Transición y transferencia del adolescente con infección por VIH / Transition and transference of adolescents living with hiv/ aids from the pediatric hospital to a general hospital of adults in Jujuy

INTRODUCCIÓN El desarrollo de nuevas opciones terapéuticas para el manejo de la infección por VIH mejoró la sobrevida de los niños con infección perinatal. A partir de estos avances, los equipos de salud deben pensar en mecanismos y estrategias para lograr que los adolescentes que ya cumplieron la edad límite de atención en el hospital pediátrico obtengan una correcta transición y transferencia a un hospital de adultos. OBJETIVOS Describir y analizar la relación entre los mecanismos de transición/transferencia y su influencia en la salud y calidad de vida de los adolescentes que viven con VIH o sida en la provincia de Jujuy. MÉTODOS Se efectuó un estudio exploratorio descriptivo de corte transversal. Se integró una metodología cualitativa y cuantitativa para la recolección de datos con adolescentes infectados con VIH, junto con entrevistas en profundidad a actores clave y padres/tutores. RESULTADOS En los siete casos estudiados pudo detectarse que los múltiples factores que se constituyen como obstaculizadores/favorecedores en el proceso de transición y transferencia inciden en la discontinuidad/continuidad del seguimiento y tratamiento y, por ende, en la salud de los adolescentes que viven con VIH/ sida. El rol que ocupa la familia en el acompañamiento es determinante para el éxito o fracaso de la transición y transferencia. Los problemas y situaciones cotidianas propias del ser adolescente son los grandes olvidados de los equipos de salud. DISCUSIÓN Para mejorar la calidad de atención de los adolescentes que viven con VIH/ sida, es fundamental trabajar desde una mirada integral e integradora de los procesos de transición y transferencia. Los resultados de esta investigación plantean la necesidad de tomar una decisión intra e interinstitucional, a fin de generar dispositivos que le permitan al adolescente tener mejores oportunidades de salud.

MEG-SIM: a web portal for testing MEG analysis methods using realistic simulated and empirical data.

MEG and EEG measure electrophysiological activity in the brain with exquisite temporal resolution. Because of this unique strength relative to noninvasive hemodynamic-based measures (fMRI, PET), the complementary nature of hemodynamic and electrophysiological techniques is becoming more widely recognized (e.g., Human Connectome Project). However, the available analysis methods for solving the inverse problem for MEG and EEG have not been compared and standardized to the extent that they have for fMRI/PET. A number of factors, including the non-uniqueness of the solution to the inverse problem for MEG/EEG, have led to multiple analysis techniques which have not been tested on consistent datasets, making direct comparisons of techniques challenging (or impossible). Since each of the methods is known to have their own set of strengths and weaknesses, it would be beneficial to quantify them. Toward this end, we are announcing the establishment of a website containing an extensive series of realistic simulated data for testing purposes ( http://cobre.mrn.org/megsim/ ). Here, we present: 1) a brief overview of the basic types of inverse procedures; 2) the rationale and description of the testbed created; and 3) cases emphasizing functional connectivity (e.g., oscillatory activity) suitable for a wide assortment of analyses including independent component analysis (ICA), Granger Causality/Directed transfer function, and single-trial analysis.

Different strategies for auditory word recognition in healthy versus normal aging.

To explore the effects of commonly encountered pathology on auditory recognition strategies in elderly participants, magnetoencephalographic (MEG) brain activation patterns and performance were examined in 30 elderly [18 controls and 12 elderly with mild cognitive impairment (MCI) or probable Alzheimer's disease (AD)]. It was predicted that participants with known pathology would reveal different networks of brain activation, compared to healthy elderly, which should correlate with poorer performance. Participants heard a list of words representing common objects, twice. After 20 minutes a list of new and old words was presented and participants judged whether each word was heard earlier. MEG responses were analyzed using a semiautomated source modeling procedure. A cluster analysis using all subjects' MEG sources revealed three dominant patterns of activity which correlated with IQ and task performance. The highest performing group revealed activity in premotor, anterior temporal, and superior parietal lobes with little contribution from prefrontal cortex. Performance and brain activation patterns were also compared for individuals with or without abnormalities such as white matter hyperintensities and/or volume reduction evidenced on their MRIs. Memory performance and activation patterns for individuals with white matter hyperintensities resembled the group of MCI/AD patients. These results emphasize the following: (1) general pathology correlates with cognitive decline and (2) full characterization of the health of elderly participants is important in studies of normal aging since random samples from the elderly population are apt to include individuals with subclinical pathology that can affect cognitive performance.

Comparison of the efficacy and safety of a novel meloxicam ophthalmic formulation with a reference diclofenac solution in cataract surgery.

A novel topical ophthalmic formulation of the preferential COX-2 inhibitor meloxicam has recently been developed. The purpose of the present study was to evaluate the efficacy and safety of this novel 0.03% meloxicam solution with regard to a reference 0.1% diclofenac formulation in a prospective, parallel, randomized, multicenter, double-blind study. Two groups of patients submitted to phacoemulsification with intraocular lens implantation were formed. Patients in one group were treated with meloxicam and those in the other group with diclofenac. Dosing was 1 drop t.i.d. for 30 days, beginning the first day after surgery, for both treatments. Inflammation was assessed by the presence of cells in the anterior chamber, anterior chamber flare, ciliary flush, photophobia and pain. Both treatments significantly reduced these indicators. Topical meloxicam and diclofenac produced a similar degree of burning sensation and conjunctival hyperemia. There was no significant difference between treatments in any of the measured parameters. It is concluded that the novel meloxicam solution is effective and safe. Meloxicam, however, did not offer any significant benefit over the diclofenac formulation in patients submitted to cataract surgery.

Effects of an ophthalmic formulation of meloxicam on COX-2 expression, PGE2 release, and cytokine expression in a model of acute ocular inflammation.

AIM: To determine the efficacy of meloxicam ophthalmic formulation on COX-2 activity and expression, inflammation-related cytokines expression and inflammation in an ocular inflammation model. METHODS: Ocular inflammation was induced in New Zealand rabbits by topical application of croton oil (3%) for 3 h. An ophthalmic solution of 0.03% meloxicam, 0.1% sodium diclofenac or vehicle (Sophisen) was administered every 4 h. Conjunctiva, cornea, aqueous humour and vitreous humour were collected. RESULTS: In irritated eyes, 72 h of meloxicam treatment downregulated COX-2 expression and activity (mRNA by RT-PCR and PGE2 levels by ELISA, respectively) in a time-dependent manner and reduced inflammation. Meanwhile, diclofenac failed to reduce COX-2 mRNA or PGE2 to basal levels after 7 days of treatment. Meloxicam treatment downregulated IL-6 and IFN-gamma expression in the conjunctiva and IL-1beta and TNF-alpha expression in the cornea. Diclofenac failed to modify these cytokines in both tissues. Meloxicam treatment increased the expression of IL-6 in conjunctiva, and IL-10 in cornea, while diclofenac had no effect on these cytokines. CONCLUSION: Meloxicam treatment was more efficient than diclofenac in downregulating the expression and activity of COX-2, reducing inflammation, and modifying the inflammatory-related cytokines.

Intra-operative parathyroid hormone monitoring in patients with parathyroid cancer.

BACKGROUND: Intra-operative parathyroid hormone (PTH) monitoring (IPM) is 97% accurate in predicting postoperative eucalcemia in sporadic primary hyperparathyroidism (SPHPT). However, its usefulness in parathyroid cancer has not been demonstrated. This study reports IPM accuracy during surgical resections for parathyroid cancer. METHODS: Eight of 556 consecutive patients with SPHPT underwent parathyroidectomy using IPM and had parathyroid cancer. Operative success was defined as eucalcemia > six months and operative failure/persistent cancer as hypercalcemia within six months of parathyroidectomy. The IPM criterion for operative success was defined as a >50% decrease of peripheral PTH levels from the highest either pre-incision or pre-excision values, 10 minutes after resection. RESULTS: In eight patients, 11 operations were performed. Ten operations (91%) resulted in >50% intra-operative PTH decrease. However, in only seven (70%) of these resections, eucalcemia was achieved for >6 months with five of these seven (71%) procedures being initial en bloc resections. The remaining 3/10 (30%) operations with >50% intra-operative PTH decrease resulted in operative failures. In the last operation, intraoperative parathormone monitoring (IPM) correctly predicted operative failure. IPM sensitivity, specificity, positive predictive value, negative predictive value, and overall accuracy in predicting outcome were 100, 40, 70, 100, and 75%, respectively. CONCLUSIONS: IPM with the criterion of >50% PTH drop from the highest level is less accurate in predicting operative success in parathyroid cancer when compared to SPHPT. A >50% intra-operative PTH level decrease in patients with parathyroid cancer, particularly in reoperative cases, is less predictive of complete resection. The initial recognition of this disease followed by proper resection remains essential in the treatment of parathyroid cancer.

Trombosis en el infarto agudo del miocardio en hospitales chilenos: la experiencia del grupo GEMI / Thrombolysis in the acute myocardial infarction in chilean hospitals: the gemi group experience

Antecedentes: La trombolisis es uno de los métodos de reperfusión coronaria que permite reducir la mortalidad del infarto agudo del miocardio (IAM). Lamentablemente no todos los pacientes con indicación de trombolítico reciben el tratamiento. Objetivo: Evaluar los cambios en el empleo de trombolíticos a través del tiempo en pacientes con IAM y supradesnivel ST y analizar las variaciones en mortalidad según el período de registro. Método: Se compara la información de tres registros efectuados los años 93-95 (R1), 97-98 (R2), y los pacientes incluidos en el año 2001 del registro GEMI actualmente en curso (R3), en el que participan 23 hospitales de Santiago y regiones. Se recolecto información sobre latencia en administración del trombolítico, motivo de la no utilización y evolución intrahospitalaria de los pacientes que ingresaron con el diagnóstico de IAM Q o con supradesnivel ST (SDST). Resultados: En R1 se recolectaron 2.155 pacientes con IAM y SDST, en R2: 1.436 pacientes y en R3: 789 pacientes. El porcentaje que recibió trombolíticos fue de 37,8 por ciento, 41,4 por ciento y 45,1 por ciento, respectivamente. La mortalidad global en cada uno de los registros fue de R1: 11,2 por ciento, R2: 9,9 por ciento y R3: 8,9 por ciento ( p para tendencias: NS). Cuando se analiza según sexo, la mortalidad en hombres fue de 8,1 por ciento 7,4 por ciento y 7,1 por ciento (p para tendencias: NS). En mujeres estas proporciones fueron 23,6 por ciento 19,2 por ciento y 14,8 por ciento, respectivamente (p para tendencias: <0,05). El motivo de no uso trombolítico, dato consignado en R2 y R3, se debió a: ingreso tardío (45 por ciento y 38 por ciento respectivamente), contraindicación (9,5 y 12,5), no disponibilidad de él (1,5 por ciento y 0,23 por ciento). En el resto de los pacientes se consignó como “otro” el motivo de no uso. (De este análisis se excluyeron los pacientes sometidos a angioplastia primaria). Se observa un aumento en la proporción de pacientes sometidos a trombosis, asociado a una reducción en la mortalidad global en ellos. Conclusión: La reducción de la mortalidad en mujeres es determinante en la mejoría del pronóstico intrahospitalario en la población de trombolisados. Estos hallazgos pueden reflejar una mejor indicación y oportunidad del empleo de trombolíticos, así como de los fármacos de eficacia demostrada para el tratamiento de IAM con SDST...

Latin american experience with two low-dose oral contraceptives containing 30 microg ethinylestradiol/75 microg gestodene and 20 microg ethinylestradiol/150 microg desogestrel.

The objective of this study was to compare cycle control, efficacy and tolerance of an oral contraceptive containing 20 microg ethinylestradiol and 150 microg desogestrel with a preparation containing 30 microg ethinylestradiol combined with 75 microg gestodene. This study involved 342 women and 4104 cycles use in Argentina, Brazil, Chile, and Mexico. Contraceptive efficacy was good with both formulations. Two pregnancies occurred in the desogestrel group but were not due to method failure. With respect to cycle control, the incidence of intermenstrual bleeding was higher during the first 3 cycles in the desogestrel group; it was significant (p <0.01) during the first 3 days of the cycle for a normal or heavy bleeding only in the Mexican group. Amenorrhea was not reported for any group, but the incidence of dysmenorrhea was significantly higher (p <0.01) in the Brazilian desogestrel group (13.8%) and was significantly lower (p <0.01) in the Mexican gestodene group (8.5%). Adverse events were similar in all the countries with headache, breast tension, and nausea, the most frequently reported symptoms. The range of mean increase in body weight varied from 0.2 kg in the Argentine group to 2.6 kg in the Chilean group (95% confidence limit, +/- 2.51) in the gestodene group, and 0.2 kg in the Argentine group to 2.5 kg in Brazilian group (95% confidence limit, +/- 2.36) in the desogestrel group. Fifteen women discontinued because of headache, but there were no significant differences between the groups regarding discontinuation for this and other medical or non-medical reasons. Both oral contraceptive preparations are reliable and well tolerated, and both have favorable effects on control cycle.

Frequency of isolation of Campylobacter from roasted chicken samples from Mexico City.

The presence of Campylobacter spp. was investigated in 100 samples of roasted chicken tacos sold in well-established commercial outlets and semisettled street stands in Mexico City. From 600 colonies displaying Campylobacter morphology only 123 isolates were positive. From these isolates, 51 (41%) were identified as C. jejuni, 23 (19%) as C. coli, and 49 (40%) as other species of this genus. All of the 27 positive samples came from one location where handling practices allowed cross-contamination of the cooked product. The results indicate that these ready-to-consume products are contaminated with these bacteria, representing a potential risk for consumers, especially in establishments lacking adequate sanitary measures to prevent cross-contamination.

La esclerosis en placas en el Perú / Sclerotic plaques in Peru: a more common condition than it classically used to be?

Entre 1993 y 1998 hemos estudiado 91 casos de esclerosis en placas (EM). Su diagnóstico ha sido hecho siguiendo los criterios clínicos de Poser y los criterios de resonancia magnética de Paty, Asbury y Herndon. Todos ellos fueron estudiados por uno de los presentadores en el Instituto Nacional de Ciencias Neurológicas "J.O. Trelles" y en RESOMASA. La enfermedad predomina, como es clásico considerar, en el sexo femenino, comenzó en la mayoría de nuestros sujetos entre los 20 y los 40 años y la mayoría de las formas fueron del tipo remisión recaídas. Todos nuestros pacientes son de origen europeo o mayoritariamente europeo hasta donde es posible evaluar por el aspecto fenotípico y por sus apellidos. La mayoría proviene de la costa, sobre todo de Lima y alrededores. No hemos encontrado, hasta el momento, ningún paciente de origen amerindio. Concluimos que la esclerosis múltiple no es una enfermedad rara en el Perú como se creía clásicamente e invocamos a iniciar un estudio epidemiológico multicéntrico para determinar con certeza las características epidemiológicas de la enfermedad.

A colorimetric-enzymatic microassay for the quantitation of antibody-dependent complement activation.

In this report we describe a reliable, sensitive, safe, and easy way to assess antibody-dependent complement-mediated hemolysis. The assay is based on the quantitation of hemoglobin (Hb) released from lysed erythrocytes indirectly, through the generation of fluorene blue, a compound formed from 2-7 diaminofluorene in an enzymatic reaction catalyzed by the Hb molecule. The fact that Hb is the most abundant protein within a mature RBC (approximately 10(11) molecules per cell) and possesses pseudoperoxidase activity, makes the fluorene blue-coupled assay more sensitive than the simple estimation of Hb adsorption at 410 nm (Soret adsorption maxima of Hb), and as sensitive and reliable as its radioactive equivalent based on the release of 51Cr from previously loaded RBCs. Using this assay chimeric mouse-human anti-dansyl antibodies, comprising all the human IgG isotypes, were tested for their ability to mediate complement activation. The results obtained agreed with previously reported data, confirming that the fluorene blue-coupled assay is reliable. This assay also has significant advantages over the radioactive-based assay in that the reagents used are inexpensive, and the concerns of using radioactivity and the associated hazards are obviated. Because there is no need for loading the target cells with the analyte to be detected since RBCs are already loaded with Hb, the fluorene blue-coupled assay is simpler and eliminates many steps in comparison to the 51Cr release based assay.

[Efficacy and tolerance of a five day course of ciprofloxacin in the treatment of urinary tract infection in women. Multicenter study]. / Eficacia y tolerancia de ciprofloxacina por 5 días en mujeres con infección urinaria. Estudio multicéntrico.

BACKGROUND: There is no consensus about the ideal antimicrobial agent and duration of treatment for urinary tract infection in women. AIM: To assess the efficacy of a five days course of ciprofloxacin for the treatment of urinary tract infection in women. PATIENTS AND METHODS: Women with urinary tract infection were treated with ciprofloxacin (Baycip, Bayer) 250 mg bid during 5 days. Patients were evaluated three to four days after treatment start, two to seven days and one month after treatment end. RESULTS: Of 101 eligible women, 96 aged 18 to 65 years old, coming from three major Chilean cities, participated in the study and 80 completed the follow up period. There was a 95% clinical success, 2.5% partial improvement and 2.5% treatment failure. The causal microorganism was erradicated in 90% of cases, in 1.2% treatment failed and in 8.7% a re-infection occurred. Adverse effects attributable to the drug were observed in 12 patients (headache in 3, gastrointestinal disturbances in 8, somnolence in 1 and irritability in 1). CONCLUSIONS: Ciprofloxacin is an useful antimicrobial for the treatment of lower urinary tract infection in women.

Effects of Ajoene on lymphocyte and macrophage membrane-dependent functions.

Ajoene, (E, Z) -4, 5, 9-trithiadeca-1, 6, 11-triene 9 oxide, is a compound originally isolated from ethanolic extracts of garlic that impairs platelet aggregation by inhibiting the functional exposure of platelet integrins GPIIb/IIIa. In vitro, Ajoene is toxic for several tumoral cell lines, and exert an antiproliferative effect on T. cruzi and murine malaria parasites. Here we show that Ajoene strongly inhibited the proliferation induced in human lymphocytes by the mitogens phytohemagglutinin (PHA), phorbol myristate acetate (PMA) and anti-CD3, and the capping formation induced in B lymphocytes by anti-IgM antibodies. On macrophages, Ajoene was also found to partially inhibit the lypopolysaccharide-induced production of Tumor Necrosis Factor (TNF), and to decrease the phagocytic activity of thioglycolate-elicited mouse peritoneal macrophages for IgG-opsonized, human erythrocytes. Ajoene also partially prevented the lytic effect of human and rabbit TNF on Actinomycin D-treated WEHI 164 cells. These results strongly suggest that Ajoene is a potent modulator of membrane-dependent functions of immune cells.

Anti-CD69 antibodies enhance phorbol-dependent glucose metabolism and Ca2+ levels in human thymocytes. Antagonist effect of cyclosporin A.

The human activation antigen CD69 is an early inducible surface glycoprotein acquired by T cells in the thymus at the stage of positive selection and during activation of mature lymphoid cells both in vivo and in vitro. We have studied the regulatory influence of CD69 activation pathway on the glycolytic process and transduction signals of thymocytes. Treatment of human thymocytes with different anti-CD69 monoclonal antibodies (mAbs), in the presence of submitogenic doses of phorbol ester, produced an enhanced release of lactate without significant alterations in Fru 2,6-P2 levels or phosphofructokinase-2 (PFK-2) and pyruvate kinase activities. A small increase in phosphofructokinase-1 (PFK-1) activity was also detected. Furthermore, anti-CD69 mAb increased the glucose detritiation from [2-3H] and [3-3H]glucose, thus indicating an enhanced flux through hexokinase and PFK-1 steps. In addition, de novo synthesis of diacylglycerol and intracellular Ca2+ levels increased after anti-CD69 mAb treatment. The stimulatory effects of anti-CD69 mAb on both glycolysis and Ca2+ levels were inhibited by cyclosporin A. Because CD69 molecules are present in certain subset populations of immature thymocytes, the ability of anti-CD69 mAb to stimulate the glycolysis, the synthesis of diacylglycerol and the intracellular Ca2+ levels suggest that the activation signals delivered through CD69 molecules could play a role in the thymus cells maturation.

Colecistectomía laparoscópica / Laparoscopic cholecistectomy

El presente trabajo tiene como objetivo el presentar un procedimiento de técnica quirúrgica nuevo en nuestro medio, además de una estadística de los resultados obtenidos por el grupo de trabajo, sobre 91 pacientes cuyas edades flutúaban entre 14 y 84 años, 72 mujeres y 19 varones. Se operaron colecistitis crónicas reagudizadas y agudas, no se registró mortalidad y la morbilidad fue muy similar a las de las realizadas por laparotomía. Estamos seguros que este procedimiento no sólo favorece el postoperatorio del paciente, sino que es una técnica más fácil y los costos son tambiem más bajos.

Enhancement of Antigen-specific functional responses by neutrophils from allergic patients.

It has been demonstrated that neutrophils from healthy donors or from patients with inflammatory disorders can bind immunoglobulin (Ig) E proteins through binding to Mac-2/epsilon bp. Functional responses to allergens were assessed by measuring the respiratory burst and intracellular Ca2+ levels, and binding of allergens to neutrophils was assessed by flow cytometry analysis and fluorescence microscopy. In this article, we demonstrate that neutrophils sensitized to specific allergens (from allergic patients), but not from healthy donors, are sensitive to allergens of the same type as those that produce clinical allergic symptoms. The activation of neutrophils was analyzed by the induction of a respiratory burst that was detected with luminol-dependent chemiluminescence. Intracellular Ca2+ levels increased parallel to those of the inducing allergens. In addition, the specific binding of allergens on the cell surface was revealed by flow cytometry and allergen-FITC-labeled staining analyses. The present data suggest a restricted recognition of allergen by sensitive neutrophils, probably associated with the specific binding of the allergen to its corresponding IgE molecule, which is bound to the Mac-2/epsilon bp structure. These findings demonstrate a functional role of allergen-associated neutrophils during the allergic state.

Streptozotocin-induced diabetes increases fructose 2,6-biphosphate levels and glucose metabolism in thymus lymphocytes.

Acute effect of streptozotocin-induced diabetes on several parameters of glucose metabolism was investigated in thymus lymphocytes (thymocytes). The cells from diabetics rats accumulated in vitro about 2-fold more fructose 2,6-bisphosphate (Fru-2, 6-P2) in the presence of increasing glucose concentration than cells from normal rats. An increased production of lactate was also observed. Phosphofructokinase-1 (PFK-1) and phosphofructokinase-2 (PFK-2) activities were enhanced in cells from diabetic rats compared with those from normal rats. [U-14C]glucose incorporation into glycogen was also increased in cells from diabetic rats and the 14CO2 liberation was lesser than in cells from normal animals. From these data it may be concluded that the response of thymocytes to streptozotocin-induced diabetes is similar to that observed in other extrahepatic tissues.

Iron overload augments the development of atherosclerotic lesions in rabbits.

Iron, a major oxidant in vivo, could be involved in atherosclerosis through the induction of the formation of oxidized LDL, a major atherogenic factor. This study was designed to test this hypothesis experimentally. Four groups of New Zealand White rabbits were included: iron-overloaded/hypercholesterolemic (group A, n = 8), iron-overloaded (group B, n = 6), hypercholesterolemic (group C, n = 6), and untreated (group D, n = 6). Iron overload was achieved by the intramuscular administration of 1.5 g of iron dextran divided in 30 doses. Hypercholesterolemia was produced by feeding rabbit chow enriched with 0.5% (wt/wt) cholesterol. Serum iron, ferritin, cholesterol, triglycerides, and lipoperoxides in serum were measured throughout the study. Lipoperoxides were measured at the end of the study in liver, aorta, and spleen homogenates. Aortas of groups A and C had multiple lesions; however, group A had greater lesional involvement than group C (P < .05). Lesions were not observed in rabbits fed normal chow (group D). As expected, serum iron and ferritin were above normal levels in groups A and B. Serum cholesterol increased in groups A and C. Lipoperoxides in liver and spleen homogenates of iron-overloaded rabbits were increased. Interestingly, iron deposits were seen by ultrastructural studies in the arterial walls of rabbits in groups A and B. Our study suggests that iron overload augments the formation of atherosclerotic lesions in hypercholesterolemic rabbits.

ABO-haemolytic disease of the newborn (ABO-HDN): factors influencing its severity and incidence in Venezuela.

The objective of this study was to determine the incidence of the Haemolytic Disease of the Newborn due to ABO blood group incompatibility (ABO-HDN) in the population of Caracas attending the Maternity Hospital 'Concepción Palacios'. The relationship between A and B antigens density of cord blood erythrocytes and the cytotoxic activity of antibodies in mothers' sera with the severity of the haemolytic disease, was also studied. From a sample of 245 blood group 'O' mothers, 68 gave birth to full term 'A' or 'B' blood group infants. The evolution of serum bilirubin and the routine haematological values, were followed in all the babies during 72 h after birth, allowing the diagnosis of ABO-HDN in 21 infants. Taking into account that in Venezuela the frequency of blood group 'O' is 59 per cent, it was concluded that in the general population of newborns, 16 per cent present foeto-maternal ABO incompatibility, and the incidence of ABO-HDN was near to 5 per cent. The density of the 'A' and 'B' antigens in cord red cells was studied using an immunoenzymatic assay. No statistically significant association between antigen maturity and severity of the ABO-HDN could be shown. A positive association was found between cytotoxic capacity of mothers' sera and development of ABO-HDN (P < 0.05). Twenty ABO incompatibles children presented moderate late anaemia at 3 weeks of age.

Perspectivas futuras de diagnostico y tratamiento del cancer colorectal / Future perspectives for diagnosis and treatment of colorectal cancer

Han ocurrido avances importantes en el cancer colorrectal. Se ha reconocido como un posible problema epidemiologico. El valor del rastreo y la deteccion temprana es obvio. La predisposicion genetica ha sido bien identificada y la intensidad de la investigacion de los biomarcadores, continua con enorme exito en algunas areas. Un abordaje multidisciplinario del tratamiento de los tumores primarios y la participacion de los pacientes en la decision de la variedad terapeutica debe implicar mejoria en la calidad de vida. La investigacion de un agente quimioterapeutico continuara, particularmente, en los estadios avanzados. Finalmente, el cirujano debe participar activamente en proporcionar mejor calidad de vida a los pacientes como ha sido ejemplificado en cuanto al hecho de mejorar el dolor. El lograr detecciones tempranas implica mayor numero de pacientes curables, inclusive con cirugias menos extensas y aun respetando el esfinter anal. El refinamiento de la estadificacion y el desarrollo de terapias adyuvantes pueden darnos un punto de vista cautelosamente optimista en el futuro del cancer colorrectal.