ESGO/ISUOG/IOTA/ESGE Consensus Statement on preoperative diagnosis of ovarian tumors.

The European Society of Gynaecological Oncology (ESGO), the International Society of Ultrasound in Obstetrics and Gynecology (ISUOG), the International Ovarian Tumour Analysis (IOTA) group and the European Society for Gynaecological Endoscopy (ESGE) jointly developed clinically relevant and evidence-based statements on the preoperative diagnosis of ovarian tumors, including imaging techniques, biomarkers and prediction models. ESGO/ISUOG/IOTA/ESGE nominated a multidisciplinary international group, including expert practising clinicians and researchers who have demonstrated leadership and expertise in the preoperative diagnosis of ovarian tumors and management of patients with ovarian cancer (19 experts across Europe). A patient representative was also included in the group. To ensure that the statements were evidence-based, the current literature was reviewed and critically appraised. Preliminary statements were drafted based on the review of the relevant literature. During a conference call, the whole group discussed each preliminary statement and a first round of voting was carried out. Statements were removed when consensus among group members was not obtained. The voters had the opportunity to provide comments/suggestions with their votes. The statements were then revised accordingly. Another round of voting was carried out according to the same rules to allow the whole group to evaluate the revised version of the statements. The group achieved consensus on 18 statements. This Consensus Statement presents these ESGO/ISUOG/IOTA/ESGE statements on the preoperative diagnosis of ovarian tumors and the assessment of carcinomatosis, together with a summary of the evidence supporting each statement.

Declaración de consenso de ESGO/ISUOG/IOTA/ESGE sobre el diagnóstico preoperatorio de los tumores de ovario La Sociedad Europea de Oncología Ginecológica (ESGO), la Sociedad Internacional de Ecografía en Obstetricia y Ginecología (ISUOG), el Grupo Internacional de Análisis de Tumores de Ovario (IOTA) y la Sociedad Europea de Endoscopia Ginecológica (ESGE) elaboraron conjuntamente declaraciones de importancia para la práctica clínica y con base empírica sobre el diagnóstico preoperatorio de los tumores de ovario, a partir de imágenes, biomarcadores y modelos de predicción, entre otras técnicas. La ESGO/ISUOG/IOTA/ESGE designó a un grupo internacional multidisciplinar, que incluye a personas expertas de la práctica clínica y la investigación que han demostrado liderazgo y experiencia en el diagnóstico preoperatorio de los tumores de ovario y en el tratamiento de las pacientes con cáncer de ovario (19 personas expertas de toda Europa). También se incluyó en el grupo a una representante de las pacientes. Para garantizar que las declaraciones tenían una base empírica, se revisó la literatura actual y se valoró de forma crítica. Se redactaron declaraciones preliminares basadas en la revisión de la literatura pertinente. La totalidad del grupo debatió durante una teleconferencia cada declaración preliminar y se llevó a cabo una primera ronda de votaciones. Las declaraciones se eliminaron cuando no se obtuvo el consenso entre los miembros del grupo. Los votantes tuvieron la oportunidad de aportar comentarios/sugerencias a la par que sus votos. Las declaraciones se revisaron en consecuencia. Se llevó a cabo otra ronda de votaciones según las mismas reglas para que todo el grupo pudiera evaluar la versión revisada de las declaraciones. El grupo logró un consenso sobre 18 declaraciones. Esta Declaración de Consenso presenta estas declaraciones de la ESGO/ISUOG/IOTA/ESGE sobre el diagnóstico preoperatorio de los tumores de ovario y la evaluación de la carcinomatosis, junto con un resumen de la evidencia que apoya cada declaración.

Optimization of the sublethal dose of silver nanoparticle through evaluating its effect on intestinal physiology of Nile tilapia (Oreochromis niloticus L.).

Silver nanoparticles (SNPs) are widely used in a variety of biomedical and consumer products as an antimicrobial additive. The present study was conducted to evaluate the impacts of low-dose SNPs on intestinal physiology of tilapia (Oreochromis niloticus L.) for assessing its apparent environmental risk due to extensive commercial use. SNPs were synthesized by a chemical reduction method yielding 1-27 nm oval shaped particles. Early fingerlings of tilapia were exposed with two sublethal concentrations (0.8 and 0.4 mg L(-1)) of SNPs for twenty one days period and its impact on the intestinal physiology was evaluated by histochemistry, catalase expression, glutamate dehydrogenase activity, SDS-PAGE and gut micro flora count. Histological analysis showed thinning of intestinal wall, swelling on mucosal layer and immunohistochemical assay exhibited an enhanced catalase expression in SNPs treated fishes. Gut microflora count elicited a dose-dependent depletion and a variable SDS-PAGE profile followed by significant (P < 0.05) elevations in glutamate dehydrogenase activity in SNPs-treated fishes. This study was designed to provide a better understanding of environmentally acceptable, dose-dependent SNPs delivery in fishes and to formulate guidelines in aquatic toxicology.

Application of ISSR-PCR for rapid strain typing of Debaryomyces hansenii isolated from dry-cured Iberian ham.

Yeast populations of dry-cured Iberian ham isolated from seven industries in the province of Badajoz were characterized by ISSR-PCR using the (CAG)4 primer and PCR-RFLP of the ITS1-5.8S rRNA-ITS2 fragment, and identified by DNA sequencing. A total of 242 isolates were analyzed, indicating the primary species present was Debaryomyces hansenii at 80.9% of the isolates followed by Candida zeylanoides at 10.3% of the isolates. The remainders of isolates were identified as Yamadazyma triangularis, Sporobolomyces roseus, Meyerozyma guilliermondii, Rhodotorula slooffiae, and Cryptococcus victoriae. The ISSR-PCR method was a fast and reliable method which was able to discriminate species at a level comparable to restriction analyses of the ITS1-5.8S rRNA-ITS2 region. This method allowed for strain typing of D. hansenii, yielding 29 different PCR patterns within 196 isolates. Moreover, ISSR-PCR using the (CAG)4 primer indicated that this technique could be a promising tool for rapid discrimination of yeast starter cultures and spoilage species in dry-cured Iberian ham.

Morphological differentiation of peritumoral brain zone microglia.

The Peritumoral Brain Zone (PBZ) contributes to Glioblastoma (GBM) relapse months after the resection of the original tumor, which is influenced by a variety of pathological factors. Among those, microglia are recognized as one of the main regulators of GBM progression and probably relapse. Although microglial morphology has been analyzed inside GBM and its immediate surroundings, it has not been objectively characterized throughout the PBZ. Thus, we aimed to perform a thorough characterization of microglial morphology in the PBZ and its likely differentiation not just from the tumor-associated microglia but from control tissue microglia. For this purpose, Sprague Dawley rats were intrastriatally implanted with C6 cells to induce a GBM formation. Gadolinium-based magnetic resonance imaging (MRI) was performed to locate the tumor and to define the PBZ (2 mm beyond the tumor border), thus delimitating the different regions of interest (ROIs: core tumoral zone and immediate interface; contralateral striatum as control). Brain slices were obtained and immunolabeled with the microglia marker Iba-1. Sixteen morphological parameters were measured for each cell, significative differences were found in all parameters when comparing the four ROIs. To determine if PBZ microglia could be morphologically differentiated from microglia in other ROIs, hierarchical clustering analysis was performed, revealing that microglia can be separated into four morphologically differentiated clusters, each of them mostly integrated by cells sampled in each ROI. Furthermore, a classifier based on linear discriminant analysis, including only three morphological parameters, categorized microglial cells across the studied ROIs and showed a gradual transition between them. The robustness of this classification was assessed through principal component analysis with the remaining 13 morphological parameters, corroborating the obtained results. Thus, in this study we provided objective and quantitative evidence that PBZ microglia represent a differentiable microglial morphotype that could contribute to the recurrence of GBM in this area.

ESGO/ISUOG/IOTA/ESGE Consensus Statement on preoperative diagnosis of ovarian tumours.

The European Society of Gynaecological Oncology (ESGO), the International Society of Ultrasound in Obstetrics and Gynecology (ISUOG), the International Ovarian Tumour Analysis (IOTA) group and the European Society for Gynaecological Endoscopy (ESGE) jointly developed clinically relevant and evidence-based statements on the preoperative diagnosis of ovarian tumours, including imaging techniques, biomarkers and prediction models. ESGO/ISUOG/IOTA/ESGE nominated a multidisciplinary international group, including expert practising clinicians and researchers who have demonstrated leadership and expertise in the preoperative diagnosis of ovarian tumours and management of patients with ovarian cancer (19 experts across Europe). A patient representative was also included in the group. To ensure that the statements were evidence-based, the current literature was reviewed and critically appraised. Preliminary statements were drafted based on the review of the relevant literature. During a conference call, the whole group discussed each preliminary statement and a first round of voting was carried out. Statements were removed when a consensus among group members was not obtained. The voters had the opportunity to provide comments/suggestions with their votes. The statements were then revised accordingly. Another round of voting was carried out according to the same rules to allow the whole group to evaluate the revised version of the statements. The group achieved consensus on 18 statements. This Consensus Statement presents these ESGO/ISUOG/IOTA/ESGE statements on the preoperative diagnosis of ovarian tumours and the assessment of carcinomatosis, together with a summary of the evidence supporting each statement.

[Study on intestinal absorption, metabolism, and adaptation]. / Evaluación de la absorción y metabolismo intestinal.

The human intestine is a complex and variable in lenght organ, oscillating between 3 and 8 metres, depending on the individual characteristics and the techniques used to measure it. The main function of the intestine is to get a suitable incorporation of food into the body and this is carried out by menas of the digestion and food absorption processes. When these functions fail, Maldigestion and Malabsorption appear. These have characteristic clinical data and must be studied with the help of specific techniques for every digestive step and every food (fat malabsorption, proteins and carbohydrates tests).

[Hungry bone syndrome related to hyperthyroidism]. / Síndrome del hueso hambriento relacionado con hipertiroidismo.

Hungry bone syndrome is a common clinical entity which is accompanying of hypocalcemia, hypomagnesemia, and hipophosphatemia, results from an increase in bone formation. It is related to a pathological scenario which causes an imbalance between osteoclast-mediated bone resorption and osteoblast-mediates bone formation, favouring the latter. Its classic presentation occurs after parathyroidectomy in hyperparathyroydism's patients. Its clinical features are largely due to plasmatic calcium levels reduction. Hungry bone syndrome is frequent in hyperparathyroid's patients who have development bone disease before surgery. Even less frequent, it has also been described after thyroydectomy in patients with hyperthyroidism. We hereby report a case of hungry bone syndrome in one patient who suffers a Graves' disease. Then, we will provide a brief review of pathogenesis and therapeutic features.

Tendencia de las hospitalizaciones en la Unidad de Corta Estadía de Psiquiatría del Hospital Clínico Herminda Martin durante 14 años / Trend of hospitalizations in the Short Stay of Psychiatry Unit of Herminda Martin Clinical Hospital for 14 years

INTRODUCCIÓN: La hospitalización psiquiátrica de corta estadía es un recurso necesario para tratar trastornos mentales con descompensación severa que no pueden resolverse ambulatoriamente. El conocimiento de sus resultados ayuda en la gestión clínica y administrativa. Este estudio tiene por objeto evaluar la evolución de indicadores hospitalarios, características sociodemográficas y clínicas de pacientes hospitalizados en unidad de corta estadía de psiquiatría. MATERIAL Y MÉTODO: Estudio longitudinal, retrospectivo, de tendencia, realizado sobre el universo constituido por 4.563 egresos de UCEP de Hospital de Chillán, Chile, durante 14 años, desde el 01/07/2005 al 30/06/2019. Se evaluaron variables hospitalarias, sociodemográficas y clínicas. RESULTADOS: en el período en estudio: Disminuyeron los egresos, se prolongó el promedio días estada, aumentó el índice ocupacional y disminuyó el índice de rotación. Un bajo número de pacientes, con predominio de adversidades socioeconómicas y psicosociales, se re-hospitalizó frecuentemente. A mayor número de internaciones mayor estadía. Se incrementaron las hospitalizaciones administrativas y judiciales; éstas últimas con mayor promedio de estada. Aumentó la hospitalización de varones, adolescentes, jóvenes y adultos mayores. Predominaron comunas y consultorios con mayor población, cercanía y acceso. Se mantuvo frecuencia de esquizofrenia y otros trastornos psicóticos y trastorno de personalidad, se duplicaron los trastornos afectivos, triplicaron los trastornos por sustancias, duplicó la patología dual, y el trastorno de personalidad fue frecuente en comorbilidad con trastorno por sustancias y trastornos afectivos. CONCLUSIONES: se requerirían estrategias con Sistema Judicial y Servicio de Salud, implementar unidad de adolescentes y unidad de adicción, y fortalecer atenciones multidisciplinarias para adultos mayores.

BACKGROUND: Short-stay psychiatric hospitalization is a necessary resource to treat mental disorders with severe decompensation that cannot be resolved outpatiently. Knowledge of your results helps in clinical and administrative management. This study aims to evaluate the evolution of hospital indicators, sociodemographic and clinics characteristics of inpatients in a short-stay unit of psychiatry. MATERIAL AND METHODS: Longitudinal, retrospective, trend study was conducted in a universe of 4,563 egress of short-stay psychiatric unit of Chile, for 14 years, from 01/07/2005 to 30/06/2019. Hospital indicators, sociodemographic and clinical variables were evaluated. RESULTS: during the period under study: The egress decreased, the average days were prolonged, the occupational index increased and the turnover rate decreased. A low number of patients, predominantly socioeconomic and psychosocial adversities, were frequently re-hospitalized. The greater the number of hospitalizations longest stay. Administrative and judicial hospitalizations were increased; the latter with the highest average stay. Hospitalization of males, adolescents, young people and older adults increased. Communes and primary care center with a greater population, proximity and access predominated. It remained frequency of schizophrenia and other psychotic disorders and personality disorders, doubled affective disorders, tripled substance disorders, doubled dual pathology, and personality disorder was common in comorbidity with substance disorder and affective disorders CONCLUSIONS: strategies would be required with the Judicial System and Health Service, implement adolescent unity and addiction unit, and strengthen multidisciplinary care for older adults.

Tuberculosis en cabeza y cuello. Experiencia en la Patagonia chilena y revisión de la literatura / Tuberculosis in head and neck. Experience in Chilean Patagonia and literature review

La tuberculosis (TBC) es una de las patologías infecciosas que más muertes ha producido a nivel mundial, sobrepasando al virus de inmunodeficiencia humana (VIH). En Chile a pesar de la baja incidencia de la patología, aun no es posible llegar a su erradicación. La TBC es una enfermedad que habitualmente compromete el pulmón, sin embargo, en ocasiones compromete otros sitios del organismo, siendo la ubicación en cabeza y cuello una de las más importantes. Las manifestaciones clínicas son variadas y el curso de estas puede ser larvado, simulando otras patologías de mayor frecuencia en el ámbito otorrinolaringológico y transformando su diagnóstico en un desafío mayor. En este artículo se presentan tres casos clínicos diagnosticados y manejados en nuestra en región, además de una revisión de la literatura disponible en relación a la presentación clínica, orientación diagnóstica y tratamiento de la patología.

Tuberculosis is one of the infectious diseases which has produced more deaths around the world, even more than human immunodeficiency virus. In Chile, despite of the low incidence, there is still not possible to eradicate it. Tuberculosis is a disease which commonly compromises lungs, however, in some occasions involves another site of the organism, been the location in head and neck one of the most important. The clinical features are diverse and the natural history of those can be masked, for this reason it can simulate another more frequent disease in otolaryngology field, making the diagnosis a real challenge. In this article, we present three clinical cases diagnosed and treated in our region, besides, a review of the available literature related with the clinical presentation, diagnosis orientation and treatment of this pathology.

Mortalidad quirúrgica durante pandemia de coronavirus en un centro universitario / Surgical mortality during a coronavirus pandemic in a university center

Resumen Introducción: La pandemia de coronavirus, iniciada en Wuhan el año 2019, ha trastocado al mundo y afectado profundamente a la actividad quirúrgica al restringir el número de intervenciones en forma dramática, después de los reportes iniciales de mortalidad posoperatoria sobre el 20% en pacientes operados portadores de COVID. El objetivo del presente estudio fue evaluar las cifras de mortalidad quirúrgica, en pacientes intervenidos quirúrgicamente durante la pandemia del COVID-19. Materiales y Método: Cohorte retrospectiva de pacientes operados entre el 15 de marzo de 2020 y el 31 de julio de 2020 en un centro universitario. Se evaluó variables clínicas asociadas a la intervención quirúrgica y coinfección por SARS-CoV-2. Resultados: Se analizaron 344 pacientes quienes presentaron una mortalidad global de 6,1%. Se realizó examen de PCR para COVID a 153 pacientes. Presentaron un riesgo de mortalidad significativo los pacientes: PCR COVID(+) (22,7%), p = 0,01, portadores de hipertensión arterial (11,6%) p = 0,03 y mayores de 60 años (12,4%) p < 0,001. No fueron factores estadísticamente significativos de mayor riesgo de mortalidad, las siguientes variables: género, obesidad, diabetes mellitus, patología oncológica, cirugía de urgencia y clasificación de ASA. Al analizar dos subgrupos se observó que los pacientes menores de 60 años COVID negativo presentaron una cifra de mortalidad de 1,26% versus 36,3% en los mayores de 60 años, COVID positivos (p = 0,01). Discusión: Los resultados del presente estudio sugieren que se deben realizar los mayores esfuerzos para descartar la infección por SARS-CoV-2 en la evaluación preoperatoria para disminuir los riesgos de mortalidad posoperatoria.

Background: The coronavirus pandemic, started in the city of Wuhan in 2019, has disrupted the world and deeply affected surgical activity. Restricting the number of interventions dramatically, after initial reports of postoperative mortality over 20% in patients with COVID. The purpose of this study is to evaluate the figures for surgical mortality, during the coronavirus pandemic. Materials and Method: Retrospective cohort of patients operated between March 15, 2020 and July 31, 2020 at a university center. Clinical variables associated with surgical intervention and coinfection by SARS-CoV-2 were evaluated. Results: 344 patients with an overall mortality of 6.1% were analyzed. PCR testing for COVID was performed on 153 patients. Only from the ninth week of the pandemic did routine preoperative testing begin. Patients who presented a higher risk of mortality were: PCR COVID(+) (22.7%), arterial hypertension (11.6%) and age over 60 years (12.4%). In the present series, the following variables were not statistically significant risk factors for mortality: gender, obesity, diabetes mellitus, oncological pathology, emergency surgery and ASA classification. When analyzing two subgroups, we observed that COVID negative patients under 60 had a mortality rate of 1.26%, versus 36.36% in those over 60 years of age, COVID positive. Discussion: The results of the present study lead us to make every effort to rule out COVID infection preoperatively to reduce the risks of postoperative mortality. Although this is a series of cases and the extrapolation of its results should be cautious, having national figures can be a useful element to make decisions in this stage of reactivation of surgical activity.

Ceramide mediates tumor necrosis factor effects on P450-aromatase activity in cultured granulosa cells.

In [3H]serine-labelled granulosa cells treatment with TNF alpha (10 ng/ml) resulted in a transient decrease in cellular [3H]sphingomyelin and generation of [3H]ceramide that remained elevated 60 min later. In cells labelled with [methyl-14C]choline, TNF alpha induced a similar reduction in [14C]sphingomyelin content that was accompanied by a sustained elevation in [14C]phosphorylcholine levels. In FSH-primed cells, TNF alpha inhibited P450-AROM activity in a dose-dependent manner, an effect that was also observed in cells treated with bacterial sphingomyelinase (SMase 0.003-0.3 U/ml) or increasing concentrations (0.1-10 microM) of N-acetylsphingosine (C2-cer) a membrane-permeable analogue of ceramide. These results support the notion that sphingomyelin degradation to a bioeffector molecule ceramide, may be an early event involved in TNF alpha-induced signal transduction in granulosa cells.

Induction of guanosine triphosphate-cyclohydrolase by follicle-stimulating hormone enhances interleukin-1 beta-stimulated nitric oxide synthase activity in granulosa cells.

In cultured granulosa cells, interleukin-1 beta (IL-1 beta) induced a time-dependent (16-72 h) and dose-related (0.3-30 ng/ml) stimulation of nitric oxide (NO) synthase (NOS) activity, as determined by the catalytic conversion of [3H]arginine to [3H]citrulline and NO2- accumulation in the culture medium. Although FSH alone failed to stimulate NOS activity, concomitant treatment with the gonadotropin (200 ng/ ml) or the cell-permeant cAMP analog (Bu)2cAMP (0.5 mM) markedly enhanced IL-1 beta-induced NO generation in cultured granulosa cells. The effect of IL-1 beta on citrulline biosynthesis and NO2- accumulation was abrogated by the NOS inhibitor NG-methyl-L-arginine or the IL-1-receptor antagonist protein. In contrast bacterial endotoxin (lipopolysaccharide), interferon-gamma, or tumor necrosis factor-alpha, which are well known inducers of inducible NOS (iNOS) in a variety of immunocompetent and nonimmunocompetent cell types, failed to increase [3H]citrulline formation or NO2- accumulation in untreated or FSH-stimulated cells. As demonstrated by reverse transcriptase-PCR analysis, IL-1 beta-stimulated NO generation was accompanied by a time-dependent increase in messenger RNA levels for iNOS and GTP-cyclohydrolase (GTPCH), the rate-limiting step for de novo tetrahydrobiopterin (BH4) biosynthesis. Treatment with FSH augmented only GTPCH messenger RNA expression, and a more than additive GTPCH signal was observed when cells were simultaneously challenged with IL-1 beta and FSH. Treatment with the GTPCH inhibitor 2,4-diamino-6-hydroxypyrimidine prevented IL-1 beta-induced NOS activity in untreated or FSH-stimulated cells, and this inhibition was completely reversed by sepiapterin, a substrate for BH4 biosynthesis, via an alternative pterin salvage pathway present in many cell types. As BH4 is an essential cofactor for NOS catalytic activity, these observations strongly suggest that FSH-induced biosynthesis of endogenous BH4 is essential for full iNOS biosynthetic capacity in IL-1 beta-stimulated granulosa cells.

North Carolina macular dystrophy (MCDR1) locus: a fine resolution genetic map and haplotype analysis.

PURPOSE: We previously reported linkage of North Carolina macular dystrophy in a single isolated family to a broad region on chromosome 6q16. In order to refine the localization of the MCDR1 gene (North Carolina macular dystrophy), additional families with this disease and new markers were studied. METHODS: We ascertained 10 families with the North Carolina macular dystrophy phenotype (MCDR1). These families were of various ethnic and geographic origins such as Caucasian, Mayan Indian, African-American, French, British, German, and American of European decent. Two hundred thirty-two individuals in these families underwent comprehensive ophthalmic examinations and blood was collected for genotyping. One hundred seventeen were found to be affected. Linkage simulation studies were performed. Two-point linkage, haplotype analysis, and multipoint linkage was performed using VITESSE and FASTLINK. HOMOG was used to test for genetic heterogeneity. RESULTS: The clinical features were consistent with the diagnosis of North Carolina macular dystrophy in all families. Multipoint linkage analysis indicates that the MCDR1 gene is in the interval between D6D249 and D6S1671 with a maximum LOD score of 41.52. There was no evidence of genetic heterogeneity among the families studied. Families 765, 768, 772, 1193, and 1292 shared the same chromosomal haplotype in this region. CONCLUSIONS: This is the largest single data set of families with the MCDR1 phenotype. The single large family from North Carolina continues to be informative for the closest flanking markers and alone supports the minimal candidate region as suggested by previous studies. There remains no evidence of genetic heterogeneity in this disease. Most of the American families appear to have descended from the same ancestral mutation. The remaining families could each represent independent origins of the mutation in the MCDR1 gene.

The transseptal approach for mitral valve replacement revisited.

We describe our experience with the transseptal approach for mitral valve replacement, a technique that we applied especially in cases of 3rd and 4th operations wherein numerous adhesions made the usual left atrial approach difficult. We report 39 cases of mitral procedures in which we used 3 slightly different transseptal approaches, depending on the cardiac anatomy and the preferences of the surgeon. There were no complications associated with any of these approaches. Indeed they made the mitral valve procedure easier, because they enabled full exposure of the mitral valvular and subvalvular apparatus. We also propose the transseptal approach as a very safe and reproducible technique for use in patients with friable tissues, heavily calcified mitral valves, or small left atria- and in patients who must undergo combined tricuspid and mitral procedures. In this series, there were no conduction abnormalities secondary to the approach, nor were there any procedure-related deaths.

[Ultrasonic diagnosis of prostatic adenocarcinoma. Prospective study of a sample of 159 patients]. / Diagnóstico ecográfico del adenocarcinoma de próstata. Estudio prospectivo sobre una muestra de 159 pacientes.

We studied the value of transrectal echography as the diagnostic means of prostate pathology. We carried out a prospective analysis of a sample of 159 patients, on whom we have anatomopathological documentation which we use as the reliability control for the clinical exploration by means of rectal touch and ultrasonography with transrectal transducer. We have obtained 137 prostate fibromuscular hyperplasias, 3 inflammatory pathologies and 19 adenocarcinomas. A 100% sensitivity in the echographic diagnosis of prostate adenocarcinoma was achieved for this sample.

Caracterización del dolor fibromiofascial, hipótesis etiológica, aplicación y efecto del tratamiento / Fibromyofascial pain characterization, etiological hypothesis, application and effect of treatment

Introducción: El dolor músculo-esquelético crónico no reumático afecta a un 20 % de la población mundial, con tendencia ascendente. Actualmente, su tratamiento es solamente sintomático, pobremente eficaz y oneroso. El objetivo de este estudio fue caracterizar la enfermedad investigada como dolor fibromiofascial, de evolución inicialmente remitente, recurrente y, luego, migratoria, progresiva y persistente. Resistente al tratamiento sintomático. La hipótesis etiológica es que esta enfermedad es producida por la impregnación de urato monosódico en el tejido conjuntivo del aparato músculo-esquelético y tejido conjuntivo laxo, en forma similar a la fisiopatología de la gota, pero sin inflamación, expresándose solamente dolor y, en algunos casos, edema. Entonces, se plantea la tesis que un tratamiento antigotoso oral será eficaz. La intervención consiste en aplicar a la muestra este tratamiento (no importando la uricemia de cada paciente) y ponderar su efecto en la disminución del dolor y otras molestias. Material y métodos: Se realizó un estudio de seguimiento individual por un año a una cohorte formada por 49 pacientes que acudieron, aleatoria y voluntariamente, en el periodo de un año, a un consultorio de medicina integral, presentando dolor según la definición de caso. El diseño es un estudio de cohorte dinámico, prospectivo, aleatorio, cuasi experimental, sin grupo control. Determinando dos grupos: 1) pacientes ya estudiados y tratados con AINE, analgésicos, fisioterapia o alternativos; y 2) pacientes sin diagnóstico ni tratamientos previos. Tratamiento aplicado: dieta hipopurínica y los fármacos colchicina y alopurinol, vía oral y, eventualmente, lidocaína transdérmica para algún punto gatillo persistente. Se excluyó absolutamente l uso de otros tratamientos analgésicos. Se determinaron las variables que componen y caracterizan el síndrome en estudio. Se evaluó las tasas de recuperación y las probabilidades de recuperación por cada intervalo de tiempo estudiado a través del análisis descriptivo de la recuperación, en conjunto con un análisis de supervivencia. Resultados: De la muestra inicial de 53 personas, 4 de ellas abandonaron el tratamiento el primer día por intolerancia a los fármacos. Permaneciendo en tratamiento y control individual por 1 año la muestra formada por 49 pacientes. De ellos, 17 son hombres (34,7 %) y 32 son mujeres (65,3 %); edad media de 58,5 años (DT = 15,07); duración de la enfermedad: 0 a 27 años, media = 4,08 años (DT = 5,23). La caracterización de la enfermedad se obtuvo de recoger y evaluar la distribución de frecuencias de síntomas y signos del conjunto de la muestra. La hipótesis etiológica se obtuvo de un estudio semiológico-clínico comparativo previo, determinando como agente etiológico el urato monosódico, sal insoluble que estimula los nocipropioreceptores sin producir inflamación. Se aplicó colchicina: 1,5 a 0,5 mg/día, en un periodo máximo de 2 meses cada dosis, obtenida la remisión: 0,5 mg/semana, y alopurinol: 300 mg/día hasta la remisión y, luego, 100 mg/día. Al final de 1 año de tratamiento y seguimiento a cada paciente, todos ellos presentaron 100 % de recuperación, en una mediana de tiempo de 2 meses, lo que se evaluó con un análisis de supervivencia. La adhesión al tratamiento fue del 92,45 %. Un 24,5 % presentó reacciones adversas tolerables. Conclusión: La caracterización semiológica clínica del síndrome de dolor fibromiofascial fue suficientemente sensible para establecer el diagnóstico. La hipótesis etiológica permitió elegir un tratamiento curativo para todas las personas efectivamente tratadas (AU)

Introduction: The chronic non-rheumatic musculoskeletal pain affects 20 % of the world population, with an upward trend. Currently, its treatment is only symptomatic, poorly efficient and onerous. The aim of this study was to characterize the disease researched as fibromyofascial pain, of an initially relapsing-remitting evolution, and then, migratory, progressive and persistent. Resistant to symptomatic treatment. The etiological hypothesis is that this disease is produced by the impregnation of the monosodium urate in the connective tissue of the musculoskeletal system and soft connective tissue; similarly to the physiopathology of gout but without inflammation. Expressing only pain, and in some cases, edema. Therefore, the hypothesis states that an oral treatment for gout will be effective. The intervention consists of applying this treatment to the sample -regardless of the uricemia of each patient- and calculate its effect in decreasing pain and other health problems. Material and methods: An individual follow-up study was held for one year of a 49-patient cohort, who attended, at random and voluntarily, for the period of one year, to an integral medicine center, presenting pain according to the definition of the case. The design is a dynamic, prospective, randomized, quasi-experimental, with no control group, cohort study. Two groups are formed: 1) patients previously studied and treated with NSAIDs, analgesics, corticoids, physiotherapy or alternative treatment; and 2) patients who had not been either diagnosed or treated previously. Treatment: Low-Purine Diet, colchicine and allopurinol, via oral and, eventually, transdermic lidocaine for some persistent trigger point. The use of other analgesic treatments was absolutely excluded. Variables that compose and characterize the syndrome in study were determined. Recovery rates and recovery probabilities were evaluated for each time interval, studied through a descriptive analysis of recovery, and also through a survival analysis. Results: From the initial sample of 53 people, 4 of them quit the treatment on the first day because of intolerance to medicines. As a result, the sample was formed by 49 patients, who continued with the treatment and individual control for 1 year. In this group, 17 are male (34.7 %) and 32 are female (65.3 %); 58.5 years old in average (SD = 15.07); length of disease: 0 to 27 years, means: 4.08 years (DT = 5.23). The characteristics of the disease were obtained by identifying and evaluating the frequency distribution of symptoms and signs of the whole group in the sample. The etiological hypothesis was obtained in a previous semiological and clinical comparative study, in which the monosodium urate was characterized as the etiological agent, that this is an insoluble salt, which stimulates the nocipropioreceptors, without causing inflammation. Treatment: colchicine: 1.5 to 0,5 mg/day, for 2 months at most each dose, remission guaranteed: 0.5 mg/week. Allopurinol: 300 mg/day until remission, and then, 100 mg/day. By the end of the year of treatment and follow-up for each patient, all of them achieved 100 % of recovery, in a median time of 2 months, which was evaluated with a survival analysis. The compliance with the treatment was 92.45 %. 24.5 % presented tolerable adverse reactions: Allopurinol: mucous dryness (1), urinary and vaginal burning (1) erectile dysfunction (1). Colchicine: gastric intolerance (2), persistent diarrhea (4), vomit (1), headache (1), nausea (1). Conclusion: The semiological-clinical characterization of the syndrome of fibromyofascial pain was sensitive enough to establish the diagnosis. The etiological hypothesis allowed to select a curative treatment for all the patients effectively treated (AU)

Uso de esteroides sistémicos en quemaduras de segundo grado en modelo animal / Systemic steroid use in second degree burns in an animal model

El uso de esteroide está reconocido en el tratamiento crítico del paciente quemado y es útil en el choque séptico que no responde a vasopresores. Este grupo de medicamentos ayuda a regular la respuesta hemodinámica mejorando el aporte de sangre a la piel, aunque sabemos que tienen un efecto nocivo en el proceso de cicatrización. Evaluamos el efecto histopatológico del empleo de esteroides en quemaduras usando un modelo animal. Empleamos 2 grupos de 10 ratas (Wistar) en las que colocamos un cilindro de metal en el dorso durante 15 segundos a 95oC, produciendo una quemadura. En ese momento, uno de los grupos recibió esteroide a dosis de estrés (hidrocortisona 5 mg/kg) y el otro no recibió ningún medicamento. Al quinto día resecamos la escara y cubrimos el defecto con cultivo de queratinocitos. Los animales fueron sacrificadas a los 14 días. Realizamos análisis histopatológico. Macroscópicamente evaluamos la (..) (AU)

The use of steroids is well recognized in critical care specially in septic shock. There are some reports of their utility in severe burns. It helps to regulate the hemodynamic response in order to improve the blood supply to the skin, although it is well known their negative effect in wound healing. Our objective is to know the hystopathologic effect of steroids in burn healing. We used 2 groups of 10 rats (Wistar). Both groups were exposed in their backs to a metallic cylinder at 95 oC for 15 seconds. At the moment of the burn, one group was given steroid (hydrocortisone at stress dose 5 mg/kg) and the other group didn't received any medication. The scar was removed at the 5th day and the burn injury was covered with queratinocyte culture. The rats were sacrificed at 14th day. We evaluated the presence of clinical signs of infection and the percentage of new epithelium. In the microscope we evaluated the following parameters: fibrosis, inflammatory process, presence of fibroblast and vascular proliferation. We compared both groups using Chi2 test (SPSS program version 10). A p =/<. 05 was considered as statistical significant. We found no difference between each group in fibrosis (p .47), inflammatory process (p .27), or fibroblast presence (p.16). But there was a difference in vascular proliferation (p .05) against the first group (steroid group). There were no signs of infection and all of them were epithelised at the 14th day. In conclusion, the use of steroids in burns in an animal model could have a final effect in wound healing. In humans it is important to say that they can be helpful in those cases with clear evidence of benefit, as for example failure to vassopresor response in septic shock. We are not sure about the final effect in wound healing in the steroid group as for example wound contracture in long term (AU)

Síndrome de fenilquetonuria materna, un nuevo desafío para Chile / Maternal phenylketonuria syndrome, a new challenge for Chile

Phenylquetonuria (PKU) is a hereditary disease, caused by the deficiency or absence of the enzyme phenylalanine hydroxylase, which produces an abnormal conversion of phenylalanine (Phe) to tyrosine. If PKU is not diagnosed and treated during the neonatal period, blood accumulation of Phe causes neurological damage. Chile has a neonatal screening program for PKU and congenital hypothyroidism since 1992; this program has diagnosed 162 PKU patients in Chile, which are being followed-up in INTA, Universidad de Chile. Nowadays, there are 20 PKU patients in adolescence, so we face a new challenge such as maternal PKU syndrome. This syndrome refers to the teratogenic effect of Phe in a pregnant PKU female. The most frequent anomalies are intrauterine growth retardation, microcephaly, global development retardation and congenital heart defects. Their occurrence is directly related to maternal Phe during pregnancy. In order to assure a normal pregnancy and to prevent this syndrome, levels of Phe in blood should be kept between 2 and 6 mgldl prior to conception and throughout pregnancy. Considering this challenge, INTA has proposed a strict protocol of follow-up to improve the compliance to nutritional therapy and prevent maternal PKU syndrome.

La fenilquetonuria (PKU) es una patología hereditaria, producida por la deficiencia o ausencia de la enzima fenilalanina hidroxilasa, lo que impide la metabolización normal de la fenilalanina (FA) a tirosina. La acumulación de fenilalanina en la sangre ocasiona daño neurológico si no es diagnosticada y tratada desde el periodo neonatal. Desde 1992 Chile tiene un programa de pesquisa neonatal de PKU e hipotiroidismo congénito, lo que ha permitido diagnosticar 162 casos con PKU, los que mantienen un seguimiento integral en el INTA, de la Universidad de Chile. Actualmente hay 20 PKU en etapa de adolescencia, por lo que nos enfrentamos a un nuevo desafío, el síndrome de PKU materna. Este síndrome se refiere al efecto teratogénico de la FA en una embarazada con PKU. Las alteraciones más características son el retraso del crecimiento intrauterino, la microcefalia, el retraso global del desarrollo y los defectos cardiacos congénitos. La presencia de estas alteraciones está directamente relacionada con los niveles de FA de la madre durante el embarazo. Para asegurar un embarazo normal y prevenir este síndrome se recomienda la mantención de niveles de FA entre 2 y 6 mg/dl, desde el período preconcepcional y durante todo el embarazo. El INTA considerando este desafío, ha propuesto un protocolo de seguimiento estricto preconcepcional y durante el embarazo con el objetivo de favorecer la adherencia al tratamiento nutricional y prevenir el síndrome de PKU materna.

[The use of suprarenal scintigraphy in the differential diagnosis of suprarenal incidentaloma]. / Utilidad de la gammagrafía suprarrenal en el diagnóstico diferencial del incidentaloma suprarrenal.

OBJECTIVES: To assess the usefulness of adrenal scintigraphy for clinical evaluation of adrenal incidentalomas, and its relation with pathological diagnosis and follow-up. PATIENTS AND METHODS: We have studied 46 patients with unilateral adrenal incidentaloma of size between 10 and 100 mm (average 30.5 +/- 19 mm). The lesions were discovered with abdominal computerized tomography in the study of a primary tumor (22%) or in the evaluation of benign pathology (78%). Adrenal scintigraphy assessed uptake in adrenal incidentaloma. Hormonal study included urinary catecholamines, plasma cortisol after dexamethasone, adrenal androgens, and renin and aldosterone in hypertensive patients. Five patients were operated, FNAB was carried out in three patients, and in the rest average follow-up was 29 +/- 21 months. Adrenal incidentaloma was considered nonfunctional if the lesion did not modified its size nor showed analytical alterations along a follow-up higher than 8 months. RESULTS: Of 46 adrenal lesions, seven didn't show uptake (three metastases, one cyst, one adrenal carcinoma, one pheochromocytoma, and one angiomyolipoma), 34 showed excessive uptake (29 nonfunctional adrenal nodules and 5 hyperfunctional adrenal nodules), and five had normal uptake (nonfunctional adrenal nodules). Adrenal scintigraphy was compatible in all cases with cytological study or the response to chemotherapy. Along the follow-up, growth of the lesion was demonstrated in 23%, and reduction or disappearance of the lesion in 11%, with no hormonal significant changes. CONCLUSIONS: Detection of a lesion with no uptake in adrenal scintigraphy forces to carry out complementary explorations in order to rule out malignant pathology. A lesion with excessive uptake is indicative of a benign process and should be assessed with hormonal determinations.

North Carolina macular dystrophy (MCDR1) in Texas.

PURPOSE: To map the gene responsible for causing a macular degeneration in a Texan family that appears clinically similar to the North Carolina macular dystrophy (MCDR1) phenotype. METHODS: A single family in Texas had all the typical clinical features of the North Carolina macular dystrophy phenotype. Of 23 family members examined, 10 were affected. Blood was collected from all 23 members and fundus photographs were obtained on those affected. A detailed family history consisting of nine generations was obtained. Genotyping and likelihood analysis was performed using the closest linked MCDR1 markers. RESULTS: The genealogic data showed no relation with the original North Carolina macular dystrophy pedigree. The dinucleotide repeat marker D6S283 yielded the highest 2-point LOD score with a Zmax = 4.1 at theta = 0. The peak LOD score generated from multipoint analysis was 6.0. CONCLUSIONS: The linkage results indicate that the macular degeneration in this Texan family is due to a mutation in the same genomic region as that causing North Carolina macular dystrophy. Furthermore, haplotype analysis suggests that the original North Carolina family and the Texan family have the same mutation and a common founder.