Colonic stenting as a bridge to surgery in malignant large-bowel obstruction: a report from two large multinational registries.

OBJECTIVES: To date, this is the largest prospective series in patients with malignant colorectal obstruction to evaluate the effectiveness and safety of colonic self-expanding metal stents (SEMSs) as an alternative to emergency surgery. SEMSs allow restoration of bowel transit and careful tumor staging in preparation for elective surgery, hence avoiding the high morbidity and mortality associated with emergency surgery and stoma creation. METHODS: This report is on the SEMS bridge-to-surgery subset enrolled in two multicenter international registries. Patients were treated per standard of practice, with documentation of clinical and procedural success, safety, and surgical outcomes. RESULTS: A total of 182 patients were enrolled with obstructive tumor in the left colon (85%), rectum (11%), or splenic flexure (4%). Of these patients, 86% had localized colorectal cancer without metastasis. Procedural success was 98% (177/181). Clinical success was 94% (141/150). Elective surgery was performed in 150 patients (9 stomas) and emergency surgery in 7 patients for treatment of a complication (3 stomas). The overall complication rate was 7.8% (13/167), including perforation in 3% (5/167), stent migration in 1.2% (2/167), bleeding in 0.6% (1/167), persistent colonic obstruction in 1.8% (3/167), and stent occlusion due to fecal impaction in 1.2% (2/167). One patient died from complications related to surgical management of a perforation. CONCLUSIONS: SEMSs provide an effective bridge to surgery treatment with an acceptable complication rate in patients with acute malignant colonic obstruction, restoring luminal patency and allowing elective surgery with primary anastomosis in most patients.

Foldable antibacterial acrylic intraocular lenses of high refractive index.

Hydrophilic copolymers with high refractive index and bactericide properties based on quaternary ammonium salts monomers and methacrylates bearing benzothiazole moieties have been developed for application as foldable intraocular lenses. Composition of the systems was adjusted to get materials with optimized flexibility, wettability, and refractive properties. All the materials have been characterized in terms of optical properties, glass transition temperature, water content, and wettability. Water contact values oscillated between 37 and 15% and refractive index values in the wet state between 1.49 and 1.53, depending on composition. Glass transition temperature interval was 63-77 degrees C. Values of surface free energy of the solid ranged from 49 to 54 mN/m, characteristic of IOL hydrogel materials. Bactericide properties of the quaternary ammonium salts methacrylates were higher than that of the benzothiazole derivative, showing inhibition halos as high as 23-25 mm in antibiogram tests against S. epidermidis and P. aeruginosa , strains found in the ocular cavity and responsible for most postsurgical endolphthalmitis. Biocompatibility of the systems was evaluated in cell cultures using human fibroblasts. Cellular viability was higher than 90%, and close to 100% in many cases, for the extracts of selected formulations collected at different periods of time.

[Seroepidemiologic study of hepatitis C virus infection in a general population from the region of La Rioja, Spain]. / Infección por el virus de la hepatitis C. Estudio seroepidemiológico en población general de La Rioja.

BACKGROUND: To assess the prevalence of hepatitis C virus (HCV) infection in a general population and to identify risk factors for acquiring infection. POBLATION AND METHODS: A cross section of the general urban population of La Rioja aged between 14 and 65, was studied by choosing a random sample (n = 890). Serum samples were screened for HCV antibodies by second-generation enzyme-linked immunosorbent assays and recombinant immunoblot assays. We investigated the relationship between HCV serostatus and age, intravenous drug use, tattoos, blood transfusion, history of hepatitis, previous surgical operations, the administration of parenteral treatment and the number of sexual partners. RESULTS: The overall prevalence of anti-HCV antibodies was 2%. The logistic regression analysis confirmed a statistically significant association between anti-HCV positivity and intravenous drug use (OR = 169.67; CI 95%: 21.1-1,364.75), exposure to a blood transfusion (OR = 10.41; CI 95%: 3.03-35.75); tattoos (OR = 9.04; CI 95%: 1.25-65.36), and male sex (OR = 5.35; CI 95%: 1.34-21.42). However, that 38% of subjects had no risk factors for HCV infection. CONCLUSIONS: These results show a high proportion of people were found to have anti-HCV antibodies. The possible mode of infection in one third of these subjects is not known. In the half of these cases the infection was found have been acquired by an intravenous mechanism: blood transfusion or drug use.