Immune cells from patients with psoriasis are defective in inducing indoleamine 2,3-dioxygenase expression in response to inflammatory stimuli.

BACKGROUND: Indoleamine 2,3-dioxygenase (IDO) is an inducible enzyme that suppresses the immune response. The role of IDO as a negative regulator of inflammatory responses has been documented in several experimental autoimmune diseases. OBJECTIVES: To explore the regulation of IDO by immune cells in psoriasis and its relation with disease severity. METHODS: The expression and activity of IDO were assessed by reverse-transcriptase polymerase chain reaction, flow cytometry and high-performance liquid chromatography in peripheral blood of patients with moderate-to-severe plaque-type psoriasis. The ability of immune cells to express IDO in response to inflammatory stimuli was studied. The functional role of IDO expression was evaluated in a regulatory T cell (Treg) differentiation assay, using cocultures of immature monocyte-derived dendritic cells with autologous peripheral CD4+ T cells. RESULTS: Analysis of the kynurenine-to-tryptophan ratio in serum samples indicated higher IDO activity in patients with psoriasis than in healthy controls. However, correlation studies showed lower IDO activity in those patients with higher Psoriasis Area and Severity Index (PASI). Although myeloid dendritic cells from patients with psoriasis expressed higher levels of IDO than those from healthy controls, these cells did not upregulate IDO in response to a combination of tumour necrosis factor-α, interleukin (IL)-1ß and IL-6 cytokines. The defective expression of IDO correlated with PASI. Immature monocyte-derived dendritic cells from patients with psoriasis also expressed low levels of IDO and induced CD4+ Treg differentiation poorly. CONCLUSIONS: Immune cells from patients with psoriasis have a defect in upregulating IDO in response to inflammation associated with the severity of psoriasis.

Reduced expression of galectin-1 and galectin-9 by leucocytes in asthma patients.

Accumulating evidence shows that galectins play roles in the initiation and resolution phases of inflammatory responses by promoting anti- or proinflammatory effects. This study investigated the presence of three members of the galectin family (galectin-1, -3 and -9) in induced sputum samples of asthma patients, as well as their possible implication in the immunopathogenesis of human asthma. Levels of interleukin (IL)-5, IL-13, and galectins were determined in leucocytes isolated from induced sputum samples by reverse transcription-polymerase chain reaction (RT-PCR) immunofluorescence and flow cytometry. High levels of IL-5 and IL-13 mRNA were detected in sputum cells from asthma patients. In parallel, immunoregulatory proteins galectin-1 and galectin-9 showed a reduced expression on macrophages from sputum samples compared with cells from healthy donors. In-vitro immunoassays showed that galectin-1 and galectin-9, but not galectin-3, are able to induce the production of IL-10 by peripheral blood mononuclear cells from healthy donors. These findings indicate that macrophages from sputum samples of asthma patients express low levels of galectin-1 and galectin-9, favouring the exacerbated immune response observed in this disease.

Registro de evaluación de tratamiento de cáncer gástrico en Chile (REGATE): características clínicas básales de 523 pacientes / Registry of gastric cancer evaluation in Chile (REGATE): basal clinical features of 523 patients

Background: Gastric cancer is one of the leading causes of cancer-related deaths in Chile and worldwide. No consensus exists for therapeutic management. Aim: To assess clinical features and practice patterns of patients with newly diagnosed gastric cancer in Chile. Method: Chilean patients > 18 years old with newly diagnosed primary gastric adenocarcinoma enrolled by thirteen centers from different regions of Chile. Target sample size calculated according to gastric cancer prevalence in Chile. Data collected from two visits within a 10-month timeframe: baseline (patients and tumor features, treatment plan) and end of study (completion of initial treatment). Herein, baseline visit data is presented. Results: Between 2005 and 2008, 523 patients enrolled. Median age 61.3 years. Diagnosis by endoscopy in 98.5 percent patients. Location: body 35.8 percent, proximal 35.4 percent, and antral 23.9 percent. Most frequently used histopathological classification was WHO classification, with tubular adenocarcinoma being most frequent finding (53.1 percent). AJCC/UICC clinical staging (available in 31.1 percent of patients) was: 0 and I - 23.3 percent, II - 18.3 percent, III- 20.8 percent, IV - 37.6 percent. Therapeutic choice based mainly on clinical staging (49.9 percent) and included surgery in 440 patients (84.1 percent). Therapy planned by surgeon (54.9 percent) or multidisciplinary team (42.3 percent). Conclusions: REGATE is the largest prospective multicenter registry study performed in Chile. Basal visit data report that diagnosis is established frequently at advanced stages. Surgery is the most frequent therapeutic choice, (neo-) adjuvant therapies are only planned in one out of four patients. End of study visit data will provide the full scope of diagnosis and treatment of these patients.

Introducción: El cáncer gástrico es una de las principales causas de muerte por cáncer en Chile. No existe consenso acerca del tratamiento. Objetivos: Conocer características clínicas y patrón de tratamiento de pacientes con cáncer gástrico recién diagnosticado. Material y Método: Pacientes chilenos mayores de 18 años con diagnóstico reciente de adenocarcinoma gástrico primario, enrolados en 13 centros de diferentes regiones de Chile. Datos obtenidos en dos visitas dentro de período de 10 meses: basal (características del tumor y paciente, plan de tratamiento) y fin de estudio (tratamiento inicial completado). Se presentan datos de visita basal. Resultados: Entre 2005 y 2008, 523 pacientes enrolados. Mediana edad 61,3 años. Diagnóstico por endoscopia en 98,5 por ciento pacientes. Localización: corporal 35,8 por ciento, proximal 35,4 por ciento y antral 23,9 por ciento. Clasificación histopatológica más usada fue clasificación OMS, y tipo histopatológico más frecuente fue tubular 53,1 por ciento. Etapificación clínica AJCC/UICC (disponible en 37,6 por ciento de pacientes) distribuida en: 0 y I - 23,3 por ciento, II -18,3 por ciento, III - 20,8 por ciento, IV - 37,6 por ciento. Principal característica clínica para elección de terapia planeada fue etapificación clínica (49,9 por ciento). Plan de tratamiento consideró cirugía en 440 pacientes (84,1 por ciento). En mayoría de casos, plan terapéutico decidido por cirujano (54,9 por ciento) o equipo multidisciplinario (42,3 por ciento). Conclusiones: REGATE es el estudio de registro prospectivo multicéntrico más grande desarrollado en Chile. Datos visita basal informan que diagnóstico se establece frecuentemente en etapas avanzadas. Cirugía es alternativa terapéutica más frecuentemente indicada; terapias (neo-) adyuvantes sólo son ofrecidas a uno de cuatro pacientes. Datos visita fin de estudio proveerá visión completa del diagnóstico y tratamiento de estos pacientes.

Fluoride concentration in toothpastes of the Mexican market / Concentración de fluor en las pastas dentales que se venden en México

Introduction. The most widely used method for applying fluoride (F-) topically is the fluoridated toothpaste. Its early use in large quantities is a risk factor for dental fluorosis. Objective: to determine the actual concentration of F in toothpastes sold in the Mexican market. Material and methods. Sixty-five different commercial toothpastes were analysed using the F ion-specific electrode technique. Results. The range of the F content was from 0 to 2 053 ppm. Of them, 16.92% were toothpastes for infant use (range= 0-1153 ppmF-). Mexican toothpastes had a mean of 879 ± 599.2 ppmF and imported toothpastes have a mean of 619.7 ppmF-; 54.5% of the infantile toothpastes presented F concentrations above 730 ppm and in 40% of the analyzed products, annotation on F content was found. Conclusions. Our results showed a wide variation in F concentration and suggest the need to implement policies to regulate the F concentration in these products. It is important that all the manufactured dentifrices show in the label and package the total F content of the product and the recommended doses will be printed, in order to prevent dental fluorosis.

Introducción. El método más usado para la aplicación tópica de flúor (F-)es la pasta dental fluorada. Su uso temprano en grandes cantidades es un factor de riesgo de fluorosis dental. Objetivo: conocer la concentración de P en las pastas dentales que se venden en México. Material y métodos. Se analizaron 65 pastas dentales usando la técnica del electrodo específico para fluoruros. Resultados. El contenido de fluoruro en la muestra analizada varió de 0-2053 ppm. De ellas, 16.92% fueron pastas para uso infantil (límite =0 -1153 ppmF-). Las pastas fabricadas en México tuvieron un promedio de 879 ± 599.2 ppmF-. Las pastas de origen extranjero tenían un promedio de 619.7 ppmF-; 54.5% de las pastas para niños presentaron valores de P superiores a 730 ppmF-. Solamente 40% de los productos analizados tenían impresa la concentración de P en las envolturas. Conclusiones. Nuestros resultados mostraron una amplia variación en la concentración de P. Esto sugiere que es necesario implementar medidas que regulen su concentración en dichos productos. Es importante que, para prevenir lesiones de fluorosis dental, los fabricantes de pastas dentales impriman en la etiqueta el contenido total de fluoruro y las dosis recomendadas.

Therapy with statins in patients with refractory rheumatic diseases: a preliminary study.

We have explored the therapeutic potential of statins in patients with different inflammatory rheumatic diseases refractory to conventional therapy. We found that simvastatin (80mg o.d. for eight days) induced a rapid and significant reduction in proteinuria levels in three systemic lupus erythematosus (SLE) patients. A similar kind of therapy had a marked beneficial effect in a patient with Wegener's granulomatosis and a patient with erythema nodosum. On the other hand, five patients with rheumatoid arthritis (RA) who received atorvastatin for eight days (20mg/day) showed reduction in C-reactive protein levels and a clinical improvement that was classified as an ACR20 response. Prior to the administration of statins, all these patients had received aggressive conventional therapy with no satisfactory response. A significant reduction in spontaneous apoptosis of peripheral blood lymphocytes and expression of CD69 and HLA-DR was observed in SLE patients after simvastatin therapy. These results prompted us to perform a pilot short-time comparative (simvastatin versus chloroquine) open clinical trial in 15 patients with RA who were receiving methotrexate as a single disease modifying antirheumatic drug with no satisfactory response. Most patients (9/10) who received simvastatin (40mg/day) showed an ACR50 or better response after eight weeks, whereas such a response was not observed in any patient (0/5) treated with chloroquine. Our preliminary results indicate that statins may be an important therapeutic tool for the treatment of inflammatory rheumatic diseases.

Effect of arsenic, cadmium and lead on the induction of apoptosis of normal human mononuclear cells.

The aim of this work was to investigate the effect of cadmium, lead and arsenic on the apoptosis of human immune cells. Peripheral blood mononuclear cells (MNC) were incubated with increasing concentrations of these metals and then cellular apoptosis was determined by flow cytometry and by DNA electrophoresis. We found that arsenic induced a significant level of apoptosis at 15 microM after 48h of incubation. Cadmium had a similar effect, but at higher concentrations (65 microM). In addition, cadmium exerted a cytotoxic effect on MNC that seemed to be independent of the induction of apoptosis. In contrast, concentrations of lead as high as 500 microM were nontoxic and did not induce a significant degree of apoptosis. Additional experiments showed that arsenic at concentrations as low as 1.0 microM had a significant pro-apoptotic effect when cells were cultured in the presence of this pollutant for more than 72. Non-T cells were more susceptible than T lymphocytes to the effect of arsenic and cadmium. Interestingly, MNC from children chronically exposed to arsenic showed a high basal rate of apoptosis and a diminished in vitro sensibility to this metalloid. Our results indicate that both arsenic and cadmium are able to induce apoptosis of lymphoid cells, and suggest that this phenomenon may contribute to their immunotoxic effect in vivo.

Innate immune response mechanisms in non-insulin dependent diabetes mellitus patients assessed by flow cytoenzymology.

It is well known that infections in patients with diabetes mellitus are more severe, although there is controversy for increased susceptibility to them. Non-specific immune response mechanisms could be related to defense and/or susceptibility to pathogens. The aim of this study was to investigate the activity of several enzymes involved in the primary host defense mechanisms in non-insulin dependent diabetes mellitus (NIDDM). Twenty NIDDM females with a mean HbA(1c) level of 8.19% were included. No patient had clinical evidence of infection. As controls 20 healthy females were studied. The enzymes tested were dipeptidyl-peptidase I (DPP-I), cathepsin B and D, NADPH oxidase and superoxide dismutase (oxidative burst) and collagenase. Isolated leukocytes were incubated with the specific substrates in pyrogen free conditions. The intracellular enzyme activity was analyzed by flow cytometry. Collagenase enzymatic activity was similar in the three leukocyte subpopulations studied. Oxidative burst induction in monocytes was comparable between both groups. Enzyme activity of cathepsin B and D in all cell subsets, oxidative burst in PMN cells, and DPP-I in lymphocytes and monocytes from patients, was higher than those from healthy females (P<0.05). Overall, our findings demonstrate an enhanced functional status of several intracellular leukocyte enzymes in NIDDM. Furthermore, the increased oxidative burst induction and the consequent production of free radicals, may contribute to vascular complications. Other mechanisms - either from the non-specific or specific immune response - deserve investigation to establish if diabetic patients are more susceptible to infectious diseases.

Multidrug resistance-1 (MDR-1) in rheumatic autoimmune disorders. Part I: Increased P-glycoprotein activity in lymphocytes from rheumatoid arthritis patients might influence disease outcome.

BACKGROUND: Multidrug resistance (MDR) is characterized by overexpression of P-glycoprotein, a pump molecule that decreases intracellular drug concentrations by increasing drug efflux from cells. OBJECTIVE: To look for correlations between clinical status and P-glycoprotein activity and/or TNF-alpha mRNA levels in patients with rheumatoid arthritis. METHODS: Sixteen patients were studied. Based on response to therapy, eight were refractory and eight nonrefractory to treatment. Findings were compared to those in 24 healthy controls. Flow cytometry was used to evaluate P-glycoprotein activity in peripheral blood mononuclear cells isolated by gradient centrifugation and incubated with the P-glycoprotein substrate daunorubicin. TNF-alpha mRNA levels were determined using quantitative PCR. RESULTS: Patients with rheumatoid arthritis showed an increased number of lymphocytes with high P-glycoprotein activity (p = 0.0001) as compared to the normal controls. P-glycoprotein activity was higher in the refractory than in the non-refractory patient subgroup (p = 0.006). Also, TNF-alpha mRNA levels were markedly higher in the refractory subgroup than in the nonrefractory subgroup, and were undetectable in the normal controls. CONCLUSIONS: Enhanced P-glycoprotein activity may be closely related to an unfavorable clinical course and a poor response to treatment. Increased TNF-alpha expression and chronic exposure to various drugs, including glucocorticoids, may contribute to increase P-glycoprotein activity. Both high P-glycoprotein activity and excessive amounts of TNF-alpha seem associated with poor outcome in rheumatoid arthritis.

Presence of activated lymphocytes in the peripheral blood of patients with halo nevi.

BACKGROUND: The involution of the central pigmented lesion in halo nevus (HN) seems to be mediated by an immune response against self antigens expressed by melanocytes. OBJECTIVE: We assessed the presence of activated lymphocytes in the peripheral blood lymphocytes from patients with HN. METHODS: Peripheral blood was obtained from patients with HN associated with benign pigmented lesions (5) or melanoma (2) as well as from patients with melanoma without HN (5) and healthy subjects (10). Activated lymphocytes were detected by flow cytometry analysis using monoclonal antibodies (mAb) against CD69, CD71, CD98, HLA-DR, and activated beta(1) integrins (HUTS-21 mAb). RESULTS: The peripheral blood lymphocytes from patients with HN, associated with either benign or malignant lesions, exhibited a significantly higher expression of all activation markers studied compared with patients with melanoma without HN or compared with healthy subjects. Therefore the peripheral blood of HN patients contained a significant fraction of lymphocytes with an activated (CD69(+), HLA-DR(+), CD98(bright)), cell proliferating (CD71( bright)), and high adhesive (HUTS-21(bright)) phenotype. These activated cells disappeared from peripheral blood after the surgical resection of the skin lesion. CONCLUSION: Our findings further support the involvement of immune activation in HN phenomenon.

Penetrating anti-DNA monoclonal antibodies induce activation of human peripheral blood mononuclear cells.

Different studies have shown that some autoantibodies are able to penetrate into living cells and that this phenomenon has functional consequences, including apoptosis. We have explored the effect of anti-DNA antibodies (Ab) on the in vitro activation of peripheral blood mononuclear cells (PBMNC) and found that a human polyclonal anti-DNA, IgG, which efficiently penetrated living cells, was able to induce the expression of different cell activation antigens in vitro such as CD69, CD71 or CD98 by PBMNC from normal individuals. However, the cell activation phenotype induced by anti-DNA Ab was considered anomalous since the expression of some activation antigens was not up-regulated, and others showed aberrant behaviour (such as down-regulation of ICAM-1 expression). Similar results were obtained using different murine anti-DNA monoclonal antibodies (mAb). In addition, mAb that showed an efficient ability to penetrate living cells tended to have a greater effect on PBMNC activation. Anti-DNA Ab were also able to induce a noticeable expression of CD95/Fas. These data indicate that penetrating anti-DNA Ab are able to induce an anomalous activation state in vitro in a significant fraction of PBMNC. We believe this effect may occur in vivoand could have an important function in the pathogenesis of the immune dysregulation seen in SLE.

Stimulation through CD50 preferentially induces apoptosis of TCR1+ human peripheral blood lymphocytes.

Apoptosis has an important role in several key immunological phenomena such as regulation of the immune response, and deletion of auto-reactive cells. This phenomenon is induced following the interaction of several cell membrane receptors with their respective ligands or after cell activation. We have studied the possible effect of signaling through CD50/ICAM-3 and CD69/AIM on apoptosis of peripheral blood lymphocytes. Apoptosis was assessed by both flow cytometry analysis (content of cell DNA and binding to annexin V), and detection of DNA fragmentation by agarose gel electrophoresis. We found that a stimulatory anti-CD50 mAb was able to induce a small but significant degree of apoptosis in resting peripheral blood mononuclear cells from most donors; this effect was dose-dependent and was evident as early as at 12 h, with a maximal induction at 48 h. Studies with T and non-T cells showed that only the former cell population was sensitive to the induction of apoptosis through CD50. Further experiments revealed that the anti-ICAM-3 mAb preferentially induced apoptosis of TCR gamma delta-bearing cells. In addition, we found a significant increase in Cai2+ in PBMC stimulated with an anti-CD50 mAb, suggesting the involvement of this signaling pathway in the induction of apoptosis through this adhesion receptor. In contrast, under our experimental conditions, stimulation through CD69 did not have any effect on the induction of apoptosis on either cultured T lymphoblasts or PMA-stimulated PBMC. Our findings suggest that the interaction of CD50 with its natural ligand LFA-1 results in the induction of apoptosis in a significant fraction of resting PBMC. This phenomenon may be involved in immune regulation, lymphocyte turnover and peripheral deletion of auto-reactive cells.

Alternativas en el manejo de la perforación esofágica: rol de la esofagectomía, ligadura esofágica y videotoracoscopía / Alternatives in the management of esophagic perforation: role of the esophagectomy, esophagic ligature and videothoracoscopy

Se presentan 10 casos de perforación esofágica tratados consecutivamente durante un período de 3 años. La localización de la perforación fue el el esofágo cervical bajo y tercio superior torácico en 4 pacientes, en el tercio inferior torácico en otros 4 y en el esófago abdominal en 2. El tiempo de evolución estimado hasta el momento de la cirugía fue en promedio 3 días; 8 pacientes fueron operados durante la evolución de una sepsis grave. Se realizó una esofagectomía tranhiatal en 5 pacientes, todos ellos fueron reconstituidos en forma diferida. Los restantes 5 pacientes fueron manejados preservando el esófago. Se efectuaron reparaciones primarias asociadas a ligaduras esofágicas en 2 pacientes, alos 3 restantes se les efectuó ligadura exclusiva. Las colecciones mediastinales y pleurales así como las complicaciones sépticas del tratamiento conservador fueron manejados por videotoracoscopía. No hubo mortalidad en esta serie

Ingesta de cáusticos: experiencia en el manejo de lesiones agudas y reconstrucciones del tubo digestivo / Caustic ingestion: experience in acute injuries management and digestive tube reconstructions

Entre enero de 1983 y diciembre de 1993 hemos realizado 21 resecciones mayores del tubo digestivo alto en igual número de pacientes que habían ingerido alguna sustancia corrosiva y desarrollado una necrosis química parcial o total del esófago y/o estómago. A 14 enfermos se les debió realizar una esofagogastrectomía total y a los otros 7 una gastrectomía total. Complicaciones postoperatorias mayores se presentaron en 6 pacientes (28.6 por ciento) y 2 fallecieron (9.5 por ciento). Durante el mismo período, realizamos en 37 pacientes igual número de reconstrucciones del tubo digestivo luego de ingesta de corrosivos. Las indicaciones de reconstrucción fueron la resección esofagogástrica previa en 17 pacientes (46 por ciento), estenosis esofágica en 8 (21.6 por ciento), postgastrectomía total en 5 (13.5 por ciento), estenosis mesogástrica en 4 (10.8 por ciento) y estenosis duodenal en 3 (8.1 por ciento). Se realizaron interposiciones de segmentos colónicos en 26 pacientes gastroyeyunoanastomosis en 6, esofagoyeyunoanastomosis en 4 y duodenoyeyunoanastomosis en 1. Complicaciones postoperatorias se observaron en 8 pacientes (21.6 por ciento) y falleció 1 paciente (2,7 por ciento)

Pancreatoduodenectomía en el cáncer de la cabeza del páncreas / Pancreatoduodenectomy in pancreas head cancer

Entre 1977 y 1993, 40 pacientes han sido sometidos a una resección pancreatoduodenal por cáncer de la cabeza del páncreas. La indicación más frecuente fue el carcinoma ductal en 36 enfermos (90 por ciento). En 33 pacientes (83,5 por ciento) se practicó pancreatoduodenectomía con preservación pilórica y en los otros 17 (17,5 por ciento) se asoció a gastrectomía. En 8 pacientes (20 por ciento) se realizó pancreatectomía total y, en 5 (12,5 por ciento) se resecaron porciones de la vena porta o mesentérica superior. Complicaciones postoperatorias se presentaron en 21 pacientes (52,5 por ciento) siendo la más frecuente la fístula pancreática en 8 (20 por ciento) y la atelectasia pulmonar infectada en 6 (15 por ciento). Fallecen 3 enfermos (7,5 por ciento). Se realizó seguimiento y etapificación TNM a 31 pacientes portadores de carcinoma ductal, correspondiendo 3 a etapa I, 13 a etapa II, 13 a etapa III y 2 a etapa IV. La sobrevida global a 1 año fue del 61,3 por ciento, a 2 años del 35,5 por ciento, a 3 años del 19,4 por ciento y a 4 años del 6,5 por ciento. La mediana de sobrevida fue de 19 meses. Los resultados obtenidos parecen justificar la pancreatoduodenectomía cada vez que sea factible como el tratamiento de elección en el cáncer de la cabeza del páncreas

Herida penetrante cardíaca: experiencia en 100 casos operados / Heart penetrating wound: experience in 100 operated cases

Se presentan 100 pacientes portadores de lesiones penetrantes del corazón operados entre 1982 y 1992. El arma blanca fue el instrumento agresor en 91 y el arma de fuego en los otros 9. Al ingreso los signos clínicos más frecuentes fueron la hipotensión (79%), la disminución de los tonos cardíacos (78%) y la hipotensión asociada a ingurgitación yugular (56%). Todos los pacientes fueron explorados vía toracotomía o esternotomía efectuada en la sala de operaciones (94%) o en la sala de emergencia (6%). Las cámaras cardíacas más frecuentemente afectadas fueron el ventrículo derecho (VD) en 69 pacientes y el ventrículo izquierdo (VI) en 23, en 11 pacientes había compromiso de 2 o más estructuras cardíacas y en 21 hubo lesiones asociadas extracardíacas. Fallecen 13 pacientes (13%), 6 durante la cirugía y 7 en el postoperatorio. Presentaron secuelas neurológicas (6) o cardíacas (5)

Pancreatoduodenectomía, análisis de la morbilidad y mortalidad en 20 años / Pancreaduodenectomy: morbidity and mortality analysis in 20 years

Se presenta una serie de 34 pacientes sometidos a una pancreatoduodenectomía entre enero de 1970 y diciembre de 1989. El origen de la lesión fue la ampolla de Vater en 18 enfermos (53%), el páncreas en 12 (35,4%), y el colédoco distal en 5 (14,7%). Un paciente tenía un adenocarcinoma ampular y otro coledociano asociados como parte de una papilomatosis maligna de la vía biliar. Los síntomas más frecuentes fueron la ictericia en 30 enfermos (88,2%) y el dolor abdominal en 26 (76,5%). Síndrome de Couvoisier-Terrier se constató en 7 pacientes (20,6%). La fístula pancreática ocurrió en 7 pacientes (20,6%) y fue la complicación más frecuente. Causó la muerte en 3 de ellos. Fallecieron 4 pacientes (11,8%), tres de ellos operados antes de diciembre de 1979, y sólo 1/17 en los últimos 10 años (5,8%)

Fascitis necrotizante: resultados del tratamiento quirúrgico agresivo / Necrotizing fasciitis: surgical treatment

Se presenta 5 casos de fascitis necrotizante (FN) hospitalizados en nuestro servicio en el último año; el promedio de días entre el inicio de los síntomas y el diagnóstico fue de 5. Dos pacientes presentaron compromiso de la pared abdominal secundario a una laparatomía y en tres hubo compromiso perineal. Al ingreso todos los pacientes presentaban evidencias de sepsis. Localmente en todos se apreció dolor a la palpación, con edema y celulitis y en 3 se observó necrosis dérmica. Los pacientes fueron operados realizando amplias necrosectomías de todo el tejido comprometido, agregando una colostomía derivativa en dos. posteriormente, cuatro pacientes necesitaron injertos. Todos los pacientes recibieron antibioterapia de amplio espectro. Los gérmenes cultivados fueron, en la mayoría, enterobacterias en combinación con anaerobios. Dos pacientes evolucionaron con un shock séptico, asociándose a distress respiratorio del adulto en un caso y a angor inestable en otro. En todos los casos se constató una desnutrición grave que requirió hiperalimentación. No hubo mortalidad en nuestra serie. El tratamiento quirúrgico precoz y agresivo, junto a un apoyo intensivo adecuado, permite ofrecer una buena sobrevida a los enfermos con FN

Características de los egresos por sarampión en el Hospital Roberto del Río 1981-1985 / Characteristics of measles discharge at Hospital Roberto del Río 1981-1985

Se hace un estudio descriptivo de los egresos por sarampión de un hospital infantil de Santiago y se analiza la posible influencia de la edad de vacunación en ese grupo. Se revisa la totalidad de los egresos con diagnóstico de sarampión del Hospital Roberto del Río S.S.M.N. entre el 1 de enero de 1981 y el 31 de diciembre de 1985, separándolos en dos grupos A y B según cambio en el esquema de vacunaciones que ocurrió a mitad de período. Un 64,5% corresponde a menores de 1 año, el 45% son desnutridos (peso/edad). Las complicaciones más frecuentes fueron bronconeumonía, neumonitis y diarrea. La letalidad hospitalaria fue de 0,43%. El promedio de días de estada fue de 9,2 días y la mediana de 7 días. La influencia del esquema de vacunaciones en hospitalizados por sarampión requiere más tiempo de observación para sacar conclusiones válidas, aún cuando existen diferencias entre ambos grupos