ABSTRACT
Prostate adenocarcinoma is the second most commonly diagnosed cancer in men worldwide, and the initiating factors are unknown. Oncogenic TMPRSS2:ERG (ERG+) gene fusions are facilitated by DNA breaks and occur in up to 50% of prostate cancers. Infection-driven inflammation is implicated in the formation of ERG+ fusions, and we hypothesized that these fusions initiate in early inflammation-associated prostate cancer precursor lesions, such as proliferative inflammatory atrophy (PIA), prior to cancer development. We investigated whether bacterial prostatitis is associated with ERG+ precancerous lesions in unique cases with active bacterial infections at the time of radical prostatectomy. We identified a high frequency of ERG+ non-neoplastic-appearing glands in these cases, including ERG+ PIA transitioning to early invasive cancer. These lesions were positive for ERG protein by immunohistochemistry and ERG messenger RNA by in situ hybridization. We additionally verified TMPRSS2:ERG genomic rearrangements in precursor lesions using tricolor fluorescence in situ hybridization. Identification of rearrangement patterns combined with whole-prostate mapping in three dimensions confirmed multiple (up to eight) distinct ERG+ precancerous lesions in infected cases. We further identified the pathogen-derived genotoxin colibactin as a potential source of DNA breaks in clinical cases as well as cultured prostate cells. Overall, we provide evidence that bacterial infections can initiate driver gene alterations in prostate cancer. In addition, our observations indicate that infection-induced ERG+ fusions are an early alteration in the carcinogenic process and that PIA may serve as a direct precursor to prostate cancer.
Subject(s)
Bacterial Infections/genetics , Prostatic Neoplasms/genetics , Prostatic Neoplasms/microbiology , Serine Endopeptidases/genetics , Atrophy , Bacterial Infections/complications , Bacterial Infections/pathology , DNA Breaks , Humans , Male , Oncogene Fusion , Peptides/genetics , Polyketides , Prostate/microbiology , Prostate/pathology , Prostatectomy , Prostatic Neoplasms/pathology , Prostatic Neoplasms/surgery , Prostatitis/genetics , Prostatitis/microbiology , Prostatitis/pathology , Transcriptional Regulator ERG/geneticsABSTRACT
Venoarterial (VA) extracorporeal membrane oxygenation (ECMO) is a treatment strategy for pediatric patients with cardiopulmonary failure. Femoral cannulation is a commonly used technique for obtaining central access in children and adolescents despite high rates of vascular complications. Ischemic limb complications remain one of the most common problems facing survivors of femoral VA ECMO. Our aim is to review the literature on femoral cannulation in children and to present a review of techniques for femoral cannula placement, decannulation, and arterial repair to help minimize and ameliorate complications related to cannulation. We performed a literature review for pediatric ECMO cannulation, complications, and femoral artery repair in pediatric patients. We focused on the management of arterial and ischemia-related complications during and after ECMO support via femoral cannulation. Vascular complications are not infrequent for patients requiring ECMO support via femoral cannulation. As such, judicious distal perfusion monitoring as well as augmentation of distal flow are important strategies during mechanical support. The use of distal perfusion catheters can be used to minimize the risk of limb ischemia. As femoral cannulation grows more popular in pediatric patients, strategies for arterial repair are essential to ensure extremity perfusion upon decannulation.
Subject(s)
Catheterization, Peripheral/methods , Extracorporeal Membrane Oxygenation/methods , Femoral Artery , Catheterization, Peripheral/adverse effects , Child , Humans , Ischemia/etiology , Ischemia/prevention & control , Perfusion , Respiration, ArtificialABSTRACT
BACKGROUND: The occurrence of central apneas when applying positive pressure (CPAP) to patients with obstructive sleep apnea syndrome (OSAS) is called complex sleep apnea (CompSA). This causes poor adherence to CPAP and persistence of symptoms. In Bogota, a city located at an altitude of 2640 m above sea level, chronic hypoxemia can generate certain instability of the respiratory system during sleep which could increase the presence of central apnea. The aim was to establish the prevalence of central apnea (central apnea index >5/h) in adults with moderate or severe OSAS during CPAP titration, and the factors associated with this. METHOD: Patients over 18 years old with OSAS were referred to the Fundacion Neumologica Colombiana Sleep Center, from January 2008 to June 2010. Polysomnogram (PSG) for CPAP titration was performed according to the American Academy of Sleep Medicine criteria. The prevalence was calculated and the clinical and baseline PSG factors associated with the CompSA were analyzed. RESULTS: We included 988 patients, 58% men. CompSA prevalence was 11.6%. Factors associated with CompSA were: central apneas in the baseline PSG (OR: 5.34 [3.49-8.16]), history of heart failure (OR: 2.53 [1.58-4.07]), and male sex (OR: 1.68 [1.06-2.69]). CONCLUSION: The prevalence of complex sleep apnea in Bogota (11.6%) was intermediate compared to the reported in lower altitudes. The factors associated with the development of CompSA were male sex, heart failure, and the presence of central apnea in the baseline PSG.
Subject(s)
Altitude , Continuous Positive Airway Pressure , Sleep Apnea, Central/epidemiology , Sleep Apnea, Obstructive/therapy , Aged , Cohort Studies , Colombia , Female , Humans , Male , Middle Aged , Polysomnography , Prevalence , Risk Factors , Sleep Apnea, Central/diagnosis , Sleep Apnea, Obstructive/complications , Sleep Apnea, Obstructive/diagnosisABSTRACT
Objetivo: Determinar el nivel de conocimientos, actitudes y prácticas sobre protección solar en Internos de Medicina. Material y métodos: Estudio analítico transversal, 190 Internos de Medicina de cinco hospitales generales de Lima y Callao resolvieron un cuestionario estructurado y autodesarrollado con preguntas sobre conocimientos, actitudes y prácticas sobre protección solar durante mayo de 2005. Resultados: El 18 por ciento tuvo un nivel de conocimientos alto, el 56 por ciento alcanzó un nivel de conocimientos intermedio y el 25 por ciento un nivel bajo. El 29 por ciento mostró una actitud favorable frente a las medidas de protección solar, mientras que el 17 por ciento tuvo prácticas adecuadas. Las actitudes estuvieron significativamente asociadas con las prácticas sobre protección solar, sin embargo, el nivel de conocimientos no estuvo asociado con las prácticas de protección solar. Conclusiones: Los internos presentan, en general, un nivel de conocimiento intermedio o bajo, actitudes desfavorables y prácticas no adecuadas sobre protección solar.
Subject(s)
Humans , Male , Female , Adult , Sunscreening Agents , Health Knowledge, Attitudes, Practice , Internship and Residency , Cross-Sectional Studies , Hospitals, GeneralABSTRACT
INTRODUCTION: Surgical wound infection is a devastating complication from the biological and economic point of view; it can result in serious disability and death, besides the high costs for the patient, the family and the health institutions. PURPOSE: To assess if appendectomized patients in whom germs were isolated in the culture of the peritoneal exudate showed surgical wound infection. MATERIAL AND METHODS: This study was performed on 104 patients who underwent surgery for Acute Appendicitis having been hospitalized through the Emergency Service of Hospital III-ESSALUD-Chimbote between November 1, 2001 and April 30, 2002; with ages ranging from 1 to 90 years. A peritoneal exudate culture was made for each of them. RESULTS: 22.12% of the appendectomized patients developed surgical wound infection. Of them, 82.61% showed positive results for bacteria in the peritoneal exudate culture. 81 appendectomized patients did not develop surgical wound infection; 23.46% of them showed positive results for germs in the peritoneal exudate culture. CONCLUSION: It was not possible to establish a relationship between surgical wound infection and peritoneal exudate culture. There was a close correlation with the development of surgical wound infection in appendectomized patients with longer periods of time for the disease and longer operation time.
Subject(s)
Appendectomy/adverse effects , Appendicitis/surgery , Surgical Wound Infection/etiology , Acute Disease , Adolescent , Adult , Aged , Aged, 80 and over , Ascitic Fluid/microbiology , Bacteria/isolation & purification , Chi-Square Distribution , Child , Child, Preschool , Emergencies , Exudates and Transudates/microbiology , Humans , Infant , Length of Stay , Middle Aged , Peru , Surgery Department, Hospital , Surgical Wound Infection/microbiology , Time FactorsABSTRACT
Introducción: La infección de sitio operatorio es una complicación devastadora desde el punto de vista biológico y económico; puede causar seria incapacidad y muerte, además de los elevados costos para el paciente, la familia y las instituciones de salud. Objetivo: Evaluar si los pacientes apendicectomizados en quienes se aislaron gérmenes en el cultivo del exudado peritoneal presentaron infección de sitio operatorio. Material y Métodos: El estudio se realizó con 104 pacientes intervenidos de Apendicitis Aguda, que ingresaron por el Servicio de Emergencia del Hospital III EsSalud - Chimbote entre el 1 de Noviembre de 2001 y el 30 de Abril de 2002; con edades que oscilaron entre 1 y 90 años. A todos ellos se les realizó cultivo del exudado peritoneal. Resultados: El porcentaje de pacientes apendicectomizados con infección de sitio operatorio fue de 22.12 por ciento. De los 23 pacientes apendicectomizados con infección de sitio operatorio fue de 22.12 por ciento. De los 23 pacientes apendicectomizados con infección de sitio operatorio, 82.61 por ciento de ellos tuvieron presencia de germen en el cultivo del exudado peritoneal. De los 81 pacientes apendicectomizados sin infección de sitio operatorio, 23.46 por ciento de ellos tuvieron presencia de germen en el cultivo del exudado peritoneal. Conclusión: No pudo establecerse la relación entre infección de sitio operatorio y cultivo de exudado peritoneal. Existió estrecha correlación, en pacientes apendicectomizados en quienes presentaron mayor intervalo de tiempo de enfermedad y mayor intervalo de tiempo operatorio, con la presencia de infección de sitio operatorio.
Subject(s)
Humans , Male , Female , Appendectomy , Exudates and TransudatesABSTRACT
Antecedentes. La presencia de un cuerpo extraño es una emergencia drámatica, especialmente en pediatría, donde su incidencia es mayor. Materiales y Métodos. Se realizó un trabajo prospectivo con el fin de establecer la incidencia, localización y variabilidad de cuerpos extraños en la población infantil menor de 15 años, que asistio a la emergencia del Hospital Dr. Robert Reid Cabral en Santo Domingo, República Dominicana, durante el periodo 1ro de septiembre 1990 al 31 de agosto 1992. Resultados. Se estudiaron un total de 297 casos. En 187 casos (63.0//) la edad estuvo por debajo de 5 años, 187 pacientes (63.0//) pertenecieron al sexo masculino. El tiempo desde que se produjo el accidente hasta la llegada a la emergencia, fue menor de 12 horas en 112 casos (41.1//) y de 12 a 24 horas en 91 casos (30,6//). En 115 (38.7//) el cuerpo extraño estuvo localizado en el oido y en 80 casos (26.9//) en las fosas nasales. en 96 casos (32.3//) el cuerpo extraño se alojó en la parte alta del tubo digestivo o la vía aérea. Los cuerpos extraños mas frecuentes encontrados fueron semillas o granos de vegetales en 79 casos (27.0//), monedas con 56 casos (18.9//) y piedaras 45 casos (15.2//). Lavados de oidos y extración (0.3//) debida a la presencia de una aguja en el pulmon izquierdo. comentario. El canal auditivo externo, las fosas nasales y la parte alta del tubo digestivo o la via aérea, son los sitios donde con mas frecuencia se alojan cuerpos extraños en niños. Toda emergencia de pediatría debe estar preparada para atender estos casos
