CSF analysis for protein biomarker identification in patients with leptomeningeal metastases from CNS lymphoma.

INTRODUCTION: Leptomeningeal metastases (LM) from lymphoma remain a difficult complication for oncologist due to the high incidence in morbidity and mortality. Early diagnostic and initiation of treatment are essential to prevent neurological deterioration. Areas covered: In this review, several proteomic approaches are described in order to help and provide the basis for the identification of biomarkers useful in early diagnosis, also in discovery novel targets for therapeutic agents. In fact, the identification of biomarkers will have a high potential to detect leptomeningeal lymphoma, as well as to predict its progression and treatment response. Expert commentary: In the case of LM by Central nervous system (CNS) lymphoma, these studies generated the first insights into the utility of proteomic analysis for biomarker identification and will be demonstrated that identifying specific proteins in cerebrospinal fluid (CSF) had much greater sensitivity for detecting LM in comparison to standard cytological protocols.

[Recurrence of uncomplicated intestinal intussusception. Can it be treated as an outpatient?] / Recurrencia de la invaginación intestinal no complicada. ¿Es posible el manejo ambulatorio?

OBJECTIVES: To estimate the recurrence rate of intussusception after successful enema reduction and to analyze the costs of hospital admission with the current management of this pathology. MATERIAL AND METHODS: A retrospective study over 5 years of 97 patients with confirmed diagnosis of intussusception was undertaken. Medical records were evaluated for patient demographic, clinical and radiological data. Patients with enema-reduced intussusception were selected and data respecting to timing and outcome of recurrences, and length of stay were analyzed. Recurrence was defined as a new episode of intussusception within 72 hours of the initial presentation. Costs were calculated using hospital-specific data. RESULTS: During the study period there were 81/97 children with successful enema reduction. Mean length of stay was 35 hours in the conservative treatment group. There were 8 episodes of recurrence, 5 of them within the first 24 hours (6.17%), for an overall recurrence rate of 9.88%. 7 children were treated by repeated enema and only one patient needed surgery for persistent illness. Assuming the overall recurrence rate of 9.88%, it would require hospitalizing 16 patients to identify a single recurrence with a cost of 1,723.75 € per patient. CONCLUSIONS: Given the low recurrence rate for enema-reduced intussusception and the possibility of repeated enema for their treatment in most of recurrences, we strongly advocated for the outpatient management as a safe and cost-effective alternative.

OBJETIVOS: Estimar la tasa de recurrencia en la invaginación intestinal tras reducción con hidroenema. Analizar los costes de estancia hospitalaria según el manejo actual de esta patología. MATERIAL Y METODOS: Estudio retrospectivo de los 97 pacientes con diagnóstico ecográfico de invaginación intestinal en los últimos 5 años. Revisamos datos demográficos, clínicos y ecográficos. Seleccionamos los casos tratados de forma conservadora, analizando las recurrencias, su tratamiento y la estancia hospitalaria. Consideramos recurrencia a un nuevo episodio de invaginación intestinal en las siguientes 72 horas a la reducción. Los costes fueron calculados según los grupos relacionados por diagnóstico en base a datos específicos del centro. RESULTADOS: En los 81/97 (83,5%) pacientes con tratamiento conservador se diagnosticaron 8 episodios de recurrencia, 5 en las primeras 24 horas. En 7 casos se resolvió la recurrencia con hidroenema, mientras que 1 requirió tratamiento quirúrgico por recidivas persistentes. La media de estancia hospitalaria fue de 35 horas en el grupo de tratamiento conservador (81/97 pacientes). La tasa global de recurrencia fue del 9,88%, (6,17% antes de 24 horas), siendo necesario el ingreso de 16 pacientes para el diagnóstico de un caso de recurrencia en las primeras 24 horas. Según estos resultados, y los costes hospitalarios/24 horas, el manejo ambulatorio supondría un ahorro de 1.723,75 €/paciente. CONCLUSIONES: Dado que el riesgo de recurrencia en la invaginación intestinal no complicada es bajo y su tratamiento es conservador en la mayoría de los casos, estaría justificada la implantación de un protocolo de manejo ambulatorio como alternativa segura y costo-efectiva.

Pediatric perianal Crohn's disease behavior in the era of biologic therapy. / Comportamiento de la afectación perianal en pacientes pediátricos con enfermedad de Crohn en la era de la terapia biológica.

AIM OF THE STUDY: To describe perianal Crohn's disease behavior and the role of biological therapy in a sample of pediatric patients. METHODS: A retrospective study of pediatric patients with Crohn's disease (CD) treated in our institution from 2017 to 2021, with a minimum follow up period of 6 months, was conducted. Patients were divided whether they had perianal disease (PD) or not. Baseline characteristics, extension of disease, growth failure rate, aggressive pattern rate, use of biological therapy and need for surgery, among other variables, were compared between both groups. Clinical and/or radiological improvement in the last 6 months of follow up was considered good control of PD. RESULTS: Seventy eight pediatric patients with CD were included. Median age at diagnosis was 10.5 years, and median follow up time was 3.8 years. 64.1% patients were male. Of all, 15 (19.2%) had perianal disease, of which 10 had fistulizing findings and 5 had non fistulizing findings. PD was presented at diagnosis in 8 patients, and the rest developed it in a median time of 1 year from diagnosis. PD was associated with growth failure (p = 0.003), use of biological therapies (p = 0.005), and need for second line of biologics (p = 0.005). Most patients (12/15, 80%) had good control of PD with the treatment received. CONCLUSIONS: CD patients with PD seem to need a more aggressive treatment, with biological therapies playing a key role for its handling nowadays. These patients require close nutritional evaluation that ensures proper development and growth.

OBJETIVO DEL ESTUDIO: Describir el comportamiento de la enfermedad de Crohn perianal y el papel de la terapia biológica en una muestra de pacientes pediátricos. METODOS: Estudio retrospectivo de pacientes pediátricos con enfermedad de Crohn (EC) tratados en nuestro centro entre 2017 y 2021, con un seguimiento mínimo de seis meses. Los pacientes se dividieron en función de si tenían enfermedad perianal (EP) o no. Se compararon entre ambos grupos las características iniciales, la extensión de la enfermedad, el índice de retraso en el crecimiento, el índice de patrón agresivo, el empleo de terapia biológica y la necesidad de cirugía, entre otras variables. Se consideró un buen control de la EP una mejoría clínica o radiológica en los 6 últimos meses de seguimiento. RESULTADOS: Se incluyeron 78 pacientes pediátricos con EC. La edad mediana en el momento del diagnóstico fue de 10,5 años, y el tiempo mediano de seguimiento fue de 3,8 años. El 64,1% de los pacientes eran varones. Del total, 15 (19,2%) tenían enfermedad perianal, de los cuales 10 presentaban hallazgos fistulizantes y 5 no fistulizantes. La EP estaba presente en el momento del diagnóstico en 8 pacientes, y el resto la desarrolló en una mediana de 1 año desde el diagnóstico. La EP se asoció con retraso en el crecimiento (p = 0,003), empleo de terapias biológicas (p = 0,005) y necesidad de una segunda línea de terapia biológica (p = 0,005). La mayoría de los pacientes (12/15, 80%) tuvieron un buen control de la EP con el tratamiento recibido. CONCLUSIONES: Los pacientes de EC con EP parecen necesitar un tratamiento más agresivo, en el que las terapias biológicas desempeñan hoy en día un papel fundamental. Estos pacientes precisan de una estrecha evaluación nutricional que garantice su correcto crecimiento y desarrollo.

Environmental factors associated with American cutaneous leishmaniasis in a new Andean focus in Colombia.

OBJECTIVE: To evaluate the environmental and ecological factors associated with Leishmania transmission and vector abundance in Chaparral, Tolima-Colombia. METHODS: First, we compared the ecological characteristics, abundance of phlebotomies and potential reservoir hosts in the peridomestic environment (100 m radius) of randomly selected houses, between two townships with high and low cutaneous leishmaniasis incidence. Second, we examined peridomestic correlates of phlebotomine abundance in all 43 houses in the higher risk township. RESULTS: The high transmission township had higher coverage of forest (23%vs. 8.4%) and shade coffee (30.7%vs. 11%), and less coffee monoculture (16.8%vs. 26.2%) and pasture (6.3%vs. 12.3%), compared to the low transmission township. Lutzomyia were more abundant in the high transmission township 2.5 vs. 0.2/trap/night. Lutzomyia longiflocosa was the most common species in both townships: 1021/1450 (70%) and 39/80 (49%). Numbers of potential wild mammal reservoirs were small, although four species were found to be infected with Leishmania (Viannia) spp. In the high transmission township, the overall peridomiciliary capture rate of L. longiflocosa was 1.5/trap/night, and the abundance was higher in houses located nearer to forest (ρ = -0.30, P = 0.05). CONCLUSION: The findings are consistent with a domestic transmission cycle with the phlebotomies dependent on dense vegetation near the house.

Acute abdomen in COVID-19 disease: the pediatric surgeon's standpoint. / Abdomen agudo en la enfermedad COVID-19. El punto de vista del cirujano pediátrico.

OBJECTIVE: To describe our experience in the diagnostic and therapeutic management of patients with acute abdomen as the main manifestation of SARS-CoV-2 infection. MATERIAL AND METHODS: A descriptive study of patients with clinical signs of acute abdomen diagnosed with COVID-19 and admitted at out healthcare facility from April 1 to May 10, 2020 was carried out. Clinical records were reviewed for data collection purposes. RESULTS: A series of 14 patients (9 male and 5 female) with a median age of 9.5 years was analyzed. All patients had abdominal pain. There were 11 patients with fever, 9 patients with vomit or diarrhea, and 9 patients with clinically suspected surgical pathology (acute appendicitis or peritonitis). Increased acute phase reactants and coagulation disorders were a common characteristic at blood tests. An abdominal ultrasonography was carried out in all patients, and a CT-scan was performed in 4 patients, which demonstrated inflammatory signs in the terminal ileum, the ileocecal valve and the ascending colon, as well as gallbladder edema. Conservative management was decided upon in all patients except one, and eight patients required intensive care admission for support treatment. CONCLUSIONS: Gastrointestinal symptoms can be the primary manifestation of the new coronavirus infection, which simulates an acute abdomen with a potentially unfavorable evolution. For an accurate diagnosis to be achieved, a good clinical record and a comprehensive physical exploration, as well as complementary tests in search of characteristic findings of COVID-19, should be carried out.

OBJETIVOS: Describir nuestra experiencia en el manejo diagnóstico y terapéutico de los pacientes que han presentado abdomen agudo como principal manifestación de la infección por SARS-Cov-2. MATERIAL Y METODOS: Estudio descriptivo de los pacientes ingresados con clínica inicial de abdomen agudo que fueron diagnosticados de COVID-19 entre el 1 de abril y el 10 de mayo de 2020. Se ha realizado la revisión de historias clínicas para la recogida de datos. RESULTADOS: Describimos una serie de 14 pacientes (9 varones y 5 mujeres) con una mediana de edad de 9,5 años. Todos ellos consultaron por dolor abdominal acompañado de fiebre en 11 y vómitos o diarrea en 9, y la sospecha clínica inicial fue de patología quirúrgica (apendicitis aguda o peritonitis) en 9. En la analítica sanguínea se encontró como característica común elevación de reactantes de fase aguda y alteraciones de coagulación. Se realizó ecografía abdominal a todos los pacientes y tomografía computarizada en cuatro observándose signos inflamatorios en íleon terminal, válvula ileocecal, colon ascendente y edema de vesícula biliar. Se optó por un manejo conservador en todos los pacientes menos uno y ocho pacientes precisaron ingreso en cuidados intensivos para tratamiento de soporte. CONCLUSIONES: La infección por el nuevo coronavirus puede producir síntomas gastrointestinales como principal manifestación, simulando un abdomen agudo que en algunos casos puede evolucionar de forma desfavorable. Para el diagnóstico es preciso realizar una buena historia clínica y exploración física, así como pruebas complementarias en busca de hallazgos característicos de COVID-19.

Routine anti-reflux surgery combined with gastrostomy in children: is it really necessary? Our single-center experience. / ¿Es realmente necesario asociar una técnica antirreflujo a la gastrostomía de forma rutinaria? Experiencia en nuestro centro.

OBJECTIVE: To study gastroesophageal reflux (GER) in children undergoing gastrostomy in a single pediatric institution. MATERIAL AND METHODS: A retrospective study of patients undergoing gastrostomy from 2000 to 2017 was carried out. Demographic data, clinical data, progression, and complications were recorded. GER was considered positive in patients with clinical signs requiring antisecretory treatment, prokinetic treatment, or anti-reflux surgery to control symptoms. RESULTS: 207 patients with a median age of 2 years [R: 0.25-18] were included. Neurological impairment was the most frequent underlying condition (74%). Swallowing difficulty and undernourishment were the main surgical indications for gastrostomy. Prior to gastrostomy, 96 out of 207 patients (46%) showed GER symptoms. Combined fundoplication and gastrostomy was performed in 41 (43%) patients with preexisting GER, 6 of whom showed GER worsening (4 required redo fundoplication). 5 complications following fundoplication were noted - gastric perforation, sustained Dumping syndrome, and gastroesophageal stenosis. 55 out of 96 (57%) patients with preexisting GER underwent gastrostomy alone. Clinical signs disappeared in 16 of them (29%) and improved or stabilized in 19 (35%). GER worsening occurred in 20 patients (36%), with subsequent fundoplication being required in 10 cases. In patients with no previous clinical signs (111 out of 207), GER symptoms occurred following gastrostomy in just 18 cases (16%), and only 2 patients required fundoplication. CONCLUSIONS: In our experience, routine anti-reflux surgery combined with gastrostomy is not justified. Individualized fundoplication should be considered in case of medical treatment failure. Further studies with an adequate design are required to establish which patients could really benefit from this procedure.

OBJETIVO: Estudio del reflujo gastroesofágico (RGE) en los pacientes en los que se ha realizado una gastrostomía en nuestro centro. MATERIAL Y METODOS: Revisión de los pacientes intervenidos de gastrostomía en el periodo 2000-2017. Registro de datos demográficos, clínicos, evolución y complicaciones. Definimos RGE como la presencia de clínica compatible en pacientes que requirieron tratamiento médico o quirúrgico antirreflujo. RESULTADOS: Incluimos 207 pacientes con una mediana de edad de 2 años [r:0,25-18]. La patología subyacente más frecuente fue déficit neurológico (74%). Las indicaciones quirúrgicas fueron trastornos deglutorios y/o desnutrición. Previamente a la gastrostomía, 96/207 pacientes (46%) presentaban clínica de RGE. Se realizó funduplicatura asociada a gastrostomía en 41/96 (43%) de los pacientes con RGE previo. En 6/41 pacientes (15%) el RGE empeoró, requiriendo 4 de ellos una segunda funduplicatura. Se registraron 5 complicaciones tras funduplicatura (perforaciones gástricas, síndromes de Dumping prolongados y estenosis esofagogástrica). En 55/96 pacientes con RGE previo a la gastrostomía no se asoció funduplicatura. La clínica desapareció en 16/55 (29%), y mejoró o se estabilizó en 19/55 pacientes (35%). En 20/55 (36%) la sintomatología empeoró, y 10 de ellos precisaron una funduplicatura posterior. De los pacientes sin clínica previa de RGE (111/207), presentaron síntomas de RGE tras la gastrostomía 18/111 (16%), y solo 2 pacientes requirieron funduplicatura. CONCLUSIONES: Según nuestra experiencia, la funduplicatura de rutina asociada a la gastrostomía no está justificada. En caso de fracaso del tratamiento médico del RGE, una técnica antirreflujo debe plantearse de forma individualizada. Son necesarios estudios adecuadamente diseñados para definir qué pacientes realmente se beneficiarían de este procedimiento.

Comportamiento de la afectación perianal en pacientes pediátricos con enfermedad de Crohn en la era de la terapia biológica / Pediatric perianal Crohn’s disease behavior in the era of biologic therapy

Objetivo del estudio: Describir el comportamiento de la enfermedad de Crohn perianal y el papel de la terapia biológica en una muestra de pacientes pediátricos. Métodos: Estudio retrospectivo de pacientes pediátricos con enfermedad de Crohn (EC) tratados en nuestro centro entre 2017 y 2021, con un seguimiento mínimo de seis meses. Los pacientes se dividieron en función de si tenían enfermedad perianal (EP) o no. Se compararon entre ambos grupos las características iniciales, la extensión de la enfermedad, el índice de retraso en el crecimiento, el índice de patrón agresivo, el empleo de terapia biológica y la necesidad de cirugía, entre otras variables. Se consideró un buen control de la EP una mejoría clínica o radiológica en los 6 últimos meses de seguimiento. Resultados: Se incluyeron 78 pacientes pediátricos con EC. La edad mediana en el momento del diagnóstico fue de 10,5 años, y el tiempo mediano de seguimiento fue de 3,8 años. El 64,1% de los pacientes eran varones. Del total, 15 (19,2%) tenían enfermedad perianal, de los cuales 10 presentaban hallazgos fistulizantes y 5 no fistulizantes. La EP estaba presente en el momento del diagnóstico en 8 pacientes, y el resto la desarrolló en una mediana de 1 año desde el diagnóstico. La EP se asoció con retraso en el crecimiento (p = 0,003), empleo de terapias biológicas (p = 0,005) y necesidad de una segunda línea de terapia biológica (p = 0,005). La mayoría de los pacientes (12/15, 80%) tuvieron un buen control de la EP con el tratamiento recibido. Conclusiones: Los pacientes de EC con EP parecen necesitar un tratamiento más agresivo, en el que las terapias biológicas desempeñan hoy en día un papel fundamental. Estos pacientes precisan de una estrecha evaluación nutricional que garantice su correcto crecimiento y desarrollo.(AU)

Aim of the study: To describe perianal Crohn’s disease behavior and the role of biological therapy in a sample of pediatric patients. Methods: A retrospective study of pediatric patients with Crohn’s disease (CD) treated in our institution from 2017 to 2021, with a minimum follow up period of 6 months, was conducted. Patients were divided whether they had perianal disease (PD) or not. Baseline characteristics, extension of disease, growth failure rate, aggressive pattern rate, use of biological therapy and need for surgery, among other variables, were compared between both groups. Clinical and/or radiological improvement in the last 6 months of follow up was considered good control of PD. Results: Seventy eight pediatric patients with CD were included. Median age at diagnosis was 10.5 years, and median follow up time was 3.8 years. 64.1% patients were male. Of all, 15 (19.2%) had perianal disease, of which 10 had fistulizing findings and 5 had non fistulizing findings. PD was presented at diagnosis in 8 patients, and the rest developed it in a median time of 1 year from diagnosis. PD was associated with growth failure (p = 0.003), use of biological therapies (p = 0.005), and need for second line of biologics (p = 0.005). Most patients (12/15, 80%) had good control of PD with the treatment received. Conclusions: CD patients with PD seem to need a more aggressive treatment, with biological therapies playing a key role for its handling nowadays. These patients require close nutritional evaluation that ensures proper development and growth.(AU)

Abdomen agudo en la enfermedad COVID-19. El punto de vista del cirujano pediátrico / Acute abdomen in COVID-19 disease: the pediatric surgeon's standpoint

OBJETIVOS: Describir nuestra experiencia en el manejo diagnóstico y terapéutico de los pacientes que han presentado abdomen agudo como principal manifestación de la infección por SARS-Cov-2. MATERIAL Y MÉTODOS: Estudio descriptivo de los pacientes ingresados con clínica inicial de abdomen agudo que fueron diagnosticados de COVID-19 entre el 1 de abril y el 10 de mayo de 2020. Se ha realizado la revisión de historias clínicas para la recogida de datos. RESULTADOS: Describimos una serie de 14 pacientes (9 varones y 5 mujeres) con una mediana de edad de 9,5 años. Todos ellos consultaron por dolor abdominal acompañado de fiebre en 11 y vómitos o diarrea en 9, y la sospecha clínica inicial fue de patología quirúrgica (apendicitis aguda o peritonitis) en 9. En la analítica sanguínea se encontró como característica común elevación de reactantes de fase aguda y alteraciones de coagulación. Se realizó ecografía abdominal a todos los pacientes y tomografía computarizada en cuatro observándose signos inflamatorios en íleon terminal, válvula ileocecal, colon ascendente y edema de vesícula biliar. Se optó por un manejo conservador en todos los pacientes menos uno y ocho pacientes precisaron ingreso en cuidados intensivos para tratamiento de soporte. CONCLUSIONES: La infección por el nuevo coronavirus puede producir síntomas gastrointestinales como principal manifestación, simulando un abdomen agudo que en algunos casos puede evolucionar de forma desfavorable. Para el diagnóstico es preciso realizar una buena historia clínica y exploración física, así como pruebas complementarias en busca de hallazgos característicos de COVID-19

OBJECTIVE: To describe our experience in the diagnostic and therapeutic management of patients with acute abdomen as the main manifestation of SARS-CoV-2 infection. MATERIALS AND METHODS: A descriptive study of patients with clinical signs of acute abdomen diagnosed with COVID-19 and admitted at out healthcare facility from April 1 to May 10, 2020 was carried out. Clinical records were reviewed for data collection purposes. RESULTS: A series of 14 patients (9 male and 5 female) with a median age of 9.5 years was analyzed. All patients had abdominal pain. There were 11 patients with fever, 9 patients with vomit or diarrhea, and 9 patients with clinically suspected surgical pathology (acute appendicitis or peritonitis). Increased acute phase reactants and coagulation disorders were a common characteristic at blood tests. An abdominal ultrasonography was carried out in all patients, and a CT-scan was performed in 4 patients, which demonstrated inflammatory signs in the terminal ileum, the ileocecal valve and the ascending colon, as well as gallbladder edema. Conservative management was decided upon in all patients except one, and eight patients required intensive care admission for support treatment. CONCLUSIONS: Gastrointestinal symptoms can be the primary manifestation of the new coronavirus infection, which simulates an acute abdomen with a potentially unfavorable evolution. For an accurate diagnosis to be achieved, a good clinical record and a comprehensive physical exploration, as well as complementary tests in search of characteristic findings of COVID-19, should be carried out

¿Es realmente necesario asociar una técnica antirreflujo a la gastrostomía de forma rutinaria? Experiencia en nuestro centro / Routine anti-reflux surgery combined with gastrostomy in children: is it really necessary? Our single-center experience

Objetivos: Estudio del reflujo gastroesofágico (RGE) en los pacientes en los que se ha realizado una gastrostomía en nuestro centro. Material y métodos: Revisión de los pacientes intervenidos degastrostomía en el periodo 2000-2017. Registro de datos demográficos,clínicos, evolución y complicaciones. Definimos RGE como la presenciade clínica compatible en pacientes que requirieron tratamiento médicoo quirúrgico antirreflujo. Resultados: Incluimos 207 pacientes con una mediana de edadde 2 años [r:0,25-18]. La patología subyacente más frecuente fue déficit neurológico (74%). Las indicaciones quirúrgicas fueron trastornosdeglutorios y/o desnutrición. Previamente a la gastrostomía, 96/207pacientes (46%) presentaban clínica de RGE. Se realizó funduplicatu-ra asociada a gastrostomía en 41/96 (43%) de los pacientes con RGEprevio. En 6/41 pacientes (15%) el RGE empeoró, requiriendo 4 deellos una segunda funduplicatura. Se registraron 5 complicaciones trasfunduplicatura (perforaciones gástricas, síndromes de Dumping prolongados y estenosis esofagogástrica). En 55/96 pacientes con RGE previoa la gastrostomía no se asoció funduplicatura. La clínica desaparecióen 16/55 (29%), y mejoró o se estabilizó en 19/55 pacientes (35%). En20/55 (36%) la sintomatología empeoró, y 10 de ellos precisaron unafunduplicatura posterior. De los pacientes sin clínica previa de RGE(111/207), presentaron síntomas de RGE tras la gastrostomía 18/111(16%), y solo 2 pacientes requirieron funduplicatura. Conclusiones: Según nuestra experiencia, la funduplicatura de rutina asociada a la gastrostomía no está justificada. En caso de fracaso del tratamiento médico del RGE, una técnica antirreflujo debe plantearsede forma individualizada. Son necesarios estudios adecuadamente di-señados para definir qué pacientes realmente se beneficiarían de esteprocedimiento.(AU)

Objective: To study gastroesophageal reflux (GER) in childrenundergoing gastrostomy in a single pediatric institution. Materials and methods: A retrospective study of patients undergoing gastrostomy from 2000 to 2017 was carried out. Demographic data,clinical data, progression, and complications were recorded. GER wasconsidered positive in patients with clinical signs requiring antisecretory treatment, prokinetic treatment, or anti-reflux surgery to controlsymptoms. Results: 207 patients with a median age of 2 years [R: 0.25-18]were included. Neurological impairment was the most frequent underlying condition (74%). Swallowing difficulty and undernourishment werethe main surgical indications for gastrostomy. Prior to gastrostomy, 96out of 207 patients (46%) showed GER symptoms. Combined fun-doplication and gastrostomy was performed in 41 (43%) patients withpreexisting GER, 6 of whom showed GER worsening (4 required redofundoplication). 5 complications following fundoplication were noted –gastric perforation, sustained Dumping syndrome, and gastroesophagealstenosis. 55 out of 96 (57%) patients with preexisting GER underwentgastrostomy alone. Clinical signs disappeared in 16 of them (29%) andimproved or stabilized in 19 (35%). GER worsening occurred in 20patients (36%), with subsequent fundoplication being required in 10cases. In patients with no previous clinical signs (111 out of 207), GERsymptoms occurred following gastrostomy in just 18 cases (16%), andonly 2 patients required fundoplication.Conclusions: In our experience, routine anti-reflux surgery combined with gastrostomy is not justified. Individualized fundoplicationshould be considered in case of medical treatment failure. Further studieswith an adequate design are required to establish which patients couldreally benefit from this procedure.(AU)

A new 123I-MIBG whole body scan scoring method--application to the prediction of the response of metastases to induction chemotherapy in stage IV neuroblastoma.

A new semi-quantitative scoring system is proposed, especially designed for the comparative interpretation of sequential whole-body meta-iodo-benzyl-guanidine (MIBG) scans in stage IV neuroblastoma children. This method was applied to assess whether MIBG scan at mid-course of induction chemotherapy could predict the final response. 27 newly diagnosed children were investigated by three sequential 123I-MIBG scans performed at the beginning, at mid-course (6 weeks) and at the end of neoadjuvant chemotherapy (12 weeks). Whole body scans were divided into nine regions in which the extension of bone metastases was separately quoted (score range: 0-3). The overall absolute scores were obtained by adding the scores of the nine regions. Relative scores were calculated by dividing the absolute score at each time by the corresponding pretreatment score. The score at mid-induction correctly predicted the overall response of metastases at the end of induction (P < 0.0001) in most cases. This method is easy to use, reproducible, subject to little inter-investigator variation, and thus well adapted to multicentric trials.

Scintigraphic study of radiolabelled interferon-alpha in osteosarcoma patients.

Interferon-alpha is currently under evaluation as an antineoplastic agent in several types of tumour. Despite its clear in vitro effects, the effectiveness of interferon in vivo is limited. To assess whether this discrepancy reflects pharmacokinetic limitations, the authors analysed interferon distribution in 2 osteosarcoma patients by scintigraphy using 123I-interferon-alpha-2a. Numerical analysis of the scintigraphic records demonstrated that the main organs of elimination were the kidneys, when the calculation was made on the basis of surface area. On the other hand, the apparent total uptake by liver (whose projection surface--i.e. the area exposed to the lens--is greater) was higher, reaching about 25 to 30% of the injected dose. The projection surface of the tumour was able to take up radiolabelled interferon in both cases, resulting in a 4-fold increase in the external radiation count compared with the equivalent region of the contralateral limb (although it is not possible to determine whether the label is present on the tumour itself or on the surrounding inflammatory cells). Thus, interferon-alpha seems able to reach at least the immediate neighbourhood of osteosarcoma mass.

The HLA-DRB9 gene and the origin of HLA-DR haplotypes.

HLA-DRB9 is a gene fragment consisting of exon 2 and flanking intron sequences. It is located at the extreme end of the DRB subregion, whose other end is demarcated by the DRB1 locus. We sequenced approximately 1400 base pairs of the segment encompassing the DRB9 locus from eight human haplotypes (DR1, DR10, DR2, DR3, DR5, DR6, DR8, and DR9, the DR4 and DR7 having been sequenced by others earlier), as well as two chimpanzee, five gorillas, one orangutan and one macaque haplotype. The analysis of these sequences indicates that the DRB9 locus, which we estimate to be more than 58 million years (my) old, has been coevolving with the DRB1 locus for the last 4.2 my. As a consequence of this coevolution, the human DRB9 alleles fall into groups that correlate with the DRB1 allelic groups and with the gene organization of the human haplotypes. This observation implies that the present-day HLA-DR haplotype groups (DR1, DR51, DR52, DR8, and DR53) were founded more than 4 my ago and have remained intact (barring minor internal rearrangements that did not recombine the DRB1 and DRB9 genes) for this period of time. The haplotypes have been transmitted during speciations from ancestral to emerging species just like allelic lineages at the DRB1 locus. Thus not only allelic but also haplotype polymorphism evolves trans-specifically.

Peripheral blood reduction of memory (CD29+, CD45RO+, and "bright" CD2+ and LFA-1+) T lymphocytes in Papillon-Lefèvre syndrome.

A Papillon-Lefèvre patient with characteristic chronic periodontal disease and palmoplantar keratoderma was studied over a 4-year period. An abnormal T-cell phenotype was steadily observed in peripheral blood; both low numbers of CD29+ and CD45RO+ cells and a low density surface expression of CD2 and LFA-1 molecules were found. T-cell activation through CD3, CD2 and ConA, PWM and IL-2 receptors was normal; however, there was impairment in the activation via CD28. CD2, LFA-1 and CD45 molecules were normal in charge and molecular weight. There was no tissue sequestering of T lymphocytes in periodontal lesions, but rather a relative T-cell reduction. It is suggested that an important decrease of the so-called "memory/hyperreactive" (CD45RO-positive) T cells does exist; therefore, hyperreactive T cells would not be available in sufficient numbers to leave the bloodstream through blood vessel endothelium, and the periodontium would be left without these important defenses and thus exposed to chronic infections. A disregulated factor affecting the transition from "naive" to "memory" T cells and the increase in certain surface molecules expression (i.e., CD2, LFA-1, CD29, and CD45RO) or the reversion from memory to naive T cells may be responsible for the disease pathogenesis. CD2 and LFA-1 molecule synthesis might be conjointly regulated on T lymphocytes.

[Radioisotopic exploration of sarcomas of the bone and soft tissue]. / Exploration radioisotopique des sarcomes des os et des tissus mous.

Radioisotopic methods are widely applied to investigations of bone sarcoma and soft tissue neoplasms. We have at our disposal molecules with osseous, tumoral or vascular tropism. Their use, as single agents or combination, is helpful in positive and differential diagnosis and provides nosological informations. They are also useful in treatment monitoring and in long-term follow-up.

[Carcinoma of the breast: diagnosis of sub-clinical bone metastases. Predictive value of isotope bone scan (author's transl)]. / Cancers du sein. Diagnostic des métastases infra-cliniques osseuses. Valeur prévisionnelle de la scintigraphie.

The possibility of drawing a distinction between two groups with or without bone metastases is of fundamental importance in the determintion of management. With this in mind, isotope bone scan using Tc 99 was performed routinely in 99 cases of locally advanced non-metastatic carcinoma of the breast. Amongst 121 "operable" (T1, T2, T3, N0, N1a) carcinomas, 4 (3%) had a positive scan. Of these 4 cases, 3 showed evidence of bone metastases within one year, in 3 of which the site was not the same as that predicted by the scan. Amongst 53 "inoperable" (T4, N0, N1, T., N2, N3) cases, 5 (10%) had a positive scan and 5 a doubtful scan. Amongst the 5 positive cases, within one year metastases were seen at the predicted site. In agreement with a large number of authors, it would thus appear that routine isotope bone scan has no role to play in the pretherapeutic assessment of so-called "operative" breast carcinomas.

[Comparative statistical study of global and local functional respiratory data in 2 groups of patients with pulmonary or pleural tuberculosis]. / Etude statistique comparative des données fonctionnelles respiratoires globales et locales de deux groupes de malades atteints de tuberculose pulmonaire ou pleurale.

Two groups of patients with unilateral tuberculosis, either pulmonary (36 cases) or pleural (75 cases) were studied. The clinical and functional results were compared statistically. These two groups were similar in terms of age, sex, tobacco consumption, the radiological unilaterality of their disease and the global reduction of respiratory function (assessed by VC, FEV1, TPC and TLCO), which can be considered to be essentially due to the local disease. In both groups, the radiological image (extent of the lesion, shape of the lesion) is the only clinical factor statistically related to the functional values. The two groups differ in terms of two functional parameters which reflect different pathophysiological mechanisms in the affected lung. The group with pulmonary tuberculosis presents an obstructive ventilatory syndrome (reduction of the FEV1/VC ratio and increase in the RV/TPC ratio), which reflects the bronchial involvement in the disease. The group with pleural tuberculosis presents a pulmonary distention (increased RV/TPC ratio), which is related to disturbed transmission of the pleural pressure to ventilated alveolar zones. Secondly, in the group with pulmonary tuberculosis, the ventilation and perfusion deficits are equivalent, while in the pleural tuberculosis group, the ventilatory deficit is predominant. Thus the global reduction in ventilatory function which is the same in the two group is caused by fundamentally distinct pathophysiological mechanisms in the two groups of patients.

Recurrencia de la invaginación intestinal no complicada. ¿Es posible el manejo ambulatorio? / Recurrence of uncomplicated intestinal intussusception. Can it be treated as an outpatient?

Objetivos. Estimar la tasa de recurrencia en la invaginación intestinal tras reducción con hidroenema. Analizar los costes de estancia hospitalaria según el manejo actual de esta patología. Material y métodos. Estudio retrospectivo de los 97 pacientes con diagnóstico ecográfico de invaginación intestinal en los últimos 5 años. Revisamos datos demográficos, clínicos y ecográficos. Seleccionamos los casos tratados de forma conservadora, analizando las recurrencias, su tratamiento y la estancia hospitalaria. Consideramos recurrencia a un nuevo episodio de invaginación intestinal en las siguientes 72 horas a la reducción. Los costes fueron calculados según los grupos relacionados por diagnóstico en base a datos específicos del centro. Resultados. En los 81/97 (83,5%) pacientes con tratamiento conservador se diagnosticaron 8 episodios de recurrencia, 5 en las primeras 24 horas. En 7 casos se resolvió la recurrencia con hidroenema, mientras que 1 requirió tratamiento quirúrgico por recidivas persistentes. La media de estancia hospitalaria fue de 35 horas en el grupo de tratamiento conservador (81/97 pacientes). La tasa global de recurrencia fue del 9,88%, (6,17% antes de 24 horas), siendo necesario el ingreso de 16 pacientes para el diagnóstico de un caso de recurrencia en las primeras 24 horas. Según estos resultados, y los costes hospitalarios/24 horas, el manejo ambulatorio supondría un ahorro de 1.723,75 Euros /paciente. Conclusiones. Dado que el riesgo de recurrencia en la invaginación intestinal no complicada es bajo y su tratamiento es conservador en la mayoría de los casos, estaría justificada la implantación de un protocolo de manejo ambulatorio como alternativa segura y costoefectiva (AU)

Objetives. To estimate the recurrence rate of intussusception after successful enema reduction and to analyze the costs of hospital admission with the current management of this pathology. Material and methods. A retrospective study over 5 years of 97 patients with confirmed diagnosis of intussusception was undertaken. Medical records were evaluated for patient demographic, clinical and radiological data. Patients with enema-reduced intussusception were selected and data respecting to timing and outcome of recurrences, and length of stay were analyzed. Recurrence was defined as a new episode of intussusception within 72 hours of the initial presentation. Costs were calculated using hospital-specific data. Results. During the study period there were 81/97 children with successful enema reduction. Mean length of stay was 35 hours in the conservative treatment group. There were 8 episodes of recurrence, 5 of them within the first 24 hours (6.17%), for an overall recurrence rate of 9.88%. 7 children were treated by repeated enema and only one patient needed surgery for persistent illness. Assuming the overall recurrence rate of 9.88%, it would require hospitalizing 16 patients to identify a single recurrence with a cost of 1,723.75 Euros er patient. Conclusions. Given the low recurrence rate for enema-reduced intussusception and the possibility of repeated enema for their treatment in most of recurrences, we strongly advocated for the outpatient management as a safe and cost-effective alternative (AU)

Labor tanatológica de enfermería en el nivel de frustración de personas con diabetes mellitus tipo 2 / Nursing thanatological activity effect on the levels of frustration in the persons with type 2 diabetes mellitus / O trabalho tanatológico de enfermagem no nível de frustração da pessoas com diabetes mellitus tipo 2

Objetivo: Determinar el efecto de la labor tanatológica de enfermería a través de la relación interpersonal en el nivel de frustración de la persona con diabetes mellitus tipo 2. Métodos: Estudio de intervención con evaluación pre y post, realizada en Yucatán, México. Las variables fueron: Edad, género, escolaridad, ocupación, estado civil, tiempo con la enfermedad y nivel de frustración. El programa de intervención constó de 6 módulos, implementado durante 4 meses. Para la prueba de hipótesis del estudio se aplicó la estadística de Wilcoxon para muestras pareadas. Resultados: Se observó que el 87% de las personas obtuvo un nivel de frustración medio previo a la intervención de enfermería, y el 13% restante un nivel de frustración alto. Posterior a la intervención, se observó que el 69.6% obtuvo un nivel de frustración bajo, el 26.1% un nivel de frustración medio y solo el 4.3% un nivel alto. De acuerdo a la prueba de hipótesis, se observó un valor de p menor a 0.000, lo cual indicó que existe diferencia significativa entre los niveles de frustración antes y después de la intervención. Conclusiones: La labor tanatológica de enfermería a través de la relación interpersonal disminuye el nivel de frustración de la persona frente a la diabetes mellitus tipo 2.

Objective: To determine the effect of the nursing thanatological activity through interpersonal relationships on the levels of frustration in the person with type 2 diabetes mellitus. Methods: Intervention study with pre and post assessment carried out in Yucatan, Mexico. Variables were age, gender, school level, occupation, civil status, time suffering the illness, and level of frustration. The intervention program consisted of 6 modules implemented during 4 months. A paired-samples Wilcoxon hypothesis test was performed. Results: 87% of the participants showed a medium level of frustration prior to the intervention, and the remaining 13% showed a high one. After the intervention, it was observed that 69% showed a low level of frustration, 26.1% showed a medium one, and only 4.3% showed a high one. The hypothesis test returned p less than 0.000 indicating that there is a significant difference between the levels of frustration before and after the intervention. Conclusions: Nursing thanatological activity through interpersonal relationships decreases the level of frustration of the person with type 2 diabetes mellitus.

Objetivo: Determinar o efeito do trabalho tanatológico de enfermagem a través da relação interpessoal no nível de frustração da pessoa com diabetes mellitus tipo 2. Métodos Estudo de intervenção com avaliação pré e post, realizada em Yucatán, México. As variáveis foram: Idade, gênero, escolaridade, ocupação, estado civil, tempo com a doença e nível de frustração. O programa de intervenção teve 6 módulos, implementado durante 4 meses. Para a prova de hipótese do estudo aplicou-se a estatística de Wilcoxon para amostras em pares. Resultados: Observou-se que 87% das pessoas obteve um nível de frustração médio, prévio à intervenção de enfermagem e o 13% restante, um nível de frustração alto. Posterior à intervenção, observou-se que 69% obteve um nível de frustração baixo, o 26.1% um nível de frustração médio e só 4.3% um nível alto. Em referência à prova de hipótese, observou-se um valor p menor a 0.000, o qual indicou que existe diferença significativa entre os níveis de frustração antes e depois da intervenção. Conclusões O trabalho tanatológico de enfermagem a través da relação interpessoal diminui o nível de frustração da pessoa perante à diabetes mellitus tipo 2.