Association of Circulating Tumor Cells and Tumor Molecular Profile With Clinical Outcomes in Patients With Previously Untreated Metastatic Colorectal Cancer: A Pooled Analysis of the Phase III VISNÚ-1 and Phase II VISNÚ-2 Randomized Trials.

BACKGROUND: The bCTC count is a well-established prognostic biomarker in mCRC, as well as in other tumor types. The aim of this analysis was to evaluate the prognostic/predictive role of the bCTC count (≥3 vs. <3) in previously untreated mCRC. PATIENTS AND METHODS: The study involved 589 untreated mCRC patients included in the intention-to-treat population of 2 randomized clinical trials (phase III VISNU-1 [NCT01640405] and phase II VISNU-2 [NCT01640444] studies). RESULTS: Of the 589 patients, 349 (59.2%) had bCTC≥3 and 240 (40.7%) had bCTC<3. Multivariate analysis showed that the bCTC count is an independent prognostic factor for overall survival (OS) (HR 0.59, 95% CI 0.48-0.72; P = 0.000) and potential for progression-free survival (PFS) (P = 0.0549). Median OS was 32.9 and 19.5 months in patients with bCTC<3 and bCTC≥3 (P <0.001), respectively. This effect was also observed comparing OS in RASwt patients from both studies. Other prognostic factors were: ECOG-PS, primary tumor site, number of metastatic sites and surgery of the primary tumor. Median OS was lower for patients treated with anti-VEGF versus anti-EGFR (22.3 vs. 33.3 months, P <0.0001) while there were no significant differences in PFS according to the targeted treatment received. CONCLUSION: This post-hoc analysis of 2 randomized studies confirms the poor prognosis of patients with bCTC≥3 but this is not associated with other adverse independent prognostic factors such as RAS/BRAF mutations.

Influence of BRAF and PIK3CA mutations on the efficacy of FOLFIRI plus bevacizumab or cetuximab as first-line therapy in patients with RAS wild-type metastatic colorectal carcinoma and <3 baseline circulating tumour cells: the randomised phase II VISNÚ-2 study.

BACKGROUND: We explored the influence of BRAF and PIK3CA mutational status on the efficacy of bevacizumab or cetuximab plus 5-fluorouracil/leucovorin and irinotecan (FOLFIRI) as first-line therapy in patients with RAS wild-type metastatic colorectal cancer (mCRC). PATIENTS AND METHODS: VISNÚ-2 was a multicentre, randomised, phase II study. Patients with RAS wild-type mCRC and <3 circulating tumour cells/7.5 ml blood were stratified by BRAF/PIK3CA status (wild-type versus mutated) and number of affected organs (1 versus >1), and allocated to bevacizumab (5 mg/kg every 2 weeks) or cetuximab (400 mg/m2 then 250 mg/m2 weekly) plus FOLFIRI [irinotecan 180 mg/m2, leucovorin 400 mg/m2, 5-fluorouracil 400 mg/m2 (bolus) then 2400 mg/m2 (46-h continuous infusion) every 2 weeks]. The primary endpoint was progression-free survival (PFS). All analyses were exploratory. RESULTS: Two hundred and forty patients with BRAF/PIK3CA wild-type (n = 196) or BRAF- and/or PIK3CA-mutated tumours (n = 44) were enrolled. Median PFS was 12.7 and 8.8 months in patients with BRAF/PIK3CA wild-type and BRAF/PIK3CA-mutated tumours, respectively [hazard ratio (HR) = 1.22; 95% confidence interval (CI) 0.80-1.85; P = 0.3602]. In the BRAF- and/or PIK3CA-mutated cohort, median PFS was 2.8, 8.8 and 15.0 months in patients with BRAF/PI3KCA-mutated (n = 8), BRAF-mutated/PI3KCA wild-type (n = 16) and BRAF wild-type/PI3KCA-mutated (n = 20) tumours, respectively (P = 0.0002). PFS was similar with bevacizumab plus FOLFIRI versus cetuximab plus FOLFIRI in BRAF/PIK3CA wild-type (HR = 0.99; 95% CI 0.67-1.45; P = 0.9486) and BRAF/PIK3CA-mutated tumours (HR = 1.11; 95% CI 0.53-2.35; P = 0.7820). The most common grade 3/4 treatment-related adverse events were neutropenia, diarrhoea and asthenia in both treatment groups. CONCLUSIONS: BRAF/PIK3CA status influences outcomes in patients with RAS wild-type mCRC but does not appear to assist with the selection of first-line targeted therapy.

A potential inflammatory role of IL-31 in psoriatic arthritis: A correlation with Th17 cytokine profile.

The goals of our study were to determine the possible association of interleukin (IL)-31 with Th17 cytokine profile in serum and to quantify retinoic acid-related orphan receptor C (RORC) mRNA expression in psoriatic arthritis (PsA) patients. This cross-sectional study was conducted in 50 patients with PsA and 30 control subjects (CS) matched by age and gender. The cytokine serum levels were quantified by magnetic bead-based assay using the Bio-Plex MAGPIX system, and RORC mRNA expression was determined by quantitative polymerase chain reaction (qPCR). As a result, significant differences in IL-31 were observed between study groups (77.23 pg/mL in PsA vs 64.4 pg/mL in CS, P < 0.001) and Th17 cytokine profile serum levels (IL-17A: 6.36 pg/mL in PsA vs 2.97 pg/mL in CS, P = 0.02; IL-17F: 44.15 pg/mL in PsA vs 23.36 pg/mL in PsA, P = 0.01; IL-17E: 3.03 pg/mL in PsA vs 0.82 pg/mL in CS, P < 0.001; IL-21: 36.45 pg/mL in PsA vs 12.44 pg/mL in CS, P = 0.02); however, significant differences were not observed for IL-23 (31.2 pg/mL in PsA vs 53.26 pg/mL in CS, P = 0.58). Furthermore, positive correlations between IL-31 and Th17 cytokine profile serum levels were found (IL-17A: rs = 0.64, P < 0.001; IL-17F: rs = 0.73, P < 0.001; IL-17E: rs = 0.70, P < 0.001; IL-21: rs = 0.54, P = 0.002; IL-23: rs = 0.5, P < 0.01). Regarding RORC gene expression, the PsA group showed an increase of 6.85-fold compared to the CS group. We did not find any association between the serum levels of cytokines and RORC gene expression. In conclusion, in PsA, there are increased serum levels of IL-31, IL-17A, IL-17F, IL-17E, and IL-21, but not IL-23. Moreover, there was a positive correlation of IL-31 with the Th17 cytokine profile and a high RORC gene expression. Altogether, these findings suggest a proinflammatory contribution of IL-31 in close association with the Th17 cytokine profile in PsA.

Temporal and spatial stratification for the estimation of nocturnal long-term noise levels.

Noise pollution in cities is mainly caused by the vehicular traffic but, depending on the place under assessment, it could be affected by the land use. For noise assessment and strategic noise mapping, the night period equivalent level (Lnight), which evaluates sleep disturbance, is one of the requirements of the European Directive 2002/49/EC to be presented for the equivalent time of one year. This research aims to find the influence of the land use in the weekdays stratification to improve the accuracy of the long-term noise level estimation for the night period. It is found that depending on the land use of the place under assessment, the weekdays temporal and spatial stratification could be affected by leisure activities. From a statistical analysis based on a clustering procedure of Lnight samples in 19 points, it is observed that both, temporal and spatial stratification depend on the intensity of the surrounding leisure activity, and not on traffic. Following these stratification criteria, a sampling method is presented that reduces by 47% the number of days needed to estimate the annual levels with respect to random sampling.

Expression of MIF and TNFA in psoriatic arthritis: relationship with Th1/Th2/Th17 cytokine profiles and clinical variables.

Psoriatic arthritis (PsA) is an autoimmune inflammatory disease associated with psoriasis. The cause of this pathology is still unknown, but research suggests the diseases are caused by a deregulated cytokine production. MIF is a cytokine associated with immunomodulation of Th1, Th2, and Th17 cytokine profiles in inflammatory diseases. Based on this knowledge, the aim of this study was to determine the association of MIF and TNFA expression with Th1, Th2, and Th17 cytokine profiles in serum levels of PsA patients. A cross-sectional study was performed in 50 PsA patients and 30 control subjects (CS). The cytokine profiles were quantified by BioPlex MagPix system and the mRNA expression levels by real-time PCR. TNFA mRNA expression was 138.81-folds higher in PsA patients than CS (p < 0.001). Regarding MIF mRNA expression, no significant differences were observed; however, a positive correlation was identified between MIF mRNA expression and PsA time of evolution (r = - 0.53, p = 0.009). An increase of Th1 (IFNγ: PsA = 37.1 pg/mL vs. CS = 17 pg/mL, p < 0.05; TNFα: PsA = 24.6 pg/mL vs. CS = 9.8 pg/mL, p < 0.0001) and Th17 cytokine profiles (IL-17: PsA = 6.4 pg/mL vs. CS = 2.7 pg/mL, p < 0.05; IL-22: PsA = 8.4 pg/mL vs. CS = 1.8 pg/mL, p < 0.001), were found in PsA patients. Th2 cytokines were not significantly different in both groups. In conclusion, a high expression of TNFA mRNA, as well as an increase of Th1 and Th17 cytokine profiles evaluated by IFNγ, TNFα, IL-17, and IL-22 cytokines, was observed in PsA patients.

Annual traffic noise levels estimation based on temporal stratification.

This paper proposes a temporal sampling strategy that increases the accuracy of long-term noise level estimation and allows to establish the estimation error according to the number of sampled days. Days of the week are stratified into working days and weekend days. This research shows how to use measurements of Leq on working days to estimate the corresponding values for weekend days. This is possible because working days have higher noise levels and less variability than weekend days. The improvement in accuracy allows for a reduction in the number of required sampled days compared to taking samples randomly, which would help to reduce the uncertainty in environmental noise assessment. As a reference, to obtain a 90% confidence interval of ±1 dB for Lday, the proposed sampling strategy reduces the required measurement days by more than 38%. For LDEN, the reduction is close to 18% of the total number of days. The proposed strategy could be adapted to different environments by simply changing a few parameters.

Changes in the membrane carbohydrates from sperm cryopreserved with dimethylsulfoxide or polyvinylpyrrolidone of red-tailed hawk (Buteo jamaicencis).

BACKGROUND: That cryopreservation can induce alterations in sperm. OBJECTIVE: The goal of this study was to evaluate sperm quality and distribution of N-acetylglucosamine, sialic acid and mannose residues in sperm cryopreserved of red-tailed hawk (Buteo jamaicensis). MATERIALS AND METHODS: We studied twenty samples of ejaculated semen for each cryoprotectant dimethylsulfoxide or polyvinylpyrrolidone. Carbohydrate identification was carried out with lectins Triticum vulgaris agglutinin to N-acetylglucosamine and sialic acid and Concanavalia ensiformis for mannose residues. Sperm viability was not altered but motility decreased significantly with both crioprotectants compared with fresh sperm. RESULTS: Neither the number of WGA positive sperm nor the distribution of N-acetylglucosamine and/or sialic acid residues were affected by the cryopreservation procedure. The sperm proportion with fluorescence associated with the presence of mannose residues was higher in thawed sperm. CONCLUSION: Values obtained with the cryopreservation technique proposed in this study by freezing drops in liquid nitrogen, were within normal parameters established for good quality fresh semen. We can say that it can be used for assisted reproduction of Buteo jamaicensis.

Mercury in the blue tilapia Oreochromis aureus from a dam located in a mining region of NW Mexico: seasonal variation and percentage weekly intake (PWI).

Uptake of mercury (Hg) through fish consumption is one of the key aspects of the Hg cycle in the aquatic ecosystems. In tropical latitudes, biomonitoring of Hg in freshwater reservoirs is scarce. The objectives of the study were to determine Hg distribution in muscle, liver, and kidney of blue tilapia Oreochromis aureus from a dam located in a mining region of northwest Mexico, to define temporal variations of Hg concentrations in fish collected during the dry and rainy seasons, and to estimate the percentage weekly intake (PWI) of Hg through fish consumption considering the individual weekly intake of fish in Mexico and the provisional tolerable weekly intake of Hg (5 µg kg(-1) body weight). The sequence of Hg concentrations was liver > kidney > muscle during the rainy season and kidney > liver > muscle during the dry season. Levels of Hg were significantly higher (p < 0.001) in muscle (0.36 µg g(-1)) and kidney (0.65 µg g(-1)) of specimens collected during the dry season in comparison to individuals collected during the rainy season; accordingly, average PWI in the dry season (5.41) was higher than in the rainy season (1.80). Though collected fish were adults, Hg levels in the edible portion are not harmful to consumers, even during the dry season that Hg levels were higher.

A retrospective observational study on the safety and efficacy of first-line treatment with bevacizumab combined with FOLFIRI in metastatic colorectal cancer.

BACKGROUND: Combination of bevacizumab and FOLFIRI has currently become one of the standard therapeutic regimens. However, published information is still limited. The objective of the present retrospective observational study is to analyse the response and toxicity of first-line treatment with FOLFIRI+bevacizumab in patients with metastatic colorectal cancer (mCRC). METHODS: Data were collected from patients from nine Spanish sites diagnosed with mCRC, ECOG≤2, whose first treatment for advanced disease was at least three cycles of FOLFIRI+bevacizumab. RESULTS: A total of 95 patients were enrolled into the study: 64.2% males, median age of 59 years (53.2-67.1 years), ECOG=0-1 in 96.9% of patients. The main site of primary tumour was the colon (69.7%), and most metastases occurred in the liver (71.6%). Clinical benefit was detected in 67.4% (57.0-76.6; 95% confidence interval (CI)), with 8.4% of CR and 42.1% of PR. Median TTP was 10.6 months (10.0-11.3; 95% CI), PFS was 10.6 months (9.8-11.3; 95% CI), and OS was 20.7 months (17.1-24.2; 95% CI). Main grade I-II toxicities included haematological toxicity (35.8%), diarrhea (27.3%), mucositis (25.3%), asthenia (19.0%), haemorrhages (11.6%), and emesis (10.6%). Toxicities reaching grades III-IV were haematological toxicity (9.5%), diarrhea (8.5%), mucositis (5.3%), hepatic toxicity (2.1%), asthenia (2.1%), proteinuria (1.1%), emesis (1.1%), pain (1.1%), and colics (1.1%). CONCLUSION: Results of this study support the beneficial effect of adding bevacizumab to FOLFIRI regimen in terms of efficacy and show a favourable tolerability profile.

Time evolution of the second-order nonlinear distribution of poled Infrasil samples during annealing experiments.

The spatial distribution of the second-order nonlinearity induced in thermally poled Infrasil silica samples is recorded after thermal annealing experiments. Two regimes have been studied: short and long poling durations. For short poling durations, the observations are in good agreement with a model where only one ion type recombines inside the depletion region. The nonlinear distribution and erasure observed for the other case are well explained by considering the addition of another positive-charged ion injected during the poling process. This second ion acts as a barrier during thermal annealing and reduces the mobility of the first one.

Colesterolemia en adolescentes sexo femenino de Morelos, México / Plasmatic levels of cholesterol in adolescent females from Morelos, Mexico

Objetivo: Conocer la prevalencia de hipercolesterolemia y factores de riesgo para sobrepeso y obesidad en mujeres adolescentes. Sujetos y método: Estudio transversal en 548 adolescentes. Se determinó la colesterolemia por la técnica de Liebermann-Burchard. Se midieron los índices antropométricos; de peso, talla, circunferencia de cintura y caderas; la ingesta por encuesta de recordatorio de 24 horas; el nivel socioeconómico y los antecedentes familiares. Se realizó un análisis univariado y bivariado (pruebas de hipótesis de Chi2, prueba de t y F). Resultados: La prevalencia de hipercolesterolemia fue de 30.4 por ciento. El peso, el Índice de Masa Corporal (IMC) y las concentraciones de colesterol sanguíneo más altas, se observan en adolescentes con familiares obesos (p<0.05). Fue mayor el consumo de lípidos totales y de ácidos grasos saturados en adolescentes con familiares obesos, diabéticos e hipertensos (p<0.05). Conclusiones: Al observar la tendencia de los datos antropométricos, las concentraciones de colesterol sanguíneo, y/o los antecedentes familiares; se puede concluir que es posible que cuando sean adultas, presenten problemas por sobrepeso u obesidad que aumentarían su riesgo de complicaciones cardiovasculares o presencia de síndrome metabólico.

Objective: The objective of the present study was to know the prevalence of hypercholesterolemia, overweight and obesity as well as, the risk factors in adolescent females. Subjects and method: In a cross - sectional study of 548 adolescents girls plasma level of cholesterol was measured using the Liebermann-Burchard technique. Anthropometrics indexes of weight, height, hip and waist circumferences were investigated. The intake was asses by a 24-hours dietary recall. Survey socioeconomic level and family history were evaluated. An univariate an bivariate statically analysis (chi square (X2), t and F tests) was performed. Results: A prevalence of hypercholesterolemia was found in 30.4 percent of girls. The weight, Body Mass Index (BMI) and the highest levels of blood cholesterol were observed in adolescents with obese relatives (p<0.05). The consumption of total lipids and saturated fatty acids was higher in adolescents with obese, diabetics and hypertensive relatives (p <0.05). Conclusions: According to the anthropometric data and cholesterolemia in adolescent girls with overweight relatives, obesity, diabetes and hypertension it is possible that as adults they may present overweight problems or obesity which will increase their risk for cardiovascular complications or the presence of metabolic syndrome.

Toll-like receptor 4 Asp299Gly polymorphism and rheumatoid arthritis: a replicative study in three different populations

Los polimorfismos de los receptores tipo toll (TLRs) han sidoextensamente estudiados con respecto a la predisposición genéticaa varias enfermedades complejas humanas. En este contexto,el papel del polimorfismo Asp299Gly de TLR4 en la patogénesisde la artritis reumatoide (AR) no está claro. El objetivo del presenteestudio fue comprobar la posible implicación de este polimorfismoen la susceptibilidad a la AR. Genotipamos el polimorfismomediante reacción en cadena de la polimerasa y posterioranálisis de la longitud de fragmentos generados por endonucleasade restricción específica (PCR-RFLP) en tres poblacionesdiferentes de Granada (sur de España), Lugo (norte de España)y Colombia. No encontramos diferencias estadísticamente significativasen la distribución de alelos y genotipos en ninguna delas cohortes a estudio. Nuestros datos, junto a los de otros gruposde investigación, no apoyan un papel relevante del polimorfismoAsp299Gly de TLR4 en la susceptibilidad a la AR

Toll-like receptors (TLRs) polymorphisms have been extensivelystudied with regard to genetic predisposition to severalhuman complex diseases. In this context, the role of TLR4Asp299Gly in the pathogenesis of rheumatoid arthritis (RA) is notclear. The aim of this study was to test the possible implication ofthis polymorphism in the susceptibility to RA. We genotyped bypolymerase chain reaction-restriction fragment length polymorphism(PCR-RFLP) in three different populations from Granada(Southern Spain), Lugo (Northern Spain), and Colombia.We did not find statistically significant differences in the distributionof alleles and genotypes in any of the cohorts under study.Our data, together with those from other groups, do not supporta relevant role of TLR4 Asp299Gly polymorphism in the susceptibilityto RA

Toll-like receptor 4 Asp299Gly polymorphism andrheumatoid arthritis: a replicative study in three different populations

Los polimorfismos de los receptores tipo toll (TLRs) han sido extensamente estudiados con respecto a la predisposición genéticaa varias enfermedades complejas humanas. En este contexto,el papel del polimorfismo Asp299Gly de TLR4 en la patogénesis de la artritis reumatoide (AR) no está claro. El objetivo del presente estudio fue comprobar la posible implicación de este polimorfismo en la susceptibilidad a la AR. Genotipamos el polimorfismo mediante reacción en cadena de la polimerasa y posterior análisis de la longitud de fragmentos generados por endonucleasade restricción específica (PCR-RFLP) en tres poblaciones diferentes de Granada (sur de España), Lugo (norte de España)y Colombia. No encontramos diferencias estadísticamente significativas en la distribución de alelos y genotipos en ninguna de las cohortes a estudio. Nuestros datos, junto a los de otros grupos de investigación, no apoyan un papel relevante del polimorfismo Asp299Gly de TLR4 en la susceptibilidad a la AR (AU)

Toll-like receptors (TLRs) polymorphisms have been extensively studied with regard to genetic predisposition to several human complex diseases. In this context, the role of TLR4Asp299Gly in the pathogenesis of rheumatoid arthritis (RA) is not clear. The aim of this study was to test the possible implication of this polymorphism in the susceptibility to RA. We genotyped by polymerase chain reaction-restriction fragment length polymorphism(PCR-RFLP) in three different populations from Granada(Southern Spain), Lugo (Northern Spain), and Colombia.We did not find statistically significant differences in the distribution of alleles and genotypes in any of the cohorts under study.Our data, together with those from other groups, do not supporta relevant role of TLR4 Asp299Gly polymorphism in the susceptibilityto RA (AU)

Protección social una sombrilla / Social protection... a parasol

El presente artículo hace inicialmente una cordial invitación a asumirlo como un insumo más a la hora de dar la discusión en lo que respecta al montaje del Sistema de Protección Social en Colombia. Plantea el panorama mundial que lleva a proponer al Banco Mundial a través de la OPS/OMS, la formulación de la protección social como la estrategia más poderosa, según ellos, para la reducción de la exclusión social y la injusticia. Describe y analiza las características de la extensión de la protección social en salud y a continuación retoma las principales normas emanadas con dicho fin en Colombia y su aplicación, y en forma simultánea hace el análisis desde el concepto mismo de la protección social en comparación con el de seguridad social, argumentando que se trata de un retroceso conceptual y práctico...

Nitric oxide disrupts VE-cadherin complex in murine microvascular endothelial cells.

Vascular endothelial cadherin (VE-cadherin), which is localized at adherent junctions, is involved in the control of vascular permeability. A growing body of evidence indicates that NO modulates the movement of fluid and proteins out of the vasculature. In this paper, we investigated whether NO can disrupt the VE-cadherin complex. We found that treatment with two NO donors (SIN-1 and SNAP) markedly reduced the amount of VE-cadherin in a murine microvascular endothelial cell line (H5V) as demonstrated by immunoprecipitation analysis, cellular ELISA, and Northern blot analysis. Beta- and gamma-catenins were also found to be affected by the two NO donors. Moreover, the disruption of the complex, induced by NO donors, correlated with increases in vascular permeability using both in vivo and in vitro models. These results clearly demonstrate a role for NO in vascular permeability.

Tumor papilar intraductal mucinoso del páncreas / Intraductal papillary mucinous tumor of the pancreas

Los tumores papilares mucinosos intraductales del pancreas son una identidad rara que comprenden cerca del 1 por ciento de las neoplasias malignas del pancreas. El espectro radiológico que presenta esta enfermedad puede ser bastante amplio. El tratamiento ideal en este tipo de patología sigue siendo la resección quirúrgica con biopsia por congelación intraoperatoria para asegurar márgenes de sección libres de tumor. El pronóstico de este tumor es bastante favorable comparado con cualquier otro tipo de neoplasia pancreática.

Eficacia y seguridad de la Piperacilina - Tazobactam en el tratamiento de la infección intraabdominal en Colombia / Eficacy and security of piperacillin - Tazobactam in the treatment of intraabdominal infection in Colombia

La infeccion intraabdominal (IIA) es un reto para el cirujano. El tratamiento consiste en la combinacion de cirugia, antibioticos y cuidado intensivo. Los antibioticos Beta-3- lactámicos juegan un papel importante en el tratamiento. Las penicilinas tienen un gran potencial de accion y, en combinacion con inhibidores de Beta-lactamasas, su poder se aumenta. El presente estudio se diseñó multicentrico y prospectivo para evaluar la eficacia de la Piperacilina/Tazobactam (Tazocin,) en el tratamiento de la IIA; 40 pacientes fueron incluidos en el estudio y tratados con Piperacilina/Tazobactam (4 g/500 mg) cada 8 horas. Todos los pacientes tuvieron peritonitis, 85 por ciento de ellos por causa de apendicitis gangrenosa perforada. La respuesta clinica favorable ocurrio en 97 por ciento de los casos despues de tratamiento con duracion entre 6 y 14 dias. En 71 aislamientos microbiológicos realizados, prevalecio la flora polimicrobiana. Piperacilina/ Tazobactam tuvo una sensibilidad de 93 por ciento para los germenes aislados aerobicos Gram negativos y Gram positivos asi como para anaerobios. Hubo tres cepas resistentes in vitro en los 71 aislamientos: una cepa de Pseudomonas aeruginosa, una cepa de Klebsiella pneumoniae y otra de Citrobacter freundii. La medicacion fue bien tolerada y sus efectos colaterales nulos.

Use of topical ketanserin for the treatment of ulcers in leprosy patients.

A comparative study was carried out in which 66 leprosy patients with ulcers were randomly divided in two groups of 33 patients each: Group A (experimental group) was treated with ketanserin gel (2%) and group B with clioquinol cream and/or Lassar paste during a three month period. At the end of the study, when ulcer sizes in the two groups were compared, the group treated with topical ketanserin showed superior results (p < 0.001 using Kolmogorov-Smirnov's test). We conclude that the drug is useful as coadjuavant treatment for healing ulcers in these patients.

Surgical management of benign strictures of the biliary tract.

Benign strictures of the biliary tract are difficult to treat surgical complications. Most biliary strictures result from injuries during cholecystectomies, and their initial management is a major determining factor of the long-term outcome. Only surgeons well trained and experienced in their management should treat this entity. The affected patients present various signs and symptoms depending on the time the lesion is detected, and the treatment modality largely depends on such timing. The success of surgical treatment with its attendant low morbidity and mortality makes it the preferred modality over transhepatic image-guided or endoscopic balloon dilatation, with or without the insertion of stents. Surgical treatment is based on three principles: good exposure for internal drainage of the intrahepatic biliary tract, mucosa-to-mucosa anastomosis, and prevention of the risk of reoperation for recurrent stenosis. Roux-en-Y hepaticojejunostomy with a blind subcutaneous jejunal loop seems to comply with these three principles. Transanastomotic stents are not necessary. We have analyzed our experience from 1988 to 1999 with 65 consecutive patients referred to us for biliary reconstruction. We used the Roux-en-Roux-en-Y hepaticojejunostomy with a blind subcutaneous jejunal loop, performed by the same surgical group in all cases.