In vitro antiviral activity against rotavirus and astrovirus infection exerted by substances obtained from Achyrocline bogotensis (Kunth) DC. (Compositae).

BACKGROUND: Achyrocline bogotensis has been traditionally used to treat infections of skin, respiratory, tract urinary and other infections, but not to treat viral gastrointestinal disease. In this study, this Colombian native medicinal plant was investigated by its in vitro anti-rotavirus and anti-astrovirus activity. METHODS: Several extracts and fractions phytochemically obtained from A. bogotensis were evaluated initially for their cell toxicity on MA104 and Caco2 cells and then for their anti-rotavirus (RRV) and anti-astrovirus (Yuc8) activity following three strategies: pre-treatment of cells (blocking effect), direct viral activity (virucidal effect) and post-treatment of infected cells (reduction of viral yield post-infection). In addition qualitative chemical studies were developed for the active compounds. RESULTS: Non-toxic concentrations of a fraction obtained exhibited antiviral activity against both viruses characterized by a virucidal effect and by the reduction of the infectious particles produced post-infection. Steroids, sterols, terpenes, phenols, flavonoids and sesquiterpenlactones were identified qualitatively in the active fraction. CONCLUSIONS: A. bogotensis contains substances with in vitro antiviral activity against rotavirus and astrovirus. This study confirms their anti-microbial properties and describes by the first time its antiviral activity in vitro.

Simultaneous surgery for corneal edema and aphakia: DSEK and placement of a retropupillary iris claw lens.

PURPOSE: The aim was to report the surgical outcomes of simultaneous Descemet stripping endothelial keratoplasty (DSEK) with a retropupillary fixated iris claw lens in patients with aphakic corneal edema without capsular support. METHODS: The clinical records of aphakic patients with corneal edema and no capsular support who underwent a combined DSEK and implantation of a retropupillary fixated iris claw lens (Artisan) were evaluated. Presurgical and postsurgical best-corrected visual acuity, postsurgical refraction, and endothelial cell count were analyzed at the first and sixth months after the surgery and were imaged with anterior segment ultrasound biomicroscopy. RESULTS: A total of 9 eyes from 7 females and 2 males were analyzed. The average age was 72.1 years. The mean duration of the postoperative follow-up was 7.7 months. All the patients achieved corrected visual acuities over 0.60 logarithm of the minimum angle of resolution. There was no significant variation in the endothelial count between the first and sixth months. Astigmatism >1 D was induced in all the patients, with 7 patients having against the rule, and 2 patients having oblique astigmatism. CONCLUSIONS: DSEK combined with a retropupillary fixated iris claw lens was shown to be a safe surgical technique in patients with aphakia without capsular support and corneal swelling. This surgery resulted in stable endothelial cell counts during the first 6 months after the surgery and an improvement in visual acuity.

[Occult breast cancer: Report of two cases]. / Cancer de mama oculto: dos casos clínicos analizados según el concepto actual.

Occult breast cancer is expressed as a metastatic axillary lymph node without clinical or imaging evidence of a primary tumor in the breast. The old concept involved non palpable tumors. Its incidence is low, representing only 0.3 to 1% of all breast cancer cases. The search for the primary tumors is performed with mammography, whose sensitivity is low, ranging from 0 to 56%. Several studies have shown a higher sensitivity of magnetic resonance imaging, ranging from 85 to 100%, to detect occult lesions. The treatment of isolated axillary metastases of breast cancer is controversial. An axillary dissection is recommended. If there is a suspicious image, a radiosurgical or stereotaxic biopsy should be done. However, in patients without radiological lesions in the breast, the tendency is not to perform a radical mastectomy as previously recommended, since the primary tumor will not be found in the surgical specimen in two thirds of cases. A superior and external quadrantectomy or exclusive radiotherapy should suffice. An expecting behavior is not recommended as a therapeutic alternative. Treatment should be complemented with hormonal therapy or chemotherapy. The literature suggests that prognosis is better than stage II, with a ten years survival ranging from 50 to 71%. We report two patients with a well defined occult breast cancer and based on them, a review of the subject is attempted. Considering its prognosis, physicians should be aware of this uncommon and difficult to diagnose disease.

Cancer de mama oculto: dos casos clínicos analizados según el concepto actual / Occult breast cancer: Report of two cases

Occult breast cancer is expressed as a metastatic axillary lymph node without clinical or imaging evidence of a primary tumor in the breast. The old concept involved non palpable tumors. Its incidence is low, representing only 0.3 to 1 percent of all breast cancer cases. The search for the primary tumors is performed with mammography, whose sensitivity is low, ranging from 0 to 56 percent. Several studies have shown a higher sensitivity of magnetic resonance imaging, ranging from 85 to 100 percent, to detect occult lesions. The treatment of isolated axillary metastases of breast cancer is controversial. An axillary dissection is recommended. If there is a suspicious image, a radiosurgical or stereotaxic biopsy should be done. However, in patients without radiological lesions in the breast, the tendency is not to perform a radical mastectomy as previously recommended, since the primary tumor will not be found in the surgical specimen in two thirds of cases. A superior and external quadrantectomy or exclusive radiotherapy should suffice. An expecting behavior is not recommended as a therapeutic alternative. Treatment should be complemented with hormonal therapy or chemotherapy. The literature suggests that prognosis is better than stage II, with a ten years survival ranging from 50 to 71 percent. We report two patients with a well defined occult breast cancer and based on them, a review of the subject is attempted. Considering its prognosis, physicians should be aware of this uncommon and difficult to diagnose disease.

Biopsia del ganglio centinela axilar en cáncer de mama: ¿estamos en condiciones de validar el método? / Axillary sentinel lymph node biopsy in breast cancer: are we in conditions for validate this method?

Se presentan los resultados de 59 pacientes con cáncer de mama en etapa in situ, I y II con axila clínicamente negativa, en las cuales se efectuó el procedimiento biopsia de ganglio centinela axilar (GC) entre febrero del 2000 y julio de 2002. El objetivo de este estudio es analizar la experiencia recogida con este grupo de pacientes enfatizando las fallas del método y estableciendo sus posibles causas, comparándolas con otras casuísticas, como forma de validación de este método de etapificación axilar. En 59 pacientes se intentó la biopsia de ganglio centinela axilar con la técnica de colorante isosulfan azul inyectado directamente en el sitio de la tumorrectomía. En 4 pacientes se asoció linfocintigrafía con tecnecio 99-dextrán y uso de gammacámara intraoperatoria para el mapeo linfático y biopsia de ganglio (técnica mixta). En 7 de los 59 pacientes no se encontró ganglio teñido (11,9 por ciento). En los 57 casos de cáncer infiltrante se efectuó disección axilar estándar, sólo 14 tuvieron compromiso histológico por tumor (24,5 por ciento). En los 41 pacientes que el ganglio centinela fue histológicamente negativo en 2 se pesquisó compromiso tumoral en el resto de la axila (falso negativo). Se propone un protocolo para optimizar la técnica del mapeo linfático y biopsia de ganglio centinela axilar para reemplazar la disección axilar estándard en la etapificación del cáncer de mama.

Biopsia del ganglio centinela axilar en cancer de mama: ¿podemos reproducir la experiencia extranjera y validar el metodo?

Se presentan los resultados de 90 pacientes con cáncer de mama en etapa in situ, I y II con axila clínicamente negativa, en las cuales se efectuó el procedimiento biopsia de ganglio centinela axilar (GC) entre febrero del 2000 y marzo del 2003. El objetivo de este estudio prospectivo es comparar la tasa de detección del ganglio centinela con el colorante Isosulfan azul (Lymphazurin 1%) y medir la especificidad y sensibilidad de la técnica con la disección axilar estándar de los niveles I y II de Berg. En 90 pacientes se intentó la biopsia de ganglio centinela axilar con la técnica de colorante Isosulfan azul inyectado directamente en el sitio de la tumorectomía o en el plexo peri areolar de Sappey. En 12 de los 90 pacientes no se encontró ganglio teñido (13%). De los 90 casos, 85 correspondían a cáncer infiltrante y 5 CDIS extenso con microinvasión. En todos se efectuó disección axilar estándar, solo en 22 de los 85 cánceres infiltrantes se encontró compromiso histológico por tumor (36%). No se pesquiso compromiso axilar en ninguno de los 5 CDIS. En los 56 pacientes que el ganglio centinela fue histológicamente negativo en 3 había compromiso tumoral en el resto de la axila (falso negativo). Concluimos que esta técnica pude ser reproducida a nivel nacional con los beneficios que conlleva el no realizar disección axilar estándar a todas las pacientes con cáncer de mama operable.

Biopsia de mama guiada por ultrasonido: cirugía mínimamente invasiva / Breast biopsy with ultrasound guide: minimally invasive surgery

Se presentan los resultados de biopsias de mama guiadas con ultrasonido utilizando el sistema percutáneo Mammotome en 50 pacientes con 55 lesiones. Los hallazgos histológicos correspondieron a fibroadenoma en el 65,4 por ciento, cambios fibroquísticos en el 20 por ciento, y papiloma en el 3,7 por ciento. En cinco pacientes se encontró una lesión maligna. El seguimiento con ecografía a los 6 meses se ha hecho hasta ahora en 14 pacientes sin cambio con respecto al diagnóstico histológico. Complicaciones no hubo, excepto un hematoma en paciente con daño hepático grave, que no fue necesario drenar. Las principales indicaciones para este tipo de biopsia son nódulos sólidos cuya etiología se requiera precisar, microcalcificaciones sospechosas visibles en ecografía, adenopatía axilar y sospecha ecográfica de recidiva local

[Causes and mortality of intestinal obstruction in the elderly]. / Causas y mortalidad de la obstrucción intestinal en el anciano.

OBJECTIVE: To determine the etiology, clinical symptom, evolution, and results of management of small bowel obstruction (SBO) in our geriatric patients. BACKGROUND: SBO is one of the first etiologies of surgical emergency procedures in the elderly with mortality at 20-40%. It is believed that etiology of these obstructions is due to the abdominal hernia adherence and oncologic problems. METHOD: In all patients older than 65 year of age, no traumatic, attending the emergency room of our General Surgery Service from December 1996 to June 1998, data concerning symptomatology and surgical finding were collected. RESULTS: In 104 surgical elderly emergency patients, 40 cases was operated on by BO. The first cause was inguinal and umbilical hernia (35%). The first symptom was hypertympanism and radiological data. Mortality was 37% conditioned by metabolic and pneumonic problems. CONCLUSIONS: The abdominal hernias were the firth etiology from SBO. We recommended immediate surgery and preoperative correction of the additional diseases.

Extra-adrenal pheochromocytoma

We have presented our experience in the diagnosis and management of three patients with extra-adrenal pheochromocytomas. Only two had hypertension, although all three had increased catecholamine production. The third patient was normotensive preoperatively and remained normotensive after the immediate postoperative period. Two patients are alive and without evidence of disease, the third patient died from what was considered to be a malignant pheochromocytoma. All three patients presented with palpable masses, confirmed by computerized tomography

Extra-adrenal pheochromocytoma.

We have presented our experience in the diagnosis and management of three patients with extra-adrenal pheochromocytomas. Only two had hypertension, although all three had increased catecholamine production. The third patient was normotensive preoperatively and remained normotensive after the immediate postoperative period. Two patients are alive and without evidence of disease, the third patient died from what was considered to be a malignant pheochromocytoma. All three patients presented with palpable masses, confirmed by computerized tomography.

Hypertension secondary to adrenal tumors ten years experience

We have presented our ten years experience in the surgical management of adrenal tumors. Patients presenting with hypertension (9) are normotensive following the removal of the offending adrenal tumor. One patient had an extra-adrenal pheochromocytoma, one had a huge organized adrenal hematoma and one patient has a non-functional tumor. The diagnosis and management of endocrine tumors is a challenge to the clinician

Hypertension secondary to adrenal tumors ten years experience.

We have presented our ten years experience in the surgical management of adrenal tumors. Patients presenting with hypertension (9) are normotensive following the removal of the offending adrenal tumor. One patient had an extra-adrenal pheochromocytoma, one had a huge organized adrenal hematoma and one patient has a non-functional tumor. The diagnosis and management of endocrine tumors is a challenge to the clinician.

Nefrectomía laparoscópica por hidronefrosis: presentación de 1 caso y revisión del tema / Laparoscopic nephrectomy for the treatment of hydronephrosis: case presentation and subject review

Se presenta 1 caso de reseccion completa de un riñon hidronefrotico gigante mediante acceso laparoscopico en una mujer de 28 años con una estenosis pieloureteral izquierda y atrofia renal severa. La evolucion posquirurgica fue excelente.

Nefrectomia laparoscopica por hidronefrosis / Laparoscopic nephrectomy for hydrophrenosis

Se presenta un caso de resección completa de un riñon hídronefrótico gigante usando abordaje laparoscópico en una mujer de 28 años con una estenosis pieloureteral izquierda y atrofia renal severa. La evolución post-quirúrgica fue excelente

[Thoughts on the spatial distribution of population]. / Reflexiones sobre la distribucion territorial de la poblacion.

PIP: Preliminary results of Mexico's 1990 census indicate that during the past decade population distribution in Puebla followed the traditional Mexican pattern of concentration and dispersion. 10 of Puebla's 217 municipios had over 50,000 inhabitants and were home to 43.6% of the state's population on 8% of its territory. The municipios of the city of Puebla contained over 25% of the state population. 74 municipios had 10,000-40,000 inhabitants, or 42% of the population on 51% of the territory. The 133 municipios with populations under 10,000 contained 14% of the state population on 41% of its territory. The demographic growth of the state is clearly related to that of the capital. The city of Puebla absorbed 11% of the state population in 1940, 15% in 1960, and 26% in 1991. Its population of 1,054,921 in 1990 was much higher than that of the next largest city, Tehuacan, with 155,174. The Puebla metropolitan zone covers 1340 sq km and includes 16 municipios, 10 in the state of Puebla and 6 in Tlaxcala. 1980 statistics show that the metropolitan zone concentrated 37.5% of the state's industrial establishments, 50% of industrial capital investment, and 58% of industrial manpower, and generated 53% of crude industrial production. About 1/4 of immigrants to the state live in the city of Puebla. 65% of migrants are aged 15-49 years, vs. 49% of the native population. 44% of the native population but only 13% the immigrant population is aged under 15 years. 31% of migrants were aged 15-24 years when they moved to Puebla. A considerably higher proportion of migrants than natives to the city of Puebla are in consensual unions. Most migrant to Puebla come from nearby states: Veracruz, Tlaxcala, Oaxaca, and recently Mexico City. Slightly over 1/3 of nonnatives in the city of Puebla are from Puebla state. Inmigrants are evenly divided between those of rural and urban origin, but those of urban origin travelled farther to the city. Women predominated among rural migrants to the city in all age groups, especially in the 15-19 cohort. A large proportion of the migrants were more highly educated than the average city dweller. The average rate of growth of the working age population in the city was 6% from 1970-80, implying a need for 35,000 new jobs annually. But in 1980-90, only 10,000 new jobs were added each year. The relative importance of tertiary sector employment has increased significantly. A review of the population characteristics and spatial distribution of the city and state of Puebla strongly suggests that decentralization should be vigorously pursued as a means of improving the wellbeing of the population.^ieng

Carcinoide apendicular / Carcinoid tumors of the appendix

En un período de 5 años (1980-1985) se efectuaron 833 apendicectomías encontrándose en 78 pacientes un tumor carcinoide del apendice, representando una incidencia de 0,8%. Se analiza el cuadro clínico, incluyendo estudio anatomo-patológico y discutiéndose el tratamiento quirúrgico realizado, enfatizando que la apendicectomía es suficiente. En algunos casos, las características del tumor y el compromiso ganglionar regional, hacen aconsejable complementarla con una hemicolectomía derecha. El pronóstico es bueno y su asociación con un síndrome carcinoide es poco frecuente

Biliary ileus: managment of the patology

Se presenta la experiencia en el tratamiento de 18 pacientes portadores de íleo biliar, haciendo énfasis en el criterio utilizado para manejar la enfermedad biliar. La serie no tiene mortalidad. Sólo en una oportunidad, fue necesario asociar cirugía biliar simultánea a la enterolitotomía, por una ictericia obstructiva debido a coledocolitiasis. Dos pacientes presentaron recidiva del IB dentro de 2 meses del postoperatorio de la enterolitotomía. No hubo otras complicaciones postoperatorias debidas a la enfermedad biliar, dado que 10 pacientes fueron colecistectomizados en un promedio de 6 meses posterior a la crisis de íleo biliar. Existe coletitiasis en 1/3 de los pacientes con íleo biliar, y coledocolitiasis en 27%. Se recomienda efectuar sólo la ELT durante la crisis de íleo biliar. Los pacientes portadores de colelitiasis, patología coledociana y fístula biliodigestiva deben ser operados de la VB meses depués. Pacientes de edad avanzada, con vesícula atrófica sin cálculos y en ausencia de coledocolitiasis, no tienen indicación de operación biliar secundaria