Maximal Aerobic Power, Quality of Life, and Ejection Fraction in Survivors of Childhood Cancer Treated with Anthracyclines.

BACKGROUND: Anthracycline-induced cardiotoxicity is a frequent complication that can occur at any stage of treatment, even in survivors. OBJECTIVE: To determine maximum aerobic power, quality of life, and left ventricular ejection fraction in childhood cancer survivors treated with anthracyclines. DESIGN: Cross-sectional, observational study. METHODS: The left ventricular ejection fraction was obtained from the transthoracic echocardiogram report in the medical records. Each patient underwent a 6-minute walk test, assessment of maximum aerobic power on a cycle ergometer, and evaluation of perceived exertion using the EPInfant scale, and finally, their quality of life was evaluated using the pediatric quality of life inventory model. RESULTS: A total of 12 patients were studied, with an average of 16.2 years of age. All patients exhibited a left ventricular ejection fraction >60%, the mean distance covered in the 6-minute walk test was 516.7 m, and the mean of the maximum aerobic power was 70 W. Low quality of life scores were obtained in the physical and psychosocial aspects. In the Pearson test, a weak correlation without statistical significance was found between all the variables studied. CONCLUSIONS: Simultaneously with the detection of cardiotoxicity in childhood cancer survivors, it is pertinent to perform physical evaluations as physical condition and cardiotoxicity seem to be issues that are not necessarily dependent.

The Colombian Chemoprevention Trial: 20-Year Follow-Up of a Cohort of Patients With Gastric Precancerous Lesions.

BACKGROUND & AIMS: Helicobacter pylori eradication and endoscopic surveillance of gastric precancerous lesions are strategies to reduce gastric cancer (GC) risk. To our knowledge, this study is the longest prospective cohort of an H pylori eradication trial in a Hispanic population. METHODS: A total of 800 adults with precancerous lesions were randomized to anti-H pylori treatment or placebo. Gastric biopsy samples taken at baseline and 3, 6, 12, 16, and 20 years were assessed by our Correa histopathology score. A generalized linear mixed model with a participant-level random intercept was used to estimate the effect of H pylori status on the score over time. Logistic regression models were used to estimate progression by baseline diagnosis and to estimate GC risk by intestinal metaplasia (IM) subtype and anatomic location. RESULTS: Overall, 356 individuals completed 20 years of follow-up. Anti-H pylori therapy (intention-to-treat) reduced progression of the Correa score (odds ratio [OR], 0.59; 95% confidence interval [CI], 0.38-0.93). H pylori-negative status had a beneficial effect on the score over time (P = .036). Among individuals with IM (including indefinite for dysplasia) at baseline, incidence rates per 100 person-years were 1.09 (95% CI, 0.85-1.33) for low-grade/high-grade dysplasia and 0.14 (95% CI, 0.06-0.22) for GC. Incomplete-type (vs complete-type) IM at baseline presented higher GC risk (OR, 13.4; 95% CI, 1.8-103.8). Individuals with corpus (vs antrum-restricted) IM showed an OR of 2.1 (95% CI, 0.7-6.6) for GC. CONCLUSIONS: In a high-GC-risk Hispanic population, anti-H pylori therapy had a long-term beneficial effect against histologic progression. Incomplete IM is a strong predictor of GC risk.

Receptores NMDA: fundamentos e implicaciones terapéuticas en el manejo del dolor / NMDA receptors: foundations and therapeutic implications in the management of pain

The NMDA receptors has been described in the development of acute pain and maintenance of chronic pain; the knowledge of physiological processes has led to the growing interest in NMDA receptors antagonists, demonstrating optimal analgesic results. Inhibition of NMDA receptors is an effective therapeutic alternative in the management of pain; with beneficial results in the management of acute postoperative pain, chronic and neuropathic pain. The current scientific challenge is to identify antagonists that perform a selective inhibition of receptor subunits, achieving optimal analgesic results. For this non-systemic review, a search of the available scientific evidence was made in databases (Pubmed/Medline, Science Direct, OVID, SciELO) through the use of keywords (Pain, NMDA receptors, antagonists, ketamine).

Los receptores NMDA han sido descritos en el desarrollo del dolor agudo y mantenimiento del dolor crónico; el conocimiento de los procesos fisiológicos ha llevado al creciente interés en los antagonistas de los receptores NMDA, demostrando resultados analgésicos óptimos. La inhibición de los receptores NMDA es una alternativa terapéutica eficaz en el manejo del dolor; con resultados benéficos en el manejo del dolor agudo postoperatorio, dolor crónico y neuropático. El reto científico actual es identificar antagonistas que realicen una inhibición selectiva de las subunidades del receptor, logrando óptimos resultados analgésicos. Para esta revisión no sistemática se realizó una búsqueda de la evidencia científica disponible en bases de datos (Pubmed/Medline, Science Direct, OVID, SciELO) mediante el uso de palabras clave (dolor, receptores NMDA, antagonistas, ketamina).

Different gastric microbiota compositions in two human populations with high and low gastric cancer risk in Colombia.

Inhabitants of Túquerres in the Colombian Andes have a 25-fold higher risk of gastric cancer than inhabitants of the coastal town Tumaco, despite similar H. pylori prevalences. The gastric microbiota was recently shown in animal models to accelerate the development of H. pylori-induced precancerous lesions. 20 individuals from each town, matched for age and sex, were selected, and gastric microbiota analyses were performed by deep sequencing of amplified 16S rDNA. In parallel, analyses of H. pylori status, carriage of the cag pathogenicity island and assignment of H. pylori to phylogeographic groups were performed to test for correlations between H. pylori strain properties and microbiota composition. The gastric microbiota composition was highly variable between individuals, but showed a significant correlation with the town of origin. Multiple OTUs were detected exclusively in either Tumaco or Túquerres. Two operational taxonomic units (OTUs), Leptotrichia wadei and a Veillonella sp., were significantly more abundant in Túquerres, and 16 OTUs, including a Staphylococcus sp. were significantly more abundant in Tumaco. There was no significant correlation of H. pylori phylogeographic population or carriage of the cagPAI with microbiota composition. From these data, testable hypotheses can be generated and examined in suitable animal models and prospective clinical trials.

[Partial stomach partitioning gastrojejunostomy in the treatment of the malignant gastric outlet obstruction]. / Gastro yeyuno anastomosis con separación gástrica parcial en el tratamiento de la obstrucción gastroduodenal secundaria a cáncer gástrico avanzado.

BACKGROUND: In patients with unresectable gastric cancer and outlet obstruction syndrome, gastric partitioning gastrojejunostomy is an alternative, which could avoid the drawbacks of the standard techniques. OBJECTIVE: Comparison of antroduodenal stent, conventional gastrojejunostomy and gastric partitioning gastrojejunostomy. MATERIAL AND METHODS: A retrospective, cross-sectional study was conducted on patients with unresectable distal gastric cancer and gastric outlet obstruction, treated with the three different techniques over the last 12 years, comparing results based on oral tolerance and complications. An analysis was performed on the results using the Student-t test for independent variables. RESULTS: The 22 patients were divided in 3 groups: group I (6 cases) stent, group II (9 cases) conventional gastrojejunostomy, and group III (7 cases) gastric partitioning gastrojejunostomy, respectively. The stent allows a shorter "postoperative" stay and early onset of oral tolerance (P<0.05), however, the gastric partitioning gastrojejunostomy achieve normal diet at 15th day (P<0.05). The mortality rate was higher in the stent group (33%) compared with surgical techniques, with a morbidity of 4/6 (66.7%) in Group I, 6/9 (66.7%) Group II, and 3/7 (42%) Group III. Re-interventions: 2/6 Group I, 3/9 Group II, and 0/7 Group III. The median survival was superior in the gastric partitioning gastrojejunostomy, achieving an overall survival of 6.5 months. CONCLUSIONS: The gastric partitioning gastrojejunostomy for treatment of gastric outlet obstruction in unresectable advanced gastric cancer is a safe technique, allowing a more complete diet with lower morbidity and improved survival.

Activation of EGFR and ERBB2 by Helicobacter pylori results in survival of gastric epithelial cells with DNA damage.

BACKGROUND & AIMS: The gastric cancer-causing pathogen Helicobacter pylori up-regulates spermine oxidase (SMOX) in gastric epithelial cells, causing oxidative stress-induced apoptosis and DNA damage. A subpopulation of SMOX(high) cells are resistant to apoptosis, despite their high levels of DNA damage. Because epidermal growth factor receptor (EGFR) activation can regulate apoptosis, we determined its role in SMOX-mediated effects. METHODS: SMOX, apoptosis, and DNA damage were measured in gastric epithelial cells from H. pylori-infected Egfr(wa5) mice (which have attenuated EGFR activity), Egfr wild-type mice, or in infected cells incubated with EGFR inhibitors or deficient in EGFR. A phosphoproteomic analysis was performed. Two independent tissue microarrays containing each stage of disease, from gastritis to carcinoma, and gastric biopsy specimens from Colombian and Honduran cohorts were analyzed by immunohistochemistry. RESULTS: SMOX expression and DNA damage were decreased, and apoptosis increased in H. pylori-infected Egfr(wa5) mice. H. pylori-infected cells with deletion or inhibition of EGFR had reduced levels of SMOX, DNA damage, and DNA damage(high) apoptosis(low) cells. Phosphoproteomic analysis showed increased EGFR and erythroblastic leukemia-associated viral oncogene B (ERBB)2 signaling. Immunoblot analysis showed the presence of a phosphorylated (p)EGFR-ERBB2 heterodimer and pERBB2; knockdown of ErbB2 facilitated apoptosis of DNA damage(high) apoptosis(low) cells. SMOX was increased in all stages of gastric disease, peaking in tissues with intestinal metaplasia, whereas pEGFR, pEGFR-ERBB2, and pERBB2 were increased predominantly in tissues showing gastritis or atrophic gastritis. Principal component analysis separated gastritis tissues from patients with cancer vs those without cancer. pEGFR, pEGFR-ERBB2, pERBB2, and SMOX were increased in gastric samples from patients whose disease progressed to intestinal metaplasia or dysplasia, compared with patients whose disease did not progress. CONCLUSIONS: In an analysis of gastric tissues from mice and patients, we identified a molecular signature (based on levels of pEGFR, pERBB2, and SMOX) for the initiation of gastric carcinogenesis.

[Laparoscopic treatment of sigmoid colon intussusception secondary to giant submucosal lipoma]. / Tratamiento laparoscópico de invaginación en sigma por lipoma submucoso gigante.

Colonic lipomas have very low frequency, are usually asymptomatic and diagnosis is made incidentally. Seventy-five per cent of lipomas larger than 4 cm are symptomatic, causing abdominal pain, rectal bleeding, obstruction and exceptionally invagination. The resection of invaginated segment is mandatory in cases with invagination and can be performed by laparoscopy when colonic dilation is moderate. We present a 73-year-old man who entered the emergency department complaining of intermitent abdominal pain, rectal bleeding, absence of bowel movements and flatulence, during four days. A CT scan showed a generalized colonic dilation until left lower quadrant. A colo-colonic invagination secondary to an endoluminal lipoma was observed in sigmoid colon. A laparoscopic sigmoidectomy was performed with extracorporeal termino-terminal anastomosis. The postoperative period was uneventful and the patient was discharged from the hospital five days later. A sumbmucous colonic lipoma was diagnosed in the pathological study.

Tratamiento laparoscópico de invaginación en sigma por lipoma submucoso gigante. / [Laparoscopic treatment of sigmoid colon intussusception secondary to giant submucosal lipoma].

Colonic lipomas have very low frequency, are usually asymptomatic and diagnosis is made incidentally. Seventy-five per cent of lipomas larger than 4 cm are symptomatic, causing abdominal pain, rectal bleeding, obstruction and exceptionally invagination. The resection of invaginated segment is mandatory in cases with invagination and can be performed by laparoscopy when colonic dilation is moderate. We present a 73-year-old man who entered the emergency department complaining of intermitent abdominal pain, rectal bleeding, absence of bowel movements and flatulence, during four days. A CT scan showed a generalized colonic dilation until left lower quadrant. A colo-colonic invagination secondary to an endoluminal lipoma was observed in sigmoid colon. A laparoscopic sigmoidectomy was performed with extracorporeal termino-terminal anastomosis. The postoperative period was uneventful and the patient was discharged from the hospital five days later. A sumbmucous colonic lipoma was diagnosed in the pathological study.

Tratamiento laparoscópico de invaginación en sigma por lipoma submucoso gigante / [Laparoscopic treatment of sigmoid colon intussusception secondary to giant submucosal lipoma].

Colonic lipomas have very low frequency, are usually asymptomatic and diagnosis is made incidentally. Seventy-five per cent of lipomas larger than 4 cm are symptomatic, causing abdominal pain, rectal bleeding, obstruction and exceptionally invagination. The resection of invaginated segment is mandatory in cases with invagination and can be performed by laparoscopy when colonic dilation is moderate. We present a 73-year-old man who entered the emergency department complaining of intermitent abdominal pain, rectal bleeding, absence of bowel movements and flatulence, during four days. A CT scan showed a generalized colonic dilation until left lower quadrant. A colo-colonic invagination secondary to an endoluminal lipoma was observed in sigmoid colon. A laparoscopic sigmoidectomy was performed with extracorporeal termino-terminal anastomosis. The postoperative period was uneventful and the patient was discharged from the hospital five days later. A sumbmucous colonic lipoma was diagnosed in the pathological study.

Eosinophils and mast cells in chronic gastritis: possible implications in carcinogenesis.

Eosinophils and mast cells participate in the immune response against Helicobacter pylori, but their involvement in the gastric precancerous process is unclear. This study aimed to estimate eosinophil and mast cell density in antral mucosa in subjects from 2 Colombian populations with contrasting gastric cancer risks. Gastric mucosa biopsies were collected from 117 adult males (72 from a high-risk area and 45 from a low-risk area). A histopathology score was used to quantify severity of the lesions. Quantitation of eosinophils in hematoxylin-eosin-stained sections and mast cells in immunostained sections for CD117/c-Kit was performed. Helicobacter pylori infection and genotyping were assessed in Steiner stain and polymerase chain reaction, respectively. Logistic regression models and semiparametric cubic smoothing splines were used for analysis of the results. Eosinophil density was significantly higher in subjects from the low-risk area as compared with subjects from the high-risk area. In both populations, eosinophil density increased with the histopathology score in the progression of lesions from normal morphology to multifocal atrophic gastritis. Intestinal metaplasia and dysplasia specimens showed further increase in eosinophil density in the high-risk area but an abrupt decrease in the low-risk area. Mast cell density increased in parallel to the histopathology score in both populations. Our results suggest that eosinophils play a dual role in chronic gastritis. In the low-risk area, elevated eosinophil density represents a T helper 2-biased response that may down-regulate the effects of proinflammatory cytokines preventing cancer development. In contrast, in the high-risk area, eosinophils might promote a T helper 1-type response leading to progression of precancerous lesions.

Helicobacter pylori genotyping and sequencing using paraffin-embedded biopsies from residents of colombian areas with contrasting gastric cancer risks.

BACKGROUND: cagA-positive and vacA s1 and m1 genotypes of Helicobacter pylori are associated with an elevated risk of gastric cancer (GC). We determined these genotypes using paraffin-embedded gastric biopsy specimens harvested from infected individuals and compared genotype distributions in two Colombian populations residing in geographic regions with a high and low incidence of GC. METHODS: DNA from paraffin-embedded gastric biopsies from 107 adults was amplified using primers specific for cagA, for the cag'empty site', for the s and m alleles of vacA, and for H. pylori 16S rRNA. RESULTS: H. pylori infection was detected by molecular assays in 97 (90.7%) biopsies. Complete genotyping of cagA and vacA was achieved in 94 (96.9%) cases. The presence of cagA was detected in 78 of 97 cases (80.4%); when considered separately, cagA and vacA s regions were not significantly associated with a particular geographic area. The vacA m1 allele and s1m1 genotypes were more common in the area of high risk for GC (p = .037 and p = .044, respectively), while the vacA m2 allele and s2m2 genotypes were more prevalent in the low-risk area. The prevalence of the combination of cagA-positive, vacA s1m1 genotypes was 84.3% and 60.5% for high and low risk areas, respectively (p = .011). CONCLUSIONS: H. pylori cagA and vacA genotyping from paraffin-embedded gastric biopsies permitted reliable typability and discrimination. The more virulent cagA-positive s1m1 strains, as well as vacA m1 genotype, were more prevalent in high risk than in low risk areas, which may contribute to the difference in GC risk between those two regions.

Effect of smoking on failure of H. pylori therapy and gastric histology in a high gastric cancer risk area of Colombia.

It has been proposed that eradication of Helicobacter pylori infection is a sound strategy for gastric cancer prevention. Several factors including smoking have been associated to treatment failure rates. This study aimed to evaluate the smoking effect on the efficacy of H. pylori therapy, as well as on the histological parameters in the gastric mucosa from subjects from a high gastric cancer risk area. Two-hundred-sixty-four Colombian subjects with gastric precancerous lesions who participated in a chemoprevention trial, received anti-H. pylori treatment at baseline and had data recorded on cigarette use, were included in this study. A detailed histopathological assessment of the gastric mucosa was performed in biopsies taken before any intervention. H. pylori eradication was assessed in gastric biopsies at 36 months post-treatment. The overall eradication rate was 52.3%; rates of 41.3% and 57.1% were observed for active-smokers and non-smokers, respectively. Multivariate logistic regression analysis showed that smokers had a 2-fold higher probability of failure in Helicobacter pylori eradication than non-smokers (OR: 2.0; 95% CI: 1.01-3.95). At baseline, active-smokers had a higher score of intestinal metaplasia compared to non-smokers. In the corpus mucosa, active-smokers showed lower scores of H. pylori density, total inflammation, neutrophil infiltration, and mucus depletion than non-smokers. In the antrum, no significant differences were observed between active-smokers and non-smokers. In summary, in patients who smoked, H. pylori treatment was less effective. Smoking cessation may benefit H. pylori eradication rates.

Effect of smoking on failure of H. pylori therapy and gastric histology in a high gastric cancer risk area of Colombia / Efecto del tabaquismo en la falla al tratamiento anti-H. pylori y en la histología gástrica en una zona de alto riesgo de cáncer gástrico en Colombia

It has been proposed that eradication of Helicobacter pylori infection is a sound strategy for gastric cancer prevention. Several factors including smoking have been associated to treatment failure rates. This study aimed to evaluate the smoking effect on the efficacy of H. pylori therapy, as well as on the histological parameters in the gastric mucosa from subjects from a high gastric cancer risk area. Two-hundred-sixty-four Colombian subjects with gastric precancerous lesions who participated in a chemoprevention trial, received anti- H. pylori treatment at baseline and had data recorded on cigarette use, were included in this study. A detailed histopathological assessment of the gastric mucosa was performed in biopsies taken before any intervention. H. pylori eradication was assessed in gastric biopsies at 36 months post-treatment. The overall eradication rate was 52.3%; rates of 41.3% and 57.1% were observed for active-smokers and non-smokers, respectively. Multivariate logistic regression analysis showed that smokers had a 2-fold higher probability of failure in Helicobacter pylori eradication than non-smokers (OR: 2.0; 95% CI: 1.01-3.95). At baseline, activesmokers had a higher score of intestinal metaplasia compared to non-smokers. In the corpus mucosa, active-smokers showed lower scores of H. pylori density, total inflammation, neutrophil infiltration, and mucus depletion than non-smokers. In the antrum, no significant differences were observed between active-smokers and non-smokers. In summary, in patients who smoked, H. pylori treatment was less effective. Smoking cessation may benefit H. pylori eradication rates.

La erradicación del Helicobacter pylori ha sido propuesta como medida promisoria en la prevención del cáncer gástrico. Varios factores, incluyendo el tabaquismo, se asocian con la falla del tratamiento. El objetivo de este estudio fue evaluar el efecto del tabaquismo en la eficacia del tratamiento anti-H. pylori y en la histología gástrica en residentes de una zona de alto riesgo de cáncer gástrico. Este estudio incluyó 264 sujetos colombianos con lesiones gástricas preneoplásicas que participaron en un estudio de quimioprevención, recibieron tratamiento anti-H. pylori al ingreso, y proveyeron información sobre tabaquismo. Se realizó un detallado análisis histopatológico en las biopsias colectadas al ingreso. La erradicación de la infección fue evaluada en las biopsias gástricas a los 36 meses post-tratamiento. El porcentaje general de erradicación fue de 52.3%, con proporciones de 41.3% y 57.1% en fumadores activos y no fumadores, respectivamente. El análisis de regresión logística múltiple mostró que el riesgo de presentar falla al tratamiento fue doble en fumadores en comparación con los no fumadores (OR: 2.0; 95% CI: 1.01-3.95). Los fumadores presentaron un mayor índice de metaplasia intestinal comparado con los no fumadores. En la mucosa del cuerpo gástrico los fumadores mostraron menores índices de colonización por H. pylori, inflamación total, infiltración de neutrófilos y depleción de moco que los no fumadores. En el antro no se observaron diferencias significacomtivas entre ambos grupos. En conclusión, el tratamiento anti-H. pylori fue menos efectivo en sujetos fumadores. La cesación del consumo de tabaco puede beneficiar las tasas de erradicación del H. pylori.

Combinacion de fijacion externa e interna en fracturas complejas de platillos tibiales / Combination of internal and external fixation in complex tibial platean fractures

En el Hospital Universitario del Valle, se realizó un estudio observacional tipo serie de casos, con el objetivo de valorar resultados en pacientes con fracturas complejas de platillos tibiales, los cuales fueron manejados con placa lateral, asociada a fijación externa medial. Trece pacientes con un promedio de edad de 41 años (27- 70) fueron tratados con este método. Tres fracturas (20 por ciento) fueron tipo Schatzker V y diez fueron tipo VI (80 por ciento). Seis fracturas fueron expuestas y siete cerradas, presentando todas lesiones importantes de tejidos blandos. Los resultados fueron evaluados de acuerdo a los criterios de Rasmussen, obteniendo 23 por ciento de excelentes resultados, 54 por ciento buenos, 15 por ciento regulares y 8 por ciento malos. Consideramos este método de manejo como una buena alternativa para el manejo de fracturas complejas de platillos tibiales las cuales requieren de fijación medial, pero donde por el grado de lesión a los tejidos blandos, no estarían indicadas osteosíntesis internas masivas, (doble placa)

¿Qué es la nomenclatura anatómica internacional? / What is the international anatomical nomenclature?

En el Quinto Congreso Internacional de Anatomía celebrado en Oxford en el año 1950, se decidió crear un comité internacional de nomenclatura anatómica (I.A.N.C.), con la función expresa de producir una nomenclatura anatómica que fuera aceptable internacionalmente. A partir de esta reunión, se crearon subcomités con participación de las prncipales universidades. La Universidad del Valle tuvo representación en la persona del Dr. Ives Chatain A.

Eficacia y seguridad del enalapril en 1.087 pacientes colombianos

El maleato de enalapril, un inhibidor específico, no sulfidrílico de la enzima convertidora de la angiotensina, fue evaluado en 1.087 pacientes con HTA leve o moderada, en un estudio abierto no comparativo, con dosis de 10 a 40 mg/día por vía oral. Se obtuvo una reducción de las cifras diastólicas por debajo de 90 mm/hg al cabo de 4 semanas en el 75 por ciento, y las cifras tensionales mostraron una disminución promedio de 18 mm/Hg para la diastólica (16.8 por ciento) y 28 mm/Hg para la sistólica (16.4 por ciento). La tolerancia fue considerada entre buena y excelente en el 93 por ciento de los casos y la eficacia global fue buena o excelente en el 91.4 por ciento de los pacientes estudiados. La incidencia de efectos colaterales fue del 5.1 por ciento, siendo los efectos más frecuentes la cefalea, el mareo y las nauseas con un porcentaje del 3.1 por ciento. Se concluye que los datos obtenidos en este estudio estan en concordancia con los reportados en la literatura mundial y que el maleato de enalapril se puede usar con confianza como droga de primer paso en manejo de la HTA leve o moderada

Alteraciones ductulares pancreaticas en alcoholicos / Alterations pancreatic duct in alcoholics

El abuso crónico de alcohol es una causa bien establecida de enfermedad hepática y pancreática. La asociación de cirrosis y pancreatitis crónica alcoholica está menos documentada pero parece haber menos injuria pancreática en daño hepático severo. La causa no se conoce. Pudiera deberse a un cierto grado de protección o a localización de daños por deficiencias enzimáticas a nivel de cada una de estas glandulas. Fue realizado un estudio prospectivo en pacientes con enfermedad hepática alcohólica para evaluar alteraciones ducturales pancreáticas determinadas mediante pancreatografía retrógrada endóscopica (P.C.R.E.); realizándose historia clínica, ultrasonido y biopsia hepática. La pancreatografía fue realizada en todos, y las condiciones de los ductos pancreáticos clasificados como normales y daño, moderado o severo. Se practicó biopsia hepática en 35 paciente , no pudiéndose realizar la misma en 7 debido a ascitis severa o trastornos de coagulación. El resultado de la biopsia hepática demostró la evidencia de alcoholismo severo, reportando cirrosis en 21, hepatitis alcohólica en 4, hígado graso en 6 y normal en 6. En los pacientes con lesiones hepáticas por alcohol (38 pacientes), se logró documentar, mediante P.C.R.E. 10 pacientes con lesiones catalogadas como moderadas (26%). En pacientes con hígado histológicamente normal (6) a pesar de su alcoholismo crónico se documentaron lesiones pancreaticas en 4 de ellos (66%). Estos datos parecen indicar que la enfermedad hepática alcohólicxa severa está asociada con alteraciones pancreáticas relativamente infrecuentes (26%) si se considera el grado de lesion..

Diagnóstico por ultrasonido de enfermedad hepática difusa / Ultrasonography diagnosis is diffuse liver diseases

La evaluación ultrasonográfica del abdomen ha demostrado tener gran utilidad por ser un método no invasivo. A fin de evaluar la efecacia del ultrasonido (US) en el diagnostico de EHD realizamos un estudio prospectivo en pacientes que tenían indicación clínica hepática . El US fue realizado por un observador experimentado, utilizando un equipo marca Simens Sonoline SL. La biopsia hepática usualmente fue tomada bajo control laparoscópico y procesada histológicamente por dos experimentados patólogos sin información del hallazgo ultrasonográfico. Fueron estudiados 47 pacientes, de los cuales la biopsia reportó 27 normales y el US 22 normales, con una efectivad del método del 81.4%; de los 20 pacientes patológicos (EHD no cirrótica y cirrrótica) el US diagnosticó 19,5 falsospositivos y un falso negativo con una sensibilidad = 95%, especificidad = 81%, V.P.P. = 79% y V.P.N. = 95.6%. El US demostró ser un método efectivo, especial;mente si estamos en presencia de hígado normal o cirrótico. Por no ser invasivo y de bajo costo, consideramos que puede ser utilizado por sí solo en aquellos casos donde la biopsia hepática está contraindicada

Estudio anatomoclinico de la arteria dorsal del pie / Anatomoclinic study of the dorsal artery of the foot

Se hizo un estudio sobre la existencia y trayectoria de la arteria dorsal del pie, mediante palpacion clinica del dorso del pie en 2000 pacientes, y por diseccion anatomica bilateral en 40 cadaveres. La palpacion fue negativa solo en 3.6% de los pacientes examinados y en el estudio anatomico 3.48%. Se encontro reemplazo de la arteria por una arteria perforante de la peronea o fibular en 1.6% de los casos y un trayecto aberrante en 0.8%. La presencia de la arteria dorsal del pie tiene importancia clinica, en el sentido de valorar facilmente la circulacion distal del miembro inferior. Debido a la rareza de su falta en el medio nacional (3.6%), dato que va en contra de estadisticas tradicionales, la cateterizacion de esta arteria ofrece un via facil, elegante y segura cuando se requiera dicho procedimiento. Ademas su acceso es mucho mas sencillo y rapido que el de la arteria tibial posterior