Acute and chronic effects of a contraceptive compound RTI-4587-073(l) on testicular histology and endocrine function in miniature horse stallions.

The objective of this study was to evaluate acute endocrine effects as well as histological changes in testicular parenchyma induced by the contraceptive compound RTI-4587-073(l). Six miniature stallions were used in this experiment. The treatment group (n = 3) received one oral dose of 12.5 mg/kg of RTI-4587-073(l), and the control group (n = 3) received placebo only. The stallions' baseline parameters (semen, testicular dimensions, endocrine values) were collected and recorded for 5 weeks before treatment and for 6 weeks after treatment. Multiple blood samples were collected for endocrine analysis. Testicular biopsies were obtained before treatment, 1 day after treatment and every other week after treatment. Ultrasound exams were performed to monitor the dimensions of the stallions' testes. All stallions were castrated 6 weeks after treatment. Sperm numbers, motility and percentage of morphologically normal sperm decreased (p < 0.05), while the number of immature germ cells increased in ejaculates from treated animals (p < 0.05). Serum concentrations of inhibin and follicle-stimulating hormone did not change. Testosterone concentrations initially transiently decreased (p < 0.05) after administration of RTI-4587-073(l), and increased several days later (p < 0.05). Testicular content of testosterone and estradiol 17-ß was lower in treated stallions than in control stallions on Day 1 after treatment (p < 0.05). Severe disorganization of the seminiferous tubules, significant loss of immature germ cells and complete depletion of elongated spermatids were observed in testicular biopsies obtained from treated stallions 1 day, 2 and 4 weeks after treatment. These changes were still present in the testicular samples taken from treated stallions after castration. The results of this study confirmed that RTI-4587-073(l) has antispermatogenic effects in stallions. Furthermore, we concluded that this compound causes acute sloughing of immature germ cells from the seminiferous tubules. RTI-4587-073(l) has significant but transient effects on Leydig cell function in stallions.

[Tuberculosis in health care workers from a public health service in Santiago, Chile]. / Tuberculosis en el personal de salud del Servicio de Salud Metropolitano Sur de Santiago, Chile.

OBJECTIVE: To evalúate the risk of tuberculosis (TBC) among health care workers (HCW) of the Southern Metropolitan Health Service (SMHS) of Santiago, Chile. METHOD: A retrospective study using records of patients receiving TBC treatment in the SMHS from 2001 to 2006 was performed, in which HCW were identified. Total population of HCWs at risk was calculated using annual records of personnel hired at the SMHS. Data on TBC cases and rates were compared against data of the SMSH and hazard ratio (HR) and confidence intervals obtained. RESULTS: Fourteen cases were identified, predominantly among auxiliary personnel (n: 4, 35.7%), nursing staff and ambulance drivers (n: 2, 14.3%) each). Cases occurred in personnel from 41.7% of hospitals and 10.3% of ambulatory care centers within the SMHS and 92.2% involved personnel with direct patient care or contact. Pulmonary localization was seen in 11 (78.6%), and more than half (57.2%) had a positive sputum stain or culture. All cases initiated treatment, but 1 abandoned it and other died of liver failure associated to cirrhosis (7.1% each). Between 2003 and 2006, the annual rate of TBC among HCW ranged between 0 and 79 per 100.000, and during 2004 it was higher than the rate observed in SMHS (Hazard ratio 4.56; IC(95): 1.83-10.62). [corrected] CONCLUSIONS: Despite TBC rate decline in Chile, this disease still represents a significant occupational risk for HCW. Notably, more than half of cases among HCWs are contagious, and despite treatment, some have a lethal evolution.

[Urinary stress incontinence: surgical experience in our center]. / Incontinencia de esfuerzo: experiencia quirúrgica en nuestro centro.

INTRODUCTION: For the treatment of the urinary stress incontinence, there are many techniques, and today the gold standard is that described by Burch. We compared the global and each technique results about rates of postoperative continence and complications seen in our experience. MATERIALS AND METHODS: We made a retrospective analysis of 292 women that have the first surgery for urinary stress incontinence in our centre, between 1991 and 2006. We considered cure the patient who did not have any level of incontinence postoperative, we made a Kaplan-Meier analysis for the postoperative continence evaluation. Besides we studied the behaviour of the postoperative complications found. RESULTS: Mean age was 53.6 years old, and mean time of follow up was 15.6 months. The vaginal techniques were the most practised (138), followed by the TVT (57), abdominal Burch (38), vaginal wall Sling (33), and the less was the laparoscopic Burch (26). The best rates of postoperative continence after 2 years were observed in the patients treated by TVT (87.6%), then with vaginal wall Sling (84.9%), laparoscopic Burch (59.3%), abdominal Burch (59.1%), and the worst with vaginal techniques (48.2%) (p = 0.007). We found more urgency and urge incontinence in the patients treated by TVT (36.8% y 21.1% respectively), and postoperative pain with vaginal techniques (36.2%). Postoperative urine retention and postoperative high residual urine more with the vaginal wall sling (54.5%) and vaginal techniques (26.1%) respectively. CONCLUSIONS: We have the best results for the incontinence treatment in our population with the TVT technique.

[Natural history of metastasic prostate cancer treated with androgen deprivation therapy and secondary hormonal therapy efficiency]. / Historia natural del cáncer de próstata metastásico sometido a bloqueo hormonal y eficacia del tratamiento hormonal de segunda línea.

OBJECTIVE: to analyze metastatic prostate cancer progression in patients treated with hormonal blockade as well as second line hormonal treatments outcomes. PATIENTS AND METHODS: 199 metastatic patients were selected from a 455 hormonal treated patients pool. Time to biochemical progression was studied with Kaplan Meier analysis and patients were stratified according to pathological differentiation. Second line treatment lasting and efficacy were also assessed. RESULTS: 74 patients out of 192 metastatic patients (56.1%) progressed in terms of PSA. Median time to biochemical progression was 1.7 years (1.2-2.3, CI 95%). We did not find stadistical differences on pathological differentiation (p = 0.238). Second line treatment's efficacy, applied to 41 patients was 34.1%, without any stadistical differences among these treatments. Response treatment median time was 6.8 months without stadistical differences among different treatments (p = 0.220). CONCLUSIONS: hormonal blockade efficacy in metastatic prostate cancer has a limited value in time in our experience. One third of these patients have a limited response to a second line treatment although this response is even shorter in duration.

Validación de una versión en español abreviada de la batería EMOTICOM (VEA-EMOTICOM) / Validation of a Spanish short version of the EMOTICOM battery (VEA-EMTICOM)

RESUMEN: Introducción: la mayoría de las escalas empleadas en la evaluación de los trastornos psiquiátricos se centran en el estado clínico del paciente. Sin embargo, es importante medir cuantitativamente dimensiones específicas, como el funcionamiento cognitivo, afectivo o social, y registrar su evolución en el ámbito clínico o de investigación. La batería EMOTICOM incluye cuatro dominios de cognición afectiva, procesamiento de emociones, motivación, impulsividad y cognición social. Aquí presentamos datos psicométricos de una versión en español abreviada (VEA-EMOTICOM). Metodología: la muestra incluyó doscientos voluntarios sanos (31,68 años ± 8,38; 111 hombres). Cuarenta y dos sujetos fueron re-evaluados para determinar la fiabilidad test-retest. La VEA-EMOTICOM comprende 9 tareas programadas en una computadora portátil a completar en una hora. La batería se administró en una secuencia aleatoria y se permitió períodos de descanso. Resultados: se observaron efectos de piso pequeños para 3 resultados y moderados para 1 resultado, además de efectos de techo pequeño para 3 resultados y moderado para 1 resultado. Dos tareas exhibieron una excelente confiabilidad prueba-reprueba, cuatro una buena confiabilidad, siete confiabilidad moderada, y, dos mostraron una confiabilidad de prueba-reprueba deficiente. Los resultados de la mayoría de las tareas no se correlacionaron con la edad ni con el género. No se pudo confirmar una estructura subyacente de 4 factores. Conclusiones: La VEA-EMOTICOM parece ser una batería práctica y adecuada para evaluar cognición afectiva en población hispano parlante.

ABSTRACT Introduction: Most scales used in the assessment of psychiatric disorders focus on the clinical status of the patient. However, it is important to quantitatively measure specific dimensions, such as cognitive, affective or social functioning, and to record their evolution in the clinical or research setting. The EMOTICOM battery includes four domains of affective cognition; processing of emotions; motivation; impulsivity; and social cognition. Here we present psychometric data from an abbreviated Spanish version (VEA-EMOTICOM). Methodology: The sample included two hundred healthy volunteers (31.68 years ± 8.38; 111 men). Forty-two subjects were re-evaluated, to determine test-retest reliability. The VEA-EMOTICOM comprises 9 tasks programmed on a laptop computer to be completed in one hour. The battery was administered in a random sequence and rest periods were allowed. Results: Small floor effects were observed for 3 outcomes and moderate for 1 outcome, as well as small ceiling effects for 3 outcomes and moderate for 1 outcome. Two tasks showed excellent test-retest reliability; four showed good reliability; seven showed moderate reliability; and two showed poor test-retest reliability. The results of most of the tasks were not correlated with age or gender. An underlying four-factor structure could not be confirmed. Conclusions: The VEA-EMOTICOM seems to be a practical and adequate battery to evaluate affective cognition in Spanish-speaking population

Use of two conventional staining methods to assess the acrosomal status of stallion spermatozoa.

REASONS FOR PERFORMING STUDY: The acrosome is a highly specialised region of the spermatozoon that is essential for fertilisation. Defects or dysfunction of this structure have been associated with fertility problems in man and various domestic species including stallions. Current methods of evaluating the acrosome of stallion spermatozoa are time consuming and require specialised equipment, which is cost prohibitive to the average practitioner. OBJECTIVES: To evaluate 2 conventional stains (Dip Quick and Spermac) and determine their usefulness in assessing acrosome integrity in stallions as compared with specific acrosomal labelling with a fluorescein-conjugated lectin - a method that has been validated for acrosome status evaluation in stallions. STUDY DESIGN: In vivo experimental design. METHODS: Semen from 6 mature Miniature horse stallions of known fertility was collected on 5 separate occasions. To increase the number of reacted acrosomes, portions of each ejaculate were incubated with the calcium ionophore, A23187. Ejaculates were divided and semen samples were processed according to recommendations for fluorescein-conjugated peanut lectin, Pisum sativum agglutin, Dip Quick, and Spermac staining methods. Slides were evaluated independently by 2 separate investigators. Spermatozoa were classified as having intact, reacting, reacted or defective acrosomes. RESULTS: All parameters obtained by both investigators, using all 3 staining methods were highly correlated (P<0.001). There was no statistical difference (P>0.05) between investigators or staining method for the percentages of intact or reacted acrosomes. However, there was a significant difference between investigators and staining methods for determining reacting acrosome percentages (P<0.05). CONCLUSIONS: Dip Quick and Spermac stains are useful for determining intact vs. reacted acrosomes for stallion spermatozoa.

[TVT and TOT for surgical correction of female stress urinary incontinence. Comparison between techniques]. / TVT y TOT para la corrección quirúrgica de la incontinencia femenina de stress. Comparacion de ambas técnicas.

OBJECTIVES: Retrospective analysis of a series of patients with stress urinary incontinence that underwent surgery in our department, by means of the TVT and TOT techniques. We evaluate post operative continence, considering "cured" the patient with complete continence and "failure" any type of involuntary stress urine leak, independently of its severity registering the time of its appearance. For this purpose we used the Kaplan-Meier analysis comparing both techniques with the Breslow test. Additionally, postoperative complications were evaluated. RESULTS: 128 patients who underwent surgery by TVT (69 patients, 53.9%) and TOT (59 patients, 46.1%). Mean age was 54.4 years for TVT (95% CI 52.0-56.8) and 59 years for TOT (95% CI 55.9-62.1). Mean follow-up time was 18.7 months for TVT (95% CI 15.6-21.9) and 7.4 months for TOT (95% CI 5.8-8.9). Overall continence rate was 86.7%, 88.4% for TVT and 84.7% for TOT The probability of being continent six months after surgery was 89.1% for TVT and 78.2% for TOT (no significant differences, p = 0.31), with almost all failures within the first six months after surgery. TVT was more frecuently associated with urgency symptoms (33.3%, p = 0.001) and urge incontinence (18.8%,p = 0.16), urinary retention (11.6%, p = 0.38), and prevesical hematoma requiring mesh retrieval. Greater post operative pain was observed with TOT (20.3%, p = 0.005). CONCLUSIONS: Our results evidence a similar efficacy with both techniques, with the failures appearing over the first months after surgery. Complications of the voiding urgency type are significantly more frequent with TVT.

Actualización Consenso Neumonía asociada a ventilación mecánica: Segunda parte. Prevención / Update. Consensus on Ventilator Associated Pneumonia: Second Part: Prophylaxis

Ventilator associated pneumonia is a life threatening disease, in spite of advances in its treatment, consequently the development of prevention strategies is a key factor in improving the morbidity and mortality in intensive care units (ICU). The new developments in this field in the last years led to the need to update the recommendations done in 2001. Then, a new search and analysis of scientific literature was performed. The obtained data support different strategies highlighting: semi-recumbent position at 45° of patients; incorporation of routinely oral hygiene procedures with chlorhexidine; preference of orotracheal intubation; performing subglotic aspiration; use of standard hand hygiene techniques; not routine change of ventilator circuits; and defining bundles to organize the work at ICU. Some strategies were recommended for being of similar efficacy to others but cost-effective as: use of heat and moisture humidificators; and changing humidificators every 5 to 7 days. The use of open or closed endotracheal suctioning system does not affect the incidence of pneumonia. Some recommendations were not incorporated because of lack of evidence supporting effectiveness, controversial data or doubtful application to our country as selective digestive decontamination.

La neumonía asociada a ventilación mecánica ha persistido como una enfermedad relacionada a una alta mortalidad, a pesar de los avances que se han tenido en tratamiento. Es así que, hacer énfasis en la prevención de ésta, es fundamental para mejorar la morbi-mortalidad de las unidades de cuidados intensivos (UCIs). Los nuevos enfoques reportados en esta materia en los últimos años, hicieron necesaria la actualización de las recomendaciones hechas el año 2001. En vista de esto, se realizó una nueva búsqueda y análisis de la literatura científica. La información obtenida apoya diferentes intervenciones destacando: el uso de la posición semisentada a 45°; la higiene oral, de rutina, con clorhexidina; preferencia de la vía endotraqueal para intubación; realización de aspiración subglótica rutinaria; uso de las precauciones estándares; evitar el cambio rutinario de los circuitos de ventilación mecánica; y desarrollar paquetes de medidas ("bundles") que permitan organizar el trabajo en las UCIs. Algunas estrategias fueron recomendadas con datos de similar eficacia, pero mejor costo efectividad como: el uso de humidificadores higroscópicos; y el cambio de humidificadores cada 5 a 7 días. El uso de sistemas de aspiración abiertos o cerrados no afecta la incidencia de neumonía. Algunas recomendaciones no fueron incorporadas por falta de evidencia que asegurase su efectividad, datos controversiales o posibilidad dudosa de aplicación a nuestro país como la descontaminación intestinal selectiva.

Tuberculosis en el personal de salud del Servicio de Salud Metropolitano Sur de Santiago, Chile / Tuberculosis in health care workers from a public health service in Santiago, Chile

Objective: To evalúate the risk of tuberculosis (TBC) among health care workers (HCW) of the Southern Metropolitan Health Service (SMHS) of Santiago, Chile. Method: A retrospective study using records of patients receiving TBC treatment in the SMHS from 2001 to 2006 was performed, in which HCW were identified. Total population of HCWs at risk was calculated using annual records of personnel hired at the SMHS. Data on TBC cases and rates were compared against data of the SMSH and hazard ratio (HR) and confidence intervals obtained. Results: Fourteen cases were identified, predominantly among auxiliary personnel (n: 4, 35.7 percent), nursing staff and ambulance drivers (n: 2, 14.3 percent) each). Cases occurred in personnel from 41.7 percent of hospitals and 10.3 percent of ambulatory care centers within the SMHS and 92.2 percent involved personnel with direct patient care or contact. Pulmonary localization was seen in 11 (78.6 percent), and more than half (57.2 percent) had a positive sputum stain or culture. All cases initiated treatment, but 1 abandoned it and other died of liver failure associated to cirrhosis (7.1 percent each). Between 2003 and 2006, the annual rate of TBC among HCW ranged between 0 and 79 per 100.000, and during 2004 it -10.62). Conclusions: Despite TBC rate decline in Chile, this disease still represents a significant occupational risk for HCW. Notably, more than half of cases among HCWs are contagious, and despite treatment, some have a lethal evolution.

Objetivo: Evaluar el riesgo de tuberculosis (TBC) clínica a través de un estudio retrospectivo sobre la razón de prevalencia de TBC entre el personal de salud (PS) del Servicio de Salud Metropolitano Sur de la Región Metropolitana (SSMS) y la población de la misma zona. Método: Los casos entre el PS y el resto del SSMS, junto a la población total y la dotación del PS, se obtuvieron de los registros existentes en el propio SSMS (2001-2006). Resultados: Se identificaron 14 casos, afectando predominantemente a técnicos paramédicos (35,7 por ciento), enfermeros y conductores de ambulancia (14,3 por ciento) cada uno). El 92,9 por ciento de los afectados laboraba en el área clínica. Los casos se presentaron entre el PS de hospitales y consultorios. Los afectados involucraban al 41,7 por ciento del total de hospitales y a 10,3 por ciento de los centros de atención primaria. La localización fue predominantemente pulmonar (78,6 por ciento) y más de la mitad tenía frotis o cultivo de expectoración positivo (57,2 por ciento). Todos los casos iniciaron tratamiento, 12 lo completaron con éxito (85,7 por ciento), uno lo abandonó y el restante falleció por falla hepática asociada a cirrosis (7,1 por ciento cada uno). La tasa entre el PS varió entre 0 y 79 casos por 100.000 y el año 2004 fue significativamente superior al valor registrado en el SSMS (razón de nesgo 4,56; IC95: 1,83 -10,62). Conclusiones: A pesar de la declinación de la TBC en Chile, aún representa un riesgo ocupacional para el PS. Notablemente, más de la mitad de los casos son bacilíferos y algunos casos tienen una evolución letal.

Tiña negra: a propósito de tres casos en el estado Táchira-Venezuela / Tinea nigra: report of three cases in the state of Táchira-Venezuela

La tiña negra es una dermatomicosis superficial, poco frecuente, quiza subdiagnosticada, cuyo agente etiológico es el phaeonnellomyces werneckii. Considerada como enfermedad tropical y subtropical de distribución universal, afecta a personas de ambos sexos, a cualquier edad; siendo los niños y los adolescentes los más afectados. Manifestada clínicamente como maculas hiperpigmentadas, asintomáticas de evolución crónica, localizada en la palma de las manos, aunque también pueden estar presentes en la planta de los pies y otras superficies. El examen micológico directo y cultivo de la lesión confirman el diagnóstico y el tratamiento con topicos de formulación sencilla incluyendo imidazolicos ofrecen buenos resultados.

Sindrome desmielinizante aislado del sistema nervioso central como expresión de una esclerosis múltiple tardía: estudio anatomoclínico de un caso / Isolated central nervous system cemyelinating syndrome as the clinical expression of a late multiple sclerosis: report of one case

We report a 56 years old male developed a transverse myelopathy with cuadriparesis,neurogenic bladder and a sensitive level at C4. Cerebral and spinal cord magnetic resonance imaging showed only one demyelinative lesion at the cervical level. Post morten neuropathological study showed segmental myelin loss without anatomical limits and with axonal preservation in the involved spinal cord segment. This lesion had the classical features of multiple sclerosis.The isolated lesion, the pathological findings and the delayed age of onset allow the definition of this case as an isolated nervous system demyelinative syndrome

Colecistectomía laparoscópica: ¿es útil la profilaxis antibiótica en colecistitis crónica? / Laparoscopic cholecystectomy: is it useful the antibiotic prophylaxis in chronic cholecystitis?

En este trabajo se evalúa prospectivamente la utilidad de la profilaxis antibiótica en la prevención de la infección postoperatoria en pacientes portadores de una colecistitis crónica y sometidos a una colecistectomía laparoscópica. Se estudiaron prospectivamente 100 pacientes consecutivos, los que se distribuyeron aleatoriamente en 2 grupos de 50 enfermos cada uno. Grupo I, a los que no se les indicó antibióticos y Grupo II se les administró preoperatoriamente una cefalosporina de tercera generación. Ambos grupos eran similares en edad y sexo, técnica operatoria, patología, etc. En esta serie no hubo complicaciones sépticas intrabdominales. La tasa de infección de la herida operatoria fue similar, 1 caso (2 porciento) para cada grupo (p=0.08). Ambas fueron leves y cedieron rápida y espontáneamente con curaciones. De los resultados de este trabajo se concluye que no se justifica la administración profiláctica de antibióticos a pacientes portadores de una colecistitis crónica y que serán sometidos en forma electiva a una colecistectomía laparoscópica

Actividad tirosina-protein-quinasas en cáncer de mama: correlación con algunos elementos de pronóstico / Tyrosine-protein-kinase activity in breast cancer: correlation with some pronostic elements

Diversas evidencias acumuladas en los últimos años relacionan la actividad de tirosina-protein-quinasa (TPK) con la transformación celular maligna y permiten suponer una relación entre dicha actividad y la capacidad de proliferación tumoral y por lo tanto, el pronóstico. En este trabajo se relaciona la actividad de TPK en 27 biopsias obtenidas de cáncer mamario humano con diversos parámetros clínicos y anátomo-patológicos de pronóstico. Las muestras de tejido fueron obtenidas quirúrgicamente de pacientes que presentaban cáncer de mama demostrado. Se determinó la actividad TPK en homogeneizados de tejido mamario utilizando (Val5) angiotensina II como sustrato exógeno. El estudio demostró una relación estadística entre la actividad global real de TPK (actividad TPK de las células tumorales menos la actividad TPK de las células mamarias normales) y el tamaño clínico del tumor, así como con el ² termográfico, sin encontrar relación con el número de ganglios invadidos ni con la pobre diferenciación celular. Estos antecedentes hacen suponer que de existir una relación entre la actividad global real de TPK y la evolución tumoral, ésta sea más bien con la velocidad de crecimiento que con el potencial metastizador

Actividad de tirosina-proteina-quinasas en cáncer de mama: comparación con la actividad obtenida en patologías benognas y en tejidos normales / Tyrosina-protein-kinase activity in breath cancer: comparison between benign pathologies and normal tissues activity

Tyrosine protein kinase (TPK) activity is associated to malignant cellular transformation. This work compares TPK activity in 27 surgical biopsy samples of mammary carcinoma, 10 samples of normal mammary tissue. TPK activity was determined in tissue homogenates using (Val5) angiotensin II as exogenous substrate. In samples of mammary carcinoma, TPK activity was 33.86 ñ 31.98 pmol P32/mg protein/30 min. This value was significantly higher that those observed in fibrocystic disease (3.92 ñ 2.35), fibroadenomas (13.86 ñ 10.9) and normal tissue (3.56 ñ 3.02)