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.

Desarrollo de una base de datos interrrelacionada para la toma de decisiones clínicas en un servicio de cirugía general / Development of an interrelated datebase for clinical decisión making in a general surgery department

Introducción: Con el fin de obtener datos estructurados para la monitorización y evaluación de indicadores clínicos y de gestión que sirviesen de apoyo en la toma de decisiones clínicas elaboramos una base de datos interrelacionada (BDI) a partir de registros hospitalarios existentes. Material y Métodos: Diseño prospectivo de una cohorte de intervenciones quirúrgicas programadas realizadas en el Servicio de Cirugía General de un hospital universitario de tercer nivel. Se obtuvieron un total de 4.572 registros entre el 1 de enero de 2011 y el 31 de marzo de 2013. A cada registro se le asoció información proporcionada por diferentes bases hospitalarias: Conjunto Mínimo Básico de Datos (CMBD), el sistema de gestión de pacientes (HP-HIS) e información aportada por un cirujano experto como auditor, que estableció el procedimiento principal depurado, deducido del informe quirúrgico y de alta del paciente. Los procedimientos se agruparon en 9 áreas quirúrgicas, y se clasificó su complejidad en tres grados. Resultados y Conclusiones: La BDI permite monitorizar la actividad de un servicio quirúrgico con un elevado volumen de actividad, alta complejidad técnica, gran número de cirujanos, y pacientes con variadas comorbilidades, etc. En un futuro inmediato se pretende evaluar la fiabilidad de los datos analizando el registro del procedimiento principal en HP-HIS y CMBD frente a la Historia Clínica. En una segunda etapa, se realizará la evaluación de diversos indicadores validados, que sirvan, mediante la comparación con los estándares, de apoyo en la toma de decisiones clínicas: eventos adversos, gravedad de estos, evitabilidad, desviaciones de la tendencia, etc

Introduction: In order to obtain structured monitoring and evaluation of clinical and management indicators that would serve to support clinical decision making, we have created an interrelated database (BDI) from existing hospital records. Methods: Prospective cohort of scheduled surgeries performed in the Department of General Surgery of a university hospital. A total of 4,572 records were recorded between January 1, 2011 and March 31, 2013. Each record was linked to information provided by different hospital databases: Minimum Basic Data Set (CMBD), the patient management system (HP-HIS) and information provided by a skilled surgeon as auditor, who established the main refined procedures obtained from the surgical and discharge reports. The procedures were grouped into nine surgical areas and classified into three complexity grades. Results and Conclusions: The BDI allows monitoring the activity of a surgical Department with a high volume of activity, high technical complexity, many surgeons and patients with several comorbidities, etc. In the immediate future, we intend to assess the reliability of the BDI data comparing the record of the main procedure in HP-HIS and CMBD to the medical record. In a second stage, we intend to assess several validated indicators that may serve, through a comparison with the standards, as support in the making of clinical decisions: adverse events, their severity and preventability, deviations from the trend, etc

Fiabilidad de un Base de Datos interrelacionada para la toma de decisiones clínicas en un servicio de cirugía general / Reliability of the records in an interrelated database for clinical decisión making in a general surgery department

Introducción: A partir de una base de datos interrelacionada elaborada con registros de las cirugías programadas del Servicio de Cirugía General de un hospital universitario de tercer nivel, evaluamos la discrepancia en el registro del procedimiento quirúrgico principal en la Historia Clínica (HC) comparándolo con el del Conjunto Mínimo Básico de Datos (CMBD) y el del sistema de gestión de pacientes (HP-HIS). Se elaboraron propuestas de mejora ante las discordancias encontradas. Material y Métodos: Se establecieron 4 grados de menor a mayor discrepancia en el registro (0,1,2,3). Se agruparon los grados en no discrepantes (0 y 1) y discrepantes (2 y 3). Se calculó la frecuencia (n, %) de registros discrepantes para cada procedimiento y área quirúrgica. Se analizó la discrepancia cruzada entre HP-HIS y CMBD. Se identificaron las áreas quirúrgicas con mayor grado de discrepancia. Se evaluó la asociación entre la discrepancia y la complejidad del procedimiento. Resultados: En CMBD las discrepancias (grados 2 y 3) supusieron el 27,7% de los registros y en HP-HIS el 25,2%. Las áreas quirúrgicas con mayor porcentaje de registros discrepantes en CMBD y HP-HIS fueron recto (25,3% y 21,4%) y colon (17,2% y 20,7%). Hubo asociación significativa entre complejidad y discrepancia. Conclusiones: Las áreas quirúrgicas peor registradas fueron colon y recto tanto en HP-HIS como en CMBD. Las IQ más complejas presentaron valores más altos de discrepancia. La deficiente codificación en HP-HIS repercutiría en la información de gestión, y en el CMBD repercutiría en el índice de complejidad del servicio y en el GRD final

Introduction: Using data from an interrelated data base made up of records of scheduled surgeries (IQ) in a General Surgery Department of a university hospital, we evaluated the discrepancy in the main procedure between medical history records (HC), Basic Minimum Data Set (CMBD) and the HP-HIS (patient management system). In addition, we made proposals for improving the discrepancies found. Material and methods: Four degrees of discrepancy were established in the records (0,1,2,3). Grades were grouped into not discrepant (0 and 1) and discrepant (2 and 3). Frequency (n,%) of discrepant records for each procedure and surgical area was calculated. Cross discrepancy between HP-HIS and CMBD was analyzed. Surgical areas with greater discrepancies were identified. The association between the discrepancy and the complexity of the procedure was evaluated. Results. Discrepancies (grades 2 and 3) accounted for 27.7% of the records in CMBD and 25.2% in HP-HIS. Surgical areas with the highest percentage of discrepant records in CMBD and HP-HIS were rectum (25.3% and 21.4%) and colon (17.2% and 20.7%). There was significant association between complexity and discrepancy. Conclusions: The worst registered surgical areas were colon and rectum (both in HP-HIS and MDS). More complex IQ discrepancy showed higher values. A poor coding in HP-HIS would affect management information, and a deficient coding in CMBD would affect both the complexity index of the Department and the final GRD

Monitorización de eventos adversos en un servicio de cirugía general mediante una base de datos interrelacionada / Monitoring of adverse events in a general surgery department by applying an interrelated database

Introducción: La monitorización de los eventos adversos (EA) permite detectar precozmente desviaciones de la práctica clínica, analizar sus causas y proponer medidas para evitarlos. En el servicio de Cirugía General de un hospital universitario de tercer nivel se desarrolló una base de datos interrelacionada (BDI) basada en registros hospitalarios para monitorizar los principales EA observados en las intervenciones quirúrgicas programadas (IQ). Material y métodos: El EA se definió como el registro en la BDI de una o más de las siguientes situaciones: exitus, reintervenciones, reingresos y diversas complicaciones (hemorragia, dehiscencia, evisceración, fístula, peritonitis, absceso, sepsis y otras). No siendo excluyentes. También se registró el grado de complejidad del procedimiento. Se describió la monitorización de los EA en acumulados mensuales. Se calcularon los porcentajes acumulados de EA y exitus respecto del acumulado de IQ consecutivas. Los cálculos se hicieron para todas las IQ y para las más complejas. Resultados: De las 4.572 IQ, 415 presentaron EA (9,08%), con 74 exitus (1,62%). En las 1.819 IQ complejas hubo 311 EA (17,1%), con 60 exitus (3,3%). Todos los EA aumentaron según lo hacía la complejidad quirúrgica (p<0,001). Se elaboraron gráficas de monitorización de la frecuencia acumulada de EA y exitus tanto en las IQ acumuladas cada mes como en las IQ totales desde el inicio de la cohorte. Conclusiones: La monitorización no sólo muestra el número de EA ocurrido durante un periodo de tiempo, sino que permite a los clínicos monitorizar resultados, detectar rápidamente desviaciones e investigar factores desencadenantes para su corrección

Introduction: The monitoring of adverse events (EA) allows early detection of deviations of clinical practice, analyzing their causes and proposing measures for improvement. In the General Surgery Department of a university hospital we developed an interrelated database (BDI) on hospital records to monitor the main EA that resulted from elective surgery (IQ). Material and Methods: The EA was defined as the registering of one or more of the following issues in the BDI: exitus, reoperation, readmission and various complications (bleeding, dehiscence, evisceration, fistula, peritonitis, abscess, sepsis and others). They were not exclusive. The complexity degree of the procedure was also recorded. The EA monitoring of monthly cumulatives was described. The cumulative percentages of EA and exitus regarding consecutive cumulative IQ were calculated. Calculations were made for all IQ and for the most complex ones. Results: EA and exitus were registered in 415 (9,8%) and 64 (1,6%) respectively out of a total of 4,572 IQ. Among 1,819 complex IQ there were 311 EA (17.1%), with 60 exitus (3.3%). The frequency of EA increased as did surgical complexity (p<0.001). We developed graphic monitoring of the accumulated frequency of EA and exitus, both IQ accumulated monthly and total IQ from the start of the cohort. Conclusions: Monitoring not only shows the number of EA that occurred over a period of time, but also allows clinicians to monitor results, to detect deviations early and to investigate triggering factors for their correction

Parada cardiaca relacionada con la anestesia en pediatría. Registro en un hospital infantil terciario / Anesthesia-related cardiac arrest in children. Data from a tertiary referral hospital registry

Objetivos. El objetivo del presente estudio es analizar las paradas cardiacas relacionadas con la anestesia en un hospital infantil terciario, con el fin de identificar factores de riesgo que permitan establecer oportunidades de mejora. Métodos. Estudio retrospectivo de 5 años, sobre las paradas cardiacas relacionadas con la anestesia que ocurrieron en pacientes pediátricos. Se incluyeron todos los procedimientos anestésicos urgentes y electivos realizados por anestesiólogos. Los datos obtenidos incluyeron características del paciente, del procedimiento, la causa probable y la evolución de la parada cardiaca. Se calculó la odds ratio mediante análisis univariante para determinar los factores clínicos asociados a la parada y a la mortalidad. Resultados. Se registraron un total de 15 paradas cardiacas relacionadas con la anestesia en 43.391 procedimientos anestésicos (3,4 por 10.000), con incidencia en niños ASA I-II frente ASA ≥ III de 0,28 y 19,27 por 10.000, respectivamente. Los principales factores de riesgo fueron niños con estado físico ASA ≥ III (p < 0,001), menores de un mes (p < 0,001), menores de un año (p < 0,001), procedimientos urgentes (p < 0,01), procedimientos cardiológicos (p < 0,001) y procedimientos del laboratorio de hemodinamia (p < 0,05). Las principales causas del paro cardiaco fueron cardiovasculares (53,3%), debidas principalmente a hipovolemia, seguidas de causas respiratorias (20%) y por efectos adversos de la medicación (20%). La incidencia de mortalidad y lesión neurológica secundaria a la parada en las primeras 24 h fue de 0,92 y 1,38 por 10.000, respectivamente. La mortalidad en los primeros 3 meses fue de 1,6 por 10.000. Las principales causas de mortalidad fueron ASA ≥ III, edad menor de un año, hipertensión arterial pulmonar, paradas en áreas alejadas del área quirúrgica, duración de la reanimación cardiopulmonar mayor de 20 min y cuando no se aplicó hipotermia tras la parada. Conclusión. Los principales factores de riesgo para la parada cardiaca fueron ASA ≥ III, edad menor de un año, procedimientos urgentes, cardiológicos y los realizados en el laboratorio de hemodinamia. La causa principal de la parada fue cardiovascular, debida principalmente a hipovolemia. Todos los pacientes que fallecieron o tuvieron lesión neurológica eran ASA ≥ III. La hipertensión arterial pulmonar conlleva riesgo de mortalidad relacionada con la anestesia (AU)

[Anesthesia-related cardiac arrest in children. Data from a tertiary referral hospital registry]. / Parada cardiaca relacionada con la anestesia en pediatría. Registro en un hospital infantil terciario.

OBJECTIVES: The aim of this study is to analyze the cardiac arrests related to anesthesia in a tertiary children's hospital, in order to identify risk factors that would lead to opportunities for improvement. METHODS: A 5-year retrospective study was conducted on anesthesia related cardiac arrest occurring in pediatric patients. All urgent and elective anesthetic procedures performed by anesthesiologists were included. Data collected included patient characteristics, the procedure, the probable cause, and outcome of the cardiac arrest. Odds ratio was calculated by univariate analysis to determine the clinical factors associated with cardiac arrest and mortality. RESULTS: There were a total of 15 cardiac arrests related to anesthesia in 43,391 anesthetic procedures (3.4 per 10,000), with an incidence in children with ASA I-II versus ASA≥III of 0.28 and 19.27 per 10,000, respectively. The main risk factors were children ASA≥III (P<.001), less than one month old (P<.001), less than one year old (P<.001), emergency procedures (P<.01), cardiac procedures (P<.001) and procedures performed in the catheterization laboratory (P<.05). The main causes of cardiac arrest were cardiovascular (53.3%), mainly due to hypovolemia, and cardiovascular depression associated with induction of anesthesia, followed by respiratory causes (20%), and medication causes (20%). The incidence of mortality and neurological injury within the first 24h after the cardiac arrest was 0.92 and 1.38 per 10,000, respectively. The mortality in the first 3 months was 1.6 per 10,000. The main causes of death were ASA≥III, age under one year, pulmonary arterial hypertension, cardiac arrest in areas remote from the surgery area, a duration of cardiopulmonary resuscitation over 20min, and when hypothermia was not applied after cardiac arrest. CONCLUSION: The main risk factors for cardiac arrest were ASA≥III, age under one year, emergency procedures, cardiology procedures and procedures performed in the catheterization laboratory. The main cause of the cardiac arrest was due mainly to cardiovascular hypovolemia. All patients who died or had neurological injury were ASA≥III. Pulmonary arterial hypertension is a risk of anesthesia-related mortality.

Perspectives from Spanish infectious diseases professionals on 2009 A (H1N1) influenza: the third half.

The first influenza pandemic in more than 40 years was declared in 2009. We aimed to evaluate the beliefs of Spanish infectious diseases professionals regarding several aspects of 2009 A (H1N1) influenza once the epidemic waned. An online survey was designed and distributed among members of the Spanish Society of Infectious Diseases and Clinical Microbiology (SEIMC). The survey considered hospital organization and preparedness planning and conduct, as well as the opinion of the infectious diseases professionals regarding several key issues. Between 7 March and 22 March 2010, 303 responses, corresponding to 12.8% of the SEIMC membership, were received. Of the respondents, 48.2% were microbiologists and 42.3% were clinicians dealing with infectious diseases. Forty-one per cent of respondents did not believe that 2009 A (H1N1) influenza had a more severe presentation than other seasonal influenzas. Only 5% fully agreed that 2009 A (H1N1) influenza had a more severe presentation. Influenza planning was available in 69.7% of represented institutions before the arrival of 2009 A (H1N1) influenza, and was considered to be useful, to different extents, by most professionals. In most institutions (88.3%), a multidisciplinary team was created to coordinate local pandemic influenza actions. The most successful protocols were those provided by regional healthcare authorities, followed by those from the CDC. The most problematic issues regarding 2009 A (H1N1) influenza were the management of patients in the emergency room and the vaccination and awareness of healthcare professionals (HCPs) regarding infection control. Microbiological diagnosis and the availability of antivirals were the least problematic areas. Although the majority of surveyed infectious diseases professionals did not believe that 2009 A (H1N1) influenza had an especially severe presentation, most of them agreed with the way that this epidemic was managed in their institutions.

[Evaluation of a clinical pathway for septic arthritis]. / Evaluación de una vía clínica de artritis séptica.

INTRODUCTION: Clinical pathways are tools that coordinate clinical work, reducing interclinican variability and improving patient care and management. The use of clinical pathways in septic arthritis is appropriate, as this disease has a predictable course and there is considerable variation in its management. The aim of this study was to evaluate a septic arthritis clinical pathway 2 years after its introduction and to describe the characteristics of the patients included. MATERIAL AND METHODS: Clinical pathway documents: pathway matrix sheet, variance form, parent information sheet, satisfaction survey and evaluation indicators sheet. RESULTS: Thirty-five patients were included, seven with a definitive diagnosis of septic arthritis and 28 with probable septic arthritis. No differences were found between the two groups, with good outcomes in both. Laboratory analyses were performed at admission in all patients, at discharge in 51 %, and at the end of treatment in 97 %. The indicators that best met the standard were clinical pathway coverage, performance of arthrocentesis/arthrotomy, and satisfaction with dealings with staff and the information received. The indicators furthest from the standard were admission shorter than 7 days (77 % vs > 95 %) and obtaining articular fluid prior to antibiotic therapy (76 % vs > 90 %). CONCLUSIONS: The clinical pathway is useful for standardizing the process of septic arthritis diagnosis and treatment. With adequate clinical support, application of this pathway allows decisions to be made on hospital discharge following the clinical criteria of improvement without worsening prognosis. Our immediate challenges are to reduce inpatient stay and to obtain synovial fluid before starting antibiotic therapy.

Evaluación de una vía clínica de artritis séptica / Evaluation of a clinical pathway for septic arthritis

Introducción. Una vía clínica es una herramienta que coordina la labor asistencial, disminuyendo la variabilidad entre profesionales, al tiempo que mejora la atención a los pacientes y la gestión. La artritis séptica es candidata a ser abordada mediante una vía clínica porque su evolución es predecible y existe gran diversidad en el manejo. El objetivo del trabajo es evaluar una vía clínica tras 2 años de implantación y describir las características de los pacientes que fueron incluidos. Material y métodos. Documentación de la vía: matriz, hoja de variaciones, hoja informativa, encuesta de satisfacción e indicadores de evaluación. Resultados. Se incluyeron 35 pacientes, siete artritis sépticas seguras y 28 probables. No hubo diferencias entre los 2 grupos, siendo su evolución favorable. Se practicó analítica al ingreso a todos los pacientes, al alta hospitalaria al 51 % y al alta definitiva al 97 %. Los mejores indicadores de evaluación fueron la cobertura de la vía, la realización de artrocentesis/artrotomía y la satisfacción en el trato o información recibidos y los indicadores más alejados del estándar fueron la hospitalización menor de 7 días (77 % frente a > 95 %) y la obtención de líquido articular sin antibióticos (76 % frente a > 90 %). Conclusiones. La vía clínica resulta útil para estandarizar el proceso de diagnóstico y tratamiento de la artritis séptica. Su aplicación con un soporte clínico adecuado permite decidir el alta hospitalaria siguiendo los criterios clínicos de mejoría, sin que por ello empeore el pronóstico. Optimizar el tiempo de hospitalización y conseguir líquido articular antes de iniciar el tratamiento antibiótico son nuestros retos inmediatos

Introduction. Clinical pathways are tools that coordinate clinical work, reducing interclinican variability and improving patient care and management. The use of clinical pathways in septic arthritis is appropriate, as this disease has a predictable course and there is considerable variation in its management. The aim of this study was to evaluate a septic arthritis clinical pathway 2 years after its introduction and to describe the characteristics of the patients included. Material and methods. Clinical pathway documents: pathway matrix sheet, variance form, parent information sheet, satisfaction survey and evaluation indicators sheet. Results. Thirty-five patients were included, seven with a definitive diagnosis of septic arthritis and 28 with probable septic arthritis. No differences were found between the two groups, with good outcomes in both. Laboratory analyses were performed at admission in all patients, at discharge in 51 %, and at the end of treatment in 97 %. The indicators that best met the standard were clinical pathway coverage, performance of arthrocentesis/arthrotomy, and satisfaction with dealings with staff and the information received. The indicators furthest from the standard were admission shorter than 7 days (77 % vs > 95 %) and obtaining articular fluid prior to antibiotic therapy (76 % vs > 90 %). Conclusions. The clinical pathway is useful for standardizing the process of septic arthritis diagnosis and treatment. With adequate clinical support, application of this pathway allows decisions to be made on hospital discharge following the clinical criteria of improvement without worsening prognosis. Our immediate challenges are to reduce inpatient stay and to obtain synovial fluid before starting antibiotic therapy

[Experimental study of the expression of the bladder wall proteins in bladder outlet obstruction in the rabbit]. / Estudio experimental de la expresión de las proteínas de la pared vesical en la obstrucción del tracto urinario inferior en el conejo.

OBJECTIVES: To determine the relationship of the bladder wall levels of the contractile proteins: whole actin, beta-actin, alpha-sarcomeric-actina caldesmon and of the Heat Stress Protein HSP-70, with the partial bladder outlet obstruction. MATERIAL AND METHODS: It was carried out an experimental study on 43 New-Zealand rabbits. These animals were divided into a control group and six experimental groups with partial bladder outlet obstruction induced by an incomplete tie around the urethra. The experimental groups were defined according the day when the animals were sacrified: at 24 hours, 7 days, 15 days, 1 month, 3 months and 6 months of the obstruction. It was determined in all animals the muscular bladder wall concentration of whole actin, beta-actin, alpha-sarcomeric-actin, caldesmon and HSP-70 protein, according to Western Blotting technique. The results were analyzed by means of ANOVA, using the Scheffe post hoc method. RESULTS: The bladder weight of the obstructed animals increased significantly in two stages: until the day 15 and between the day 15 and the end of the study, corresponding to theoretical phases of initial hypertrophy and compensation. The level of whole actin showed a significant decrease at the beginning of compensation phase, while the beta-actin level increased in the phase of initial hypertrophy and the alpha-sarcomeric-actin level increased at the end of the compensation phase, while the caldesmon and the HSP-70 made it at the end of the initial hypertrophy phase. CONCLUSIONS: Analysing our data we conclued that the determination of the caldesmon levels is the marker that better adjusts to the changes associated with partial bladder outlet obstruction in the rabbit.

Estudio experimental de la expresión de las proteínas de la pared vesical en la obstrucción del tracto urinario inferior en el conejo / Experimental study of the expression of the bladder wall proteins in bladder outlet obstruction in the rabbit

OBJETIVOS: Determinar la relación de los niveles tisulares de las proteínas contráctiles: actina total, beta-actina, alfa-actina sarcomérica y caldesmón y de la "Heat Stress Protein" HSP-70, con la obstrucción parcial del tracto urinario inferior. MATERIAL Y MÉTODOS: Se realizó un estudio experimental en 43 conejos machos neozelandeses que fueron divididos en un grupo control y seis grupos experimentales a los que se les realizó obstrucción parcial del tracto urinario inferior mediante ligadura de la uretra. Los grupos experimentales se definieron por el día del sacrificio de los animales que tuvo lugar a las 24 horas, 7 días, 15 días, 1 mes, 3 meses y 6 meses de la obstrucción. En todos los animales se determinó la concentración en la pared de la capa muscular de actina total, beta-actina, alfa-actina sarcomérica, caldesmón y HSP-70, mediante antisueros y electroforesis según la técnica del "Western Blotting". Los resultados fueron analizados mediante ANOVA, utilizando el test de contraste a posteriori de Scheffe. RESULTADOS: El peso de las vejigas de los animales obstruidos aumentó significativamente en dos etapas: hasta el día 15, y entre el día 15 y el final del estudio, correspondiendo a las fases de hipertrofia inicial y compensación, respectivamente. El nivel total de actina mostró una disminución significativa al inicio de la fase de compensación, mientras que la beta-actina aumentó en la fase de hipertrofia inicial, y la alfa-actina sarcomérica al final de la fase de compensación, mientras que el caldesmón y la HSP-70 lo hicieron al final de la fase de hipertrofia inicial. CONCLUSIONES: Del análisis de datos se deduce que la determinación de los niveles de caldesmón es el marcador que mejor se ajusta a los cambios asociados a la obstrucción parcial del tracto urinario inferior en el conejo (AU)

OBJECTIVES: To determine the relationship of the bladder wall levels of the contractile proteins: whole actin, beta-actin, alpha-sarcomeric-actina caldesmon and of the Heat Stress Protein HSP-70, with the partial bladder outlet obstruction. MATERIAL AND METHODS: It was carried out an experimental study on 43 New-Zealand rabbits. These animals were divided into a control group and six experimental groups with partial bladder outlet obstruction induced by an incomplete tie around the urethra. The experimental groups were defined according the day when the animals were sacrified: at 24 hours, 7 days, 15 days, 1 month, 3 months and 6 months of the obstruction. It was determined in all animals the muscular bladder wall concentration of whole actin, beta-actin, alpha-sarcomeric-actin, caldesmon and HSP-70 protein, according to Western Blotting technique. The results were analyzed by means of ANOVA, using the Scheffe post hoc method. RESULTS: The bladder weight of the obstructed animals increased significantly in two stages: until the day 15 and between the day 15 and the end of the study, corresponding to theoretical phases of initial hypertrophy and compensation. The level of whole actin showed a significant decrease at the beginning of compensation phase, while the beta-actin level increased in the phase of initial hypertrophy and the alpha-sarcomeric-actin level increased at the end of the compensation phase, while the caldesmon and the HSP-70 made it at the end of the initial hypertrophy phase. CONCLUSIONS: Analysing our data we conclued that the determination of the caldesmon levels is the marker that better adjusts to the changes associated with partial bladder outlet obstruction in the rabbit (AU)

[Usefulness of PSA-complex in the diagnosis of prostatic carcinoma]. / Utilidad del PSA-complex en el diagnóstico del carcinoma de próstata.

OBJECTIVE: Since its discovery as a marker for prostate cancer, there have been many attempts to enhance the diagnostic efficacy of the prostate specific antigen (PSA). Among these are the studies that analyze the behavior of different forms of serum PSA bound to different antiproteases, such as alpha-1-antichymotrypsin, which forms the complexed PSA (PSA-c). This study analyzed the utility of PSA-c to enhance specificity without altering sensitivity in comparison to total PSA (PSA-t). METHODS: From September 1998 to March 1999, blood samples were obtained from 96 patients that had undergone a prostate biopsy due to a suspicion of prostate cancer. PSA-c, PSA-t (Technicon Immunol system, Bayer) and PSA-c/PSA-t ratio were analyzed in these patients. RESULTS: ROC curves were plotted and the optimal cutoffs were found for which the specificity was higher for PSA-c (44.6% [CI 95%, 32-57]) versus PSA-t (35.4% [CI 95%, 25-49]) and the PSA-c/PSA-t ratio (38.5% [CI 95%, 27-51]) while maintaining a similar sensitivity index (90%). PSA-c showed similar results for other values of sensitivity. CONCLUSIONS: PSA-c was found to improve specificity in comparison to PSA-t and PSA-c/PSA-t ratio. PSA-c determination could avoid unnecessary biopsies without altering sensitivity; i.e., the same number of prostate cancers will be detected.