Randomized clinical trial to compare the efficacy to improve the quality of surgical field of hypotensive anesthesia with clonidine or dexmedetomidine during functional endoscopic sinus surgery.

PURPOSE: Intense bleeding of the surgical field is a potential factor influencing success of functional endoscopic sinus surgery (FESS). Hypotensive anesthesia with α2 intravenous agonists reduces intraoperative bleeding, but which is the best agent is unknown. The main objective of this trial was to compare the current standard adjuvant drug for hypotensive anesthesia, clonidine, with the recently available alternative dexmedetomidine. METHODS: A randomized clinical trial compared the efficacy of clonidine and dexmedetomidine during FESS. Treatment was open label for the anesthesiologist and operating surgeon, but blind for an external evaluator who evaluated video-recorded surgeries. A Boezaart scale was assessed every 30 min during FESS until surgery completion. Main end-point was the proportion of patients with mean Boezaart scores > 2 (heavy bleeding) by external blinded evaluator. Secondary end-points included other bleeding parameters, surgery duration, hemodynamic measures and surgical complications. RESULTS: 94 patients were randomized. There were no significant differences in the proportion of patients with mean Boezaart scores > 2 in clonidine (42.6%) and dexmedetomidine (42.6%). Consistently, no differences were observed in secondary variables of bleeding, duration or complications. Small differences in mean heart rate were observed that might reflect different pharmacological profiles of the products, but are of uncertain clinical relevance. CONCLUSIONS: No significant differences were observed between clonidine and dexmedetomidine when used as anesthetic adjuvants in the reduction of surgical bleeding in FESS. A longer experience with clonidine and its lower costs suggest it may be a preferable option as an adjuvant for hypotensive anesthesia.

Utility of Molecular Analysis of Peritoneal Fluid in Staging Laparoscopy of Advanced Esophagogastric Junction and Gastric Cancer Prior to Neoadjuvant Treatment.

PURPOSE: Molecular analysis of peritoneal fluid in staging laparoscopy of gastric cancer is performed to improve the detection of free intraperitoneal tumor cells. Nevertheless, its significance is controversial, especially in patients with negative cytology but positive molecular analysis. The aim of this study was to analyze the sensitivity of molecular analysis and its prognostic value. METHODS: A retrospective analysis from April 2011 to October 2019 was performed. Cytology (Cyt) and molecular analysis were analyzed by real-time reverse transcriptase polymerase chain reaction (RT-PCR) of the carcinoembryonic antigen (CEA) and cytokeratin 20 (CK20) tumor makers. RESULTS: During the study period, 138 staging laparoscopies were performed. Macroscopic carcinomatosis was found in 12.3%. Of the remaining 87.7%, 9.9% were Cyt + and 11.6% were Cyt- RT-PCR + . Of the latter, 9 responded to chemotherapy and underwent radical surgery. The sensitivity of cytology and molecular analysis was 0.70 and 0.76, respectively (p = 0.67). The 2-year overall survival (OS) of Cyt- RT-PCR + vs. Cyt + was similar (p = 0.1). The 2-year OS of Cyt-RT-PCR + subgroup who underwent radical surgery vs. Cyt-RT-PCR- patients was similar (p = 0.69), but disease-free survival was shorter in the first group (p = 0.005). CONCLUSION: Our results show that the sensitivity of molecular analysis is similar to that of cytology. The prognostic value of positive molecular analysis was similar to positive cytology in terms of 2-year overall survival, except in the subgroup of operated patients in whom the overall survival was similar to that of those with a negative molecular analysis, albeit with a shorter disease-free survival.

Asthma related to Alternaria sensitization: an analysis of skin-test and serum-specific IgE efficiency based on the bronchial provocation test.

BACKGROUND: It is difficult to find a causal relationship between exposure to Alternaria spores and the development of asthma symptoms in sensitized individuals due to the complexity of clinical situations in which positive diagnostic tests are often found. OBJECTIVE: To analyse the diagnostic efficiency of skin testing (ST) and serum-specific IgE to Alternaria, based on the results of a bronchial specific challenge with Alternaria extracts. METHODS: Seventy-four asthmatic patients sensitized to Alternaria underwent a specific bronchial challenge with this mould. Skin-testing weal sizes, serum-specific IgE values (CAP-system) and bronchial challenge results were analysed by receiver operating characteristics curves (ROC curves) and logistic regression. The sensitivity, specificity, positive and negative predictive values were calculated for different cut-off points. RESULTS: Bronchial challenges to Alternaria elicited a positive result in 45 patients (61%). Skin prick testing almost perfectly predicted the outcome of bronchoprovocation tests (area under the ROC curve of 0.957), whereas intradermal skin testing had moderate efficacy. A negative result for skin prick test (SPT) showed a 4% probability of a positive bronchial challenge in the logistic regression analysis. However, weals around 5.5 mm in diameter had 90% probability of a positive challenge. Quantification of serum-specific IgE correctly classified 86% of the cases. In the logistic regression analysis, a CAP value 16 kU(A)/L predicted a positive bronchial challenge result with 99% accuracy, whereas for a CAP value <0.35 kU(A)/L, this probability was 33%. CONCLUSIONS AND CLINICAL RELEVANCE: Most asthmatic patients with positive SPT results to Alternaria would have a positive bronchial challenge. As atmospheric mould levels may vary significantly with the weather conditions, sensitized patients should be instructed on the risk situations, environmental control measures and the importance of correct medication compliance. Immunotherapy with Alternaria could also be taken into account as a valid therapeutic option.

Incidence of acute respiratory tract infections (2006-2015) and influenza (2006-2013) among French armed forces.

OBJECTIVES: We aimed to assess the incidence of respiratory tract infections in military settings between 2006 and 2015. PATIENTS AND METHODS: We performed a retrospective epidemiological study of the entire military population from 2006 to 2015. Comprehensive data was collected from all medical centers, operational medical units, naval services, and army training hospitals and provided by the epidemiological surveillance of the armies. RESULTS: The annual average population of the study was 331,394 soldiers. For acute respiratory tract infections (2006-2015), 22,818 cases were reported in metropolitan France, 3,211 cases in French overseas territories, 1,595 cases in the French Navy, and 1,318 cases in external military operations for a total of 28,942 cases. For influenza (2006-2013), 934 cases were reported in metropolitan France, 101 cases in French overseas territories, and 23 cases in external operations, for a total of 1,058 cases. The mean incidence rate of acute respiratory tract infections expressed as case number per 1,000 person-years (PY) was 8.7 PY (95% CI [8.6-8.8]) with an exceptional increased incidence rate in 2009 (25.9 PY, 95% CI [25.4-26.4]). The mean incidence rate of influenza was 0.35 PY (95% CI [0.33-0.37]) with a peak incidence rate of 1.9 PY in 2009. CONCLUSION: Acute respiratory tract infections are at the forefront of infectious episodes in the French armies. Although not necessarily severe, current prevention measures are not enough to reduce the incidence threshold of these infections and need to be improved.

Safety of triflusal (antiplatelet drug) in patients with aspirin-exacerbated respiratory diseases.

BACKGROUND AND AIMS: Aspirin, a cyclo-oxygenase (COX)-1 and COX-2 inhibitor, is the antiplatelet drug of choice to prevent serious vascular events. Adverse reactions to aspirin are frequent particularly among patients with asthma, chronic rhinosinusitis and nasal polyps. COX-1 inhibitors but not COX-2 inhibitors precipitate asthma attacks. Triflusal is a preferential COX-2 inhibitor antiplatelet agent that is as effective as aspirin in the prevention of serious vascular events. The aim of the study was to assess the tolerability of triflusal in patients with aspirin-exacerbated respiratory disease (AERD). METHODS: We studied 26 asthma patients [11 males, aged 52 (23-75) years] who had suffered asthma episodes triggered by one or more (23% of patients) nonsteroidal anti-inflammatory drugs. Aspirin sensitivity was confirmed by either intranasal or oral aspirin challenge. All subjects underwent a single-blind, placebo-controlled oral challenge with three doses of triflusal separated by 1 week (first cumulative dose = 225 mg; second cumulative dose = 450 mg; third cumulative dose = 900 mg). Cutaneous, respiratory, general symptoms and lung function were monitored for 4 h in the laboratory and for 24 h at home. RESULTS: No clinical reactions to triflusal were observed. There were no significant changes in lung function measurements. CONCLUSION: Our study appears to demonstrate that triflusal is a suitable alternative to aspirin as antiplatelet agent to prevent AERD.

[Virus and heparan sulphate: from adsorption mechanism to cellular entry]. / Virus et héparane sulfate : des mécanismes d'adsorption cellulaire à l'entrée virale.

Heparan sulphates are complex polysaccharides that belong to a class of molecules called glycosaminoglycans. Linked to different core proteins, they are ubiquitously expressed at most cells' surface. These molecules interact with a huge number of distinct proteins and regulate their biological activities. In particular different viruses make use of heparan sulphate interactive properties to dock themselves at the surface of their cellular targets. This interaction enables the viruses to concentrate at the close proximity of others molecules that act as co-receptors, and as such increases viral entry. Recent progresses in the structural characterisation of glycosaminoglycans have helped to understand the relationship between the structure of these molecules and their ability to recognise viral capside or envelope glycoproteins. These works also showed the direct role of these molecules in viral tropism and mechanism of entry, and suggest medical applications as biotechnological strategies.

Sebaceous gland hyperplasia of the vulva: a case report.

A unique case of sebaceous gland hyperplasia presenting as polypoid lesions on the vulva of a 32-year-old white woman is reported. Sebaceous hyperplasia is a benign condition most frequently seen on the forehead of elderly patients. The reported case presented with three soft, nontender polypoid lesions located on mons veneris and right labium majus. Histological examination showed hyperplastic sebaceous lobules not associated with hair follicles. The extremely rare site of the lesion, the clinical and histopathological differential diagnosis, and a therapeutical approach are discussed.

[Etiologic and epidemiologic study of dermatomycoses in Navarra (Spain)]. / Estudio etiológico y epidemiológico de las dermatofitosis en Navarra (España).

We review the etiology of the dermatophytosis in Navarra (Spain) over a 5-year period and it is compared with previous studies. We have isolated 312 strains of dermatophyte fungi in 285 patients (188 men and 97 women). Trichophyton rubrum was the most frequently isolated species (58.6%) followed by Trichophyton mentagrophytes (26.2%) and Microsporum canis (10.5%). Concerning the location of the lesions, tinea pedis was the clinical pattern found in the greatest number of patients, followed by tinea corporis, tinea unguium and tinea capitis. Twenty eight percent of the isolations were accomplished in October and November. More than half of those patients questioned had had epidemiological contact with animals or practiced sports. The rise of tinea pedis in our region is emphasised. The possible causes of this increment are analyzed and some recommendations for its control are made.

Fine needle aspiration biopsy of myxoid metastasis of malignant melanoma.

The cytopathologic features of the fine needle aspiration biopsy of a myxoid metastasis of a cutaneous malignant melanoma are documented. The cytologic findings included fusiform-to-round cells with elongated cytoplasmic processes, fibroblastlike cells and inflammatory cells in a characteristic amorphous background substance. Immunocytochemical staining for S-100 protein was positive. The cytologic findings correlated well the histologic, histochemical, immunohistochemical and ultrastructural studies of the neoplasm. The cytologic differential diagnosis between metastases of malignant melanoma and other myxoid tumors of soft tissues is discussed.

Using a new lipidocolloid dressing in paediatric wounds: results of French and German clinical studies.

OBJECTIVE: To evaluate the efficacy, tolerance and acceptability of a lipidocolloid dressing, Urgotul (Laboratoires Urgo), in the local treatment of acute and chronic paediatric wounds. METHOD: Two non-comparative multicentre prospective clinical studies were conducted using the same protocol in France and Germany. A total of 100 patients were recruited from 16 centres (11 in France and five in Germany), and followed up for four weeks. Seventy wounds (55 burns and 15 other wounds) from France and 30 from Germany (22 burns and eight other wounds) were evaluated by nursing staff at every dressing change and by the medical investigator on a weekly basis. RESULTS: In the French study population, 86% of the burns (superficial and deep partial-thickness) and 53% of the other wounds healed completely within the four weeks. Figures for the German study population were 100% and 88% respectively. Pain was evaluated using pain scales adapted to the patient's age (objective pain scale, faces scale for pain and a visual analogue scale) at each dressing change. Dressing removal was non-traumatic, inducing very limited pain. Minor local adverse events were reported in four children. CONCLUSION: Urgotul is not only efficacious, but also well-tolerated and accepted by children with acute and chronic wounds. The dressing, therefore, might be an appropriate and highly promising alternative to conventional dressings.

[Smoking and school children: context, opinions and behavior]. / El tabaco y los escolares: contexto, opiniones y comportamiento.

BACKGROUND: This paper studies smoking epidemiology in school-age students. MATERIAL AND METHODS: A cross-sectional survey of 8th grade students (13-14 years-old) in the schools of Barcelona (Catalonia, Spain) in 1987, 1992 and 1994. RESULTS: The perception of smoking in the students environment has decreased. The proportion of regular smokers decreases, from 12.6% in 1987 to 9.5% in 1994 (p < 0.05) (an annual decrease of 3.5%) although the proportion who experiment with tobacco remains table. CONCLUSIONS: There is a decrease in the prevalence of regular smoking in the school-age population (13-14 years-old) in Barcelona (Spain).

[Sweet's syndrome. Presentation of six cases and review of the literature]. / Síndrome de Sweet. Presentacíon de 6 casos y revisión de literatura.

The acute febrile neutrophilic dermatosis or Sweet syndrome, initially described in 1964 by Robert Sweet (1). It is characterized fever, neutrophilic leucocytosis, abrupt appearance of erythematous, painful, cutaneous plaquets and dense dermal infiltrate consisting of mature neutrophils without vasculitis sings. Malignancy has been described in the 10-15% of the reported cases. We report our series of 6 patients diagnosticated of this illness in our department. One of this patients has Sweet syndrome associated with a malignancy disorder. All of them had diagnostic criteria of the described disease and had good response to corticotherapy. We also report a bibliographic review of this infrequent syndrome.

[Atopic dermatitis in paediatric practice]. / Dermatitis atópica en pediatría.

Atopic dermatitis is the most frequent dermatitis amongst children under 11 years of age. It is an inflammatory cutaneous disease, chronic and recurrent, and it involves numerous outbreaks and relapses that affect the child, and hence his family milieu, generally for several years. Its chronic character and the lack of fully satisfactory therapies force the primary care paediatrician to consider this entity as a factor conditioning the quality of life of the patients and as a warning sign for the possible development of other allergic processes. As we do not have a curative treatment available, special relevance is assumed by family collaboration, by the measures for preventing relapses and by efficacy in their symptomatic treatment.

Analysis of skin testing and serum-specific immunoglobulin E to predict airway reactivity to cat allergens.

BACKGROUND: When the clinical history is not conclusive, it may be difficult to make an accurate interpretation of the value of skin tests and serum-specific IgE to cat allergens in asthma cases. OBJECTIVE: To analyse the diagnostic efficiency of skin testing (ST) and serum-specific IgE to cat allergens, based on the results of bronchial-specific challenge with cat epithelium. METHODS: Sixty-four asthma patients (49 with cat exposure and 15 without) who did not clearly relate their asthma symptoms to cat exposure and had a positive skin prick testing and/or a positive cat dander-specific IgE determination (CAP-system) underwent intradermal skin tests and specific bronchial challenge with cat epithelium. The results were analysed by receiver operating characteristics curves (ROC curves) and logistic regression. Sensitivity, specificity, positive predictive values and negative predictive values were calculated for different cut-off points. RESULTS: Twenty-seven patients (42.2%) had a positive bronchial-specific challenge. The area under the ROC curve for serum-specific IgE quantification is 0.85, which makes a good diagnostic tool out of this test. Intradermal ST predicts the outcome of the bronchoprovocation test better than skin prick testing (area under the ROC curve of 0.74 vs. area under the ROC curve of 0.54, respectively). The logistic regression analysis shows that the estimated probability of a positive bronchial challenge is > or =93% if CAP values are > or =17 kU(A)/L, whereas if CAP values are less than 0.35 kU(A)/L the estimated probability of a positive bronchial challenge is 16%. When the intradermal skin test is negative, the estimated probability of a positive bronchoprovocation test is 9%, being the test that better identifies patients with a negative bronchoprovocation test. CONCLUSIONS: Levels of serum-specific IgE to cat allergens and intradermal ST can be used to diagnose and treat more accurately asthmatic patients sensitized to cat epithelium when there is uncertainty about cat epithelium causality.

Recurrent eosinophilic panniculitis associated with Fasciola hepatica infection.

Eosinophilic panniculitis is characterized by a prominent infiltration of subcutaneous fat with eosinophils. We report a case of Fasciola hepatica infection presenting with eosinophilic panniculitis successfully treated with bithionol. To our knowledge, this is the first report of recurrent eosinophilic panniculitis associated with Fasciola hepatica infection.

Combined strong anion-exchange HPLC and PAGE approach for the purification of heparan sulphate oligosaccharides.

Heparan sulphates are highly sulphated linear polysaccharides involved in many cellular functions. Their biological properties stem from their ability to interact with a wide range of proteins. An increasing number of studies, using heparan sulphate-derived oligosaccharides, suggest that specific structural features within the polysaccharide are responsible for ligand recognition and regulation. In the present study, we show that strong anion-exchange HPLC alone, a commonly used technique for purification of heparan sulphate-derived oligosaccharides, may not permit the isolation of highly pure heparan sulphate oligosaccharide species. This was determined by PAGE analysis of hexa-, octa- and decasaccharide samples deemed to be pure by strong anion-exchange HPLC. In addition, subtle differences in the positioning of sulphate groups within heparan sulphate hexasaccharides were impossible to detect by strong anion-exchange HPLC. PAGE analysis on the other hand afforded excellent resolution of these structural isomers. The precise positioning of specific sulphate groups has been implicated in determining the specificity of heparan sulphate interactions and biological activities; hence, the purification of oligosaccharide species that differ in this way becomes an important issue. In this study, we have used strong anion-exchange HPLC and PAGE techniques to allow production of the homogeneous heparan sulphate oligosaccharide species that will be required for the detailed study of structure/activity relationships.