Interstitial fibrosis evolution on early sequential screening renal allograft biopsies using quantitative image analysis.

Screening renal biopsies (RB) may assess early changes of interstitial fibrosis (IF) after transplantation. The aim of this study was to quantify IF by automatic color image analysis on sequential RB. We analyzed RB performed at day (D) 0, month (M) 3 and M12 from 140 renal transplant recipients with a program of color segmentation imaging. The mean IF score was 19 ± 9% at D0, 27 ± 11% at M3 and 32 ± 11% at M12 with a 8% progression during the first 3 months and 5% between M3 and M12. IF at M3 was correlated with estimated glomerular rate (eGFR) at M3, 12 and 24 (p < 0.02) and IF at M12 with eGFR at M12 and 48 (p < 0.05). Furthermore, IF evolution between D0 and M3 (ΔIFM3-D0) was correlated with eGFR at M24, 36 and 48 (p < 0.03). IF at M12 was significantly associated with male donor gender and tacrolimus dose (p = 0.03). ΔIFM3-D0 was significantly associated with male donor gender, acute rejection episodes (p = 0.04) and diabetes mellitus (p = 0.02). Thus, significant IF is already present before transplantation. IF evolution is more important during the first 3 months and has some predictive ability for change in GFR. Intervention to decrease IF should be applied early, i.e. before 3 months, after transplantation.

Prevalence of Sarcocystis spp. in Argentinean cattle.

Sarcocystis cruzi, S. hirsuta and S. hominis are apicomplexan parasites that affect cattle worldwide with variable prevalence. The aim of the present study was to evaluate the prevalence of Sarcocystis spp. in Argentinean cattle comparing microscopic fresh examination and molecular methods. Blood, myocardium and loin samples were collected in five slaughterhouses from a total of 380 bovines. Origin of animals was representative of the major beef cattle production area of Argentina. Samples were analyzed by fresh microscopical examination, transmission electron microscopy (TEM), IFAT and PCR-RFLP. Thin walled sarcocysts corresponding with S. cruzi were found in 99.5% of heart samples. Sarcocysts were detected in 73.1% of loin samples; 71.5% had S. cruzi cysts and 23.1% had thick walled sarcocysts (S. hirsuta or S. hominis). TEM observation revealed the presence of characteristic S. hominis and S. hirsuta cyst walls in 7 and 1 loin samples respectively. Using IFAT, 379/380 animals had titers 25 or higher, showing a full agreement with fresh examination. Amplification products were detected in 35.5% (135/380) of loin samples; however Sarcocystis species could only be determined by RFLP in 29 samples. Agreement between fresh examination and PCR was low (Kappa value=0.262). This is the first report of S. hominis and S. hirsuta in Argentina. Further studies are needed to improve the sensitivity of molecular methods for species identification, especially for differentiation of S. cruzi and S. hirsuta from the zoonotic species S. hominis. The results of the present study and others focusing on sensitivity and specificity of Sarcocystis spp. diagnostic methods should contribute to improve food safety.

Interstitial fibrosis quantification in renal transplant recipients randomized to continue cyclosporine or convert to sirolimus.

Conversion from cyclosporine (CsA) to sirolimus at week 12 after kidney transplantation is associated with a significant improvement in renal function. The aim of this analysis was to investigate the effect of this conversion on interstitial fibrosis (IF), a hallmark of chronic allograft injury, in patients taking part in the CONCEPT trial. This multicenter, prospective, trial included 193 renal recipients randomized at week 12 to switch from CsA to sirolimus or to continue CsA, with mycophenolate mofetil. Routine biopsy with automated, quantified assessment of IF by a program of color segmentation was performed at 1 year in 121 patients. At 1 year, renal function was significantly improved in the conversion group as assessed by estimated GFR (MDRD) and measured GFR. Biopsy results, however, showed no between-group difference in percentage of IF. Calculated GFR at 1 year was significantly associated with the percentage of IF (p = 0.004, R(2)= 0.07). By multivariate analysis diabetic patients had more fibrosis than non-diabetic patients. In conclusion, although kidney transplant patients converted from CsA to sirolimus showed significant improvement in renal function, we found no difference of IF on 1-year biopsies.

Surgical management of hereditary colorectal cancer: surgery based on molecular analysis and family history.

The importance of colorectal cancer (CRC) is increasing. A proportion show a hereditary component, as in Lynch syndrome and Familial Adenomatous Polyposis, and a recently defined entity as well, namely, Familial Colorectal Cancer type X. The high probability to develop CRC in these groups may, at the time of recognition, change surgical management, including its timing or even the surgical technique. In some cases prophylactic surgery can play an important role. The possibility of using tools that allow recognition of the aforementioned syndromes, including microsatellite instability, immunohistochemistry for DNA mismatch repair system proteins, and especially their mutations, is on the basis of therapeutic strategies that differ from those employed in sporadic CRC cases.

Quantification of interstitial fibrosis by image analysis on routine renal biopsy 1 year after transplantation in patients managed by C2 monitoring of cyclosporine microemulsion.

BACKGROUND: Renal interstitial fibrosis (IF), the main histopathologic feature of chronic allograft nephropathy (CAN), may be an important surrogate endpoint for patient follow-up. IF is currently assessed by semiquantitative analysis, but automatic color image analysis may be a more reliable, reproducible method to evaluate IF. We performed a retrospective analysis to calculate IF on routine renal biopsies 1 year after transplantation. METHODS: Data were obtained from MO2ART, a prospective multicenter trial in which the cyclosporine microemulsion dose was adjusted based on C(2) levels. We included 26 patients in whom routine renal biopsy at 1 year was available from two centers. For each biopsy, a section was analyzed by a program of color segmentation image that automatically extracted green-colored areas characteristic of IF. Results were expressed as percent IF and grade namely grade I, <25%; grade II, 25% to 50%; and grade III, >50%. The results were compared according to clinical and biological data. RESULTS: The 26 patients had a mean IF score of 0.35 +/- 0.04. We observed 34.6% CAN grade I; 46.1%, grade II; and 19.2%, grade III. Serum creatinine at 3 years was greater in the higher grade of automated IF by repeated ANOVA. CONCLUSION: Automatic quantification of IF on routine biopsy at 1 year after transplantation was predictive of renal outcome. This technique may provide an interesting tool for the early diagnosis of CAN after renal transplantation.

Endoscopist controlled administration of propofol: an effective and safe method of sedation in endoscopic procedures.

OBJECTIVES: Propofol is a short-acting, hypnotic agent that is increasingly being used for gastrointestinal endoscopic sedation. There are concerns about the use of propofol by non anesthesiologists due to its potential for respiratory and cardiovascular depression. This report describes our experience concerning effectiveness and safety of propofol administered in endoscopic procedures by the endoscopist and the assistant nurse. METHODS: In this prospective study, a total of 102 consecutive endoscopies (60 colonoscopies and 42 upper endoscopies) performed under sedation with propofol were included. In 27 (26.47%) endoscopies propofol was administered alone and in 75 endoscopies (73.53%) it was combined with benzodiazepines and/or opioids. Seventy-six (74.51%) endoscopies were performed in patients under 65 years of age and 26 (25.49%) in patients over 65 years of age. Ninety-one (89.22%) endoscopies were performed in patients with low surgical risk (ASA I-II) and 11 (10.78%) in patients with high surgical risk. The medication was administered by the endoscopist that performed the procedure and the assistant nurse. RESULTS: The mean dose of propofol used was 72.14 mg for gastroscopies and 71.33 for colonoscopies (p = 0.92). The mean dose of propofol when infused alone was 84.81 mg whereas in combination with benzodiazepines/opioids was 66.93 mg (p = 0.06). The doses of propofol required were lower for those colonoscopies in which midazolam and/or meperidine was combined and in patients over 65 years of age (p = 0.006 y p = 0.001, respectively). Eleven (10.8%) minor complications were reported, and managed by the own endoscopist. Patients had no memories of the procedure. The tolerance rated by the endoscopist was excellent-good, fair, bad-very bad in 83, 5 and 12% of the gastroscopies and in 79, 8 and 13% of the colonoscopies respectively. Nevertheless bad tolerance did not hinder the completion of the procedure in any case. CONCLUSIONS: The administration of propofol by the endoscopist and the assistant nurse, is an effective and safe method of sedation in patients of low and high-risk as well as in elderly patients. The doses of propofol required for an adequate sedation were lower in patients over 65 years of age and for colonoscopies in which medication was combined.

Safe endoscopic resection of gangliocytic paraganglioma of the major duodenal papilla.

A case of gangliocytic paraganglioma of the papilla of Vater in a 76-year-old man with a history of recurrent obstructive jaundice is presented. This is the first case of gangliocytic paraganglioma of the major papilla successfully resected by endoscopic ampullectomy.

Enfermedad hemorroidal. Concepto y tratamiento quirúrgico

Los autores describen la técnica de hemorroidectomía semicerrada, como una buena alternativa que disminuye el dolor y las complicaciones postoperatorias en el tratamiento de la enfermedad hemorroidal. Esta técnica es ampliamente usada en el Brasil

Anastomosis coloanal: Cirugía que preserva el esfínter

Esta es una revisión sobre la Anastomosis Colo-anal como procedimiento que preserva el esfínter, muy útil para enfermedades rectales benignas y malignas. La ventaja de esta técnica en el tratamiento del cáncer rectal bajo son sus buenos a excelentes resultados funcionales

Trauma cardíaco / Cardiac trauma

Se estudiaron 55 historias clinicas de sujetos con trauma cardiaco atendidos en el Hospital de Caldas en 10 años, y 2.342 necropsias desde 1988 hasta 1991; se analizaron 179 de ellas que presentaban lesion cardiaca, de las cuales se dedujeron las siguientes observaciones: Predominio del sexo masculino; la sintomatologia predominante fue la triada de Beck; el promedio de edad fue de 23 años; el arma empleada con mayor frecuencia fue el arma de fuego seguida por el arma blanca. La pericardiocentesis se empleo en un 33 por ciento de los casos atendidos en el hospital, y la ventana subxifoidea en un 20 por ciento. En la mayoria de los pacientes la via de acceso fue a traves de la esternotomia; las lesiones encontradas más frecuentemente se localizaron sobre los ventriculos; el compromiso coronario fue escaso (2 casos); se reintervinieron 4 pacientes; las complicaciones más frecuentes fueron el hemotorax seguido de la falla cardiaca, CIV, bronconeumonia y pericarditis. De 39 casos analizables en 10 años, fallecieron 2 pacientes. La mortalidad prehospitalaria fue del 70.7 por ciento. Los hallazgos en nuestros casos fueron comparados con otras series nacionales e internacionales.

Tratamiento del hemotórax coagulado postraumático: toracoscopia vs. toracotomía / Thoracoscopy vs. thoracotomy in the treatment of coagulated post-traumatic hemotorax

Se presenta un ensayo clinico prospectivo, aleatorio que evalua el tratamiento del hemotorax coagulado mediante toracoscopia comparándolo con la toracotomia de limpieza convencional. El drenaje del hemotorax coagulado postraumático por toracoscopia es un metodo de fácil aprendizaje y realizacion, seguro y eficaz,, con las ventajas de menor tiempo quirurgico, menor incapacidad postoperatoria, reincorporacion laboral temprana y resultado estetico inobjetable.