carcinoma gástrico de tipo intestinal entre observadores con diferente experiencia. Material y métodos. Se estudiaron 1 056 casos de biopsias gástricas: 341 de Colombia, 382 de México y 333 de Paraguay. En el diagnóstico de cada caso participaron patólogos sin experiencia en patología gastrointestinal (A), patólogos con experiencia en patología gastrointestinal (B) y expertos que trabajan en un centro de referencia internacional (C). Resultados. La concordancia (k) entre patólogos inexpertos y expertos fue pobre en el diagnóstico de gastritis atrófica (k=0.04 a 0.12) y displasia (k=0.11 a 0.05) y buena en el diagnóstico de metaplasia intestinal (k=0.52 a 0.58); la supervisión de un patólogo inexperto por un experto mejoró notablemente la concordancia en el diagnóstico de gastritis atrófica (k=0.65) y metaplasia intestinal (k=0.91) y, en un menor grado, de displasia (k=0.28). Al comparar la concordancia entre expertos antes y después de la reunión de consenso no hubo variación en el diagnóstico de gastritis atrófica (k=0.57); la concordancia varió de buena a excelente en el de metaplasia intestinal (k=0.67 a 0.81) y de pobre a buena en el de displasia (k=0.18 a 0.66). Conclusión. Los principales problemas se presentan en el diagnóstico de la gastritis crónica atrófica y la displasia. La concordancia interobservador depende de la experiencia del observador y la lectura de consenso.

Objective. The aim was to evaluate the concordance in the diagnosis of precursor lesions of intestinal-type gastric carcinoma among observers with different levels of experience. Material and Methods. Gastric biopsies from 1 056 cases were studied: 341 from Colombia, 382 from Mexico, and 333 from Paraguay. Pathologists without experience (A) and with experience (B) in gastrointestinal pathology, as well as experts working in an international reference center (C) participated in the diagnosis of each case. Results. The concordance (k) between pathologists with experience and those without was poor for the diagnosis of atrophic gastritis (k=0.04 to 0.12) and dysplasia (k=0.11 to 0.05), and good for the diagnosis of intestinal metaplasia (k=0.52 to 0.58). Supervision of pathologists without experience by those with experience remarkably improved the concordance in the diagnosis of atrophic gastritis (k=0.65) and intestinal metaplasia (k=0.91), and to a lesser degree, of dysplasia (k=0.28). The concordance among experts before and after the consensus meeting showed no variation in the diagnosis of atrophic gastritis (k=0.57); the concordance varied from good to excellent in the diagnosis of intestinal metaplasia (k=0.67 to 0.81) and from poor to good in that of dysplasia (k=0.18 to 0.66). Conclusion. The greatest differences arose in the diagnosis of chronic atrophic gastritis and dysplasia. The interobserver concordance depended on the experience of the observer and the consensus reading.

El género femenino como factor predictivo en los resultados de la endarterectomía carotídea / Female gender as a predictive factor in the outcome of carotid endarterectomy

Introducción: Existe evidencia contradictoria acerca del beneficio de la endarterectomía carotídea (EC) en la mujer. Objetivo: Evaluar si el género femenino afecta los resultados inmediatos y alejados de la EC. Material y método: Estudio retrospectivo de 346 EC realizadas entre Enero de 1990 y Julio de 2008 en el Hospital Guillermo Grant Benavente de Concepción. Del total, 137 EC fueron realizadas en mujeres. Como grupo control se consideró a los hombres operados en el mismo período, quienes presentaron características demográficas y otras variables potencialmente adversas en proporción similar a las mujeres. Todas las variables se analizaron en un estudio bivariado y multivariado. Se comparó la morbimortalidad operatoria AVC/muerte), la sobrevida global a 5 y 10 años, el intervalo libre de eventos neurológicos y de reestenosis a 5 años. Se utilizó el método de Kapplan-Meier para la sobrevida actuarial, el Test de Log Rank y Chi Cuadrado para la significación estadística y la regresión logística (Backward Stepwise) para el análisis multivariado. Los resultados alejados se expresan en sobrevida promedio + error estándar. Resultados: El género femenino no mostró ser una variable independiente negativa para los resultados de la EC. La incidencia de AVC/muerte en las mujeres fue 1,5 por ciento.(hombres: 1,4 por ciento) (p= NS). La sobrevida global a 5 y 10 años fue 82,5 por ciento +/- 4,1 y 49,7 por ciento +/- 9,7, respectivamente (hombres: 73,5por ciento + 4,0 y 45 por ciento +/- 7,8) (p= NS). A 5 años, el intervalo libre de eventos neurológicos fue 97 por ciento +/- 1,8 (hombres: 98,3 por ciento +/- 1,0) (p= NS) y el de reestenosis fue 93,9 por ciento +/- 3,6 (hombres: 98,5 por ciento +/- 1,1) (p= NS). Conclusión: El género femenino no afecta los resultados de la EC por lo que no se debe considerar un factor predictivo adverso.

Background: The benefits of carotid endarterectomy (CE) in women have been questioned Aim: to evaluate whether female gender influences the results of CE Methods: 346 procedures of CE performed between January 1990 and July 2008 at Hospital Guillermo Grant Benavente in Concepcion were restrospectively analyzed. 137 CE were performed in women. Demographic characteristics were similar between males and females. A university and multi variate analysis including other adverse factors influencing the results of surgery was performed. Operative morbidity and mortality, global survival, neurologic events free survival and the re stenosis rate at 5 years were analyzed. Actuarial survival was analyzed by the Kapplan-Meir procedure using the Log-rank and Chi square tests; Backward stepwise logistic regression was used in multivariate analysis. Results: Female gender was not found to be an independent risk factor for poorer outcomes of CE. Stroke plus total death in woman was 1,5 percent, versus 1,4 percent in man (P=NS). Survival in woman at 5 and 10 years was 82,5 percent +/- 4,1 and 49,7 percent +/- 9,7, respectively, whereas in man it was 73,5 percent +/- 4,0 and 45 percent +/- 7,8) (p NS). At 5 years follow-up 97 percent +/- 1,8 of woman versus 98,3 percent +/- 1,0 of men were free of neurological events; free of having restenosis were 93,9 percent +/- 3,6 of woman versus 98,5 percent +/- 1,1 of man (p= NS). Conclusion: female gender did not result in poorer results following CE and, therefore, should not be considered an adverse predictive factor for this surgical procedure.

Fuentes de variabilidad en el diagnóstico de gastritis atrófica multifocal asociada con la infección por Helicobacter pylori / Source of variation in the diagnosis of Helicobacter pylori-associated multifocal atrophic gastritis

Introducción: El mapeo de las diferentes regiones del estómago y el número de fragmentos de mucosa gßstrica disponibles para evaluación histopatológica son fuentes importantes de variación en el momento de clasificar y hacer la gradación de la gastritis crónica. Objetivos: Estimar la sensibilidad del número de fragmentos de mucosa gßstrica necesarios para establecer los diagnósticos de gastritis atrófica con metaplasia intestinal (MI), displasia y estado de infección por Helicobacter pylori. Ademßs evaluar la variabilidad intra-observador en la clasificación de estas lesiones precursoras del cancer gastrico. Materiales y métodos: En una cohorte de 6 a±os de seguimiento se evaluaron 1,958 procedimientos de endoscopia realizados por dos gastroenterólogos. En cada procedimiento y de cada participante se obtuvieron 5 biopsias de mucosa gßstrica que representaban antro, incisura angularis y cuerpo. Un único patólogo hizo la interpretación histológica de las 5 biopsias y proporcionó un diagnóstico definitivo global que se utilizó como patrón de referencia. Cada fragmento de mucosa gßstrica examinado condujo a un diagnóstico individual para cada biopsia que se comparó con el patrón de referencia. La variabilidad intra-observador se evaluó en 127 personas que corresponden a una muestra aleatoria de 20% del total de endoscopias hechas a los 72 meses de seguimiento. Resultados: La sensibilidad del diagnóstico de MI y displasia gßstrica aumentó de manera significativa con el número de fragmentos de mucosa gßstrica evaluados El sitio anatómico de mayor sensibilidad para el diagnóstico de MI y displasia fue la incisura angularis. Para descubrir H. pylori se logró alta sensibilidad con el estudio de un solo fragmento de mucosa gastrica (95.9%) y fue independiente del sitio de obtención de la biopsia. El acuerdo intra-observador para el diagnóstico de gastritis crónica fue 86.1% con valor kappa de 0.79 IC 95% (0.76-0.85).

Introduction: Multiple sampling from different sites of the stomach as well as the number of fragments of gastric mucosa available for histopathologic evaluation are important sources of variation when classifying and grading chronic gastritis. Objective: To estimate the sensitivity of the number of fragments of gastric mucosa necessary to establish the diagnosis of atrophic gastritis with intestinal metaplasia, gastric dysplasia and H. pylori infection. In addition, this study will attempt to assess the intra-observer variability in the classification of these premalignant gastric lesions. Methods: This is a 6 year-cohort study, wherein 1958 gastric endoscopic procedures performed by two gastroenterologists were reviewed. Five gastric biopsy samples were obtained from the antrum, body and lesser curvature during each procedure. One pathologist was in charge of reviewing the five histopathology samples for each subject and providing a definitive diagnosis which was used as the gold standard. Each gastric mucosa sample reviewed led to an individual diagnosis for that sample which was compared with the gold standard. Intra-observer variability was assessed in 127 individuals who correspond to a random sample of 20% of the total endoscopic procedures performed during the 72 month-follow-up. Results: The sensitivity of the diagnosis of intestinal metaplasia (IM) and gastric dysplasia increased proportionally with the number of gastric mucosa samples reviewed. The lesser curvature of the stomach had the highest sensitivity for the diagnosis of IM and dysplasia, among all the stomach regions studied. Just one sample of gastric mucosa attained a sensitivity of 95.9% for the detection of H. pylori infection. The intra-observer agreement for the diagnosis of multifocal atrophic gastritis was 86.1% and the kappa value was 0.79 (95% CI 0.76-0.85). Alcohol-fixed biopsy specimens were inadequate to diagnose H. pylori infection and to assess dysplasia.

[Source of variation in the diagnosis of Helicobacter pylori-associated multifocal atrophic gastritis.] / Fuentes de variabilidad en el diagnóstico de gastritis atrófica multifocal asociada con la infección por Helicobacter pylori.

INTRODUCTION: Multiple sampling from different sites of the stomach as well as the number of fragments of gastric mucosa available for histopathologic evaluation are important sources of variation when classifying and grading chronic gastritis. OBJECTIVE: To estimate the sensitivity of the number of fragments of gastric mucosa necessary to establish the diagnosis of atrophic gastritis with intestinal metaplasia, gastric dysplasia and H. pylori infection. In addition, this study will attempt to assess the intra-observer variability in the classification of these premalignant gastric lesions. METHODS: This is a 6 year-cohort study, wherein 1958 gastric endoscopic procedures performed by two gastroenterologists were reviewed. Five gastric biopsy samples were obtained from the antrum, body and lesser curvature during each procedure. One pathologist was in charge of reviewing the five histopathology samples for each subject and providing a definitive diagnosis which was used as the gold standard. Each gastric mucosa sample reviewed led to an individual diagnosis for that sample which was compared with the gold standard. Intra-observer variability was assessed in 127 individuals who correspond to a random sample of 20% of the total endoscopic procedures performed during the 72 month-follow-up. RESULTS: The sensitivity of the diagnosis of intestinal metaplasia (IM) and gastric dysplasia increased proportionally with the number of gastric mucosa samples reviewed. The lesser curvature of the stomach had the highest sensitivity for the diagnosis of IM and dysplasia, among all the stomach regions studied. Just one sample of gastric mucosa attained a sensitivity of 95.9% for the detection of H. pylori infection. The intra-observer agreement for the diagnosis of multifocal atrophic gastritis was 86.1% and the kappa value was 0.79 (95% CI 0.76-0.85). Alcohol-fixed biopsy specimens were inadequate to diagnose H. pylori infection and to assess dysplasia. CONCLUSION: The number of mucosa gastric fragments reviewed, the fixation method used, and the biopsy site are all important factors in order to ensure a correct classification of chronic gastritis.