Comparison of open gastrectomy and the laparoscopic procedure in advanced gastric cancer. / Comparación de gastrectomía abierta frente a laparoscópica en cáncer gástrico avanzado.

INTRODUCTION AND AIM: Gastric cancer is one of the most frequent neoplasias in Peru and worldwide, with surgery as the only potentially curative or palliative treatment. Laparoscopic gastrectomy is the most frequent alternative surgical technique utilized, but one of its main drawbacks is the technical difficulty involved in perigastric lymphadenectomy. The aim of the present study was to evaluate the clinical and surgical characteristics, postoperative complications, and survival rate in patients with advanced gastric cancer that underwent open gastrectomy or laparoscopic gastrectomy at the Hospital Nacional P.N.P "Luis N. Sáenz" in Lima, Peru, within the time frame of 2005 to 2014. MATERIALS AND METHODS: An analytic, longitudinal, retrospective cohort study was conducted on 482 patients that underwent surgery for gastric cancer, within the time frame of January 2005 to December 2014. The clinical, epidemiologic, and postoperative characteristics were evaluated, and a survival analysis was carried out. RESULTS: Of the 475 patients included in the study, 236 underwent open gastrectomy and 239 had laparoscopic gastrectomy. Median follow-up time was 61.9 months in the open surgery group and 46.7 months in the laparoscopy group. There were fewer postoperative complications in the laparoscopy group and no statistically significant difference between the two groups in relation to the survival analysis. CONCLUSIONS: In our study, laparoscopic gastrectomy resulted in fewer postoperative complications, compared with the open procedure, but did not modify overall survival during the follow-up period.

Surgery and trauma care providers' perception of the impact of dual-practice employment on quality of care provided in an Andean country.

BACKGROUND: Dual-practice, simultaneous employment by healthcare workers in the public and private sectors is pervasive worldwide. Although an estimated 30 per cent of the global burden of disease is surgical, the implications of dual practice on surgical care are not well understood. METHODS: Anonymous in-depth individual interviews on trauma quality improvement practices were conducted with healthcare providers who participate in the care of the injured at ten large hospitals in Peru's capital city, Lima. A grounded theory approach to qualitative data analysis was employed to identify salient themes. RESULTS: Fifty interviews were conducted. A group of themes that emerged related to the perceived negative and positive impacts of dual practice on the quality of surgical care. Participants asserted that the majority of physicians in Lima working in the public sector also worked in the private sector. Dual practice has negative impacts on physicians' time, quality of care in the public sector, and surgical education. Dual practice positively affects patient care by allowing physicians to acquire management and quality improvement skills, and providing incentives for research and academic productivity. In addition, dual practice provides opportunities for clinical innovations and raises the economic status of the physician. CONCLUSION: Surgeons in Peru report that dual practice influences patient care negatively by creating time and human resource conflicts. Participants assert that these conflicts widen the gap in quality of care between rich and poor. This practice warrants redirection through national-level regulation of physician schedules and reorganization of public investment in health via physician remuneration.

Similar biological activity in skin prick test for Oralair® (8200 BAU) and Grazax® (6200 BAU) reinforces effective SLIT dosing level.

In Europe, allergen extracts are standardized based on skin prick wheal size in 20-30 allergic subjects. To understand the biological activity of clinically effective Sublingual immunotherapy, we used this method to determine the biological activity of solution and tablet Timothy grass pollen (TIM) extracts, compared to an FDA-approved extract (Reference) of 10 000 BAU/ml. Blinded, quadruplicate skin prick tests with concentrate and three serial half-log dilutions allowed the construction of a semilogarithmic regression line per extract. Bioequivalent allergy units (BAU) values were obtained from the comparison with reference. Extracts and dilutions showed a neat linear dose response (all: R2 > 0.98) in 33 rhinitis patients. Relative potencies: Staloral® 12 000 BAU/ml, Soluprick® 10 300 BAU/ml, Oralair® 8200 BAU, and Grazax® 6200 BAU. Even though all extract concentrates differed in wheal size (P = 0.01-0.001), Grazax® producing a 25% smaller wheal size than Oralair® , and the biological activity of these clinically effective TIM tablets led in the same range (6200-8200 BAU; 0.92-1.23 cm2 ). SLIT dose-finding studies for other pollens might start with allergen extracts producing 1.1 cm2 wheal surface.

[Schönlein-Henoch purpura. A report of 55 cases]. / Púrpura de Henoch-Schönlein. Informe de 55 casos.

The clinical, histological and laboratory data from a series of 55 pediatric patients with Henoch-Schönlein purpura studied at the Hospital General de Mexico in a 16-years period are presented herein. Even when there are a few clinical features in this example of Mexican children, the clinical presentation and the course of the disease are similar to what is found in the literature.

Effect of ADP on the orientation of spin-labeled myosin heads in muscle fibers: a high-resolution study with deuterated spin labels.

We have used electron paramagnetic resonance (EPR) to determine the effects of ADP on the orientational distribution of nitroxide spin labels attached to myosin heads in skinned rabbit psoas muscle fibers. To maximize the specificity of labeling, we spin-labeled isolated myosin heads (subfragment 1) on a single reactive thiol (SH1) and diffused them into unlabeled muscle fibers. To maximize spectral and orientational resolution, we used perdeuterated spin labels, 2H-MSL and 2H-IASL, eliminating superhyperfine broadening and thus narrowing the line widths. Two different spin labels were used, with different orientation relative to the myosin head, to ensure that the results are not affected by unfavorable probe orientation. In rigor, a very narrow three-line spectrum was observed for both spin labels, indicating a narrow orientational distribution, as reported previously (Thomas & Cooke, 1980). ADP induced very slight changes in the spectrum, corresponding to very slight (but significant) changes in the orientational distribution. These changes were quantified by a digital analysis of the spectra, using a two-step simplex fitting procedure (Fajer et al., 1990). First, the magnetic tensor values and line widths were determined by fitting the spectrum of a randomly oriented sample. Then the spectrum of oriented fibers was fit to a model by assuming a Gaussian distribution of the tilt angle (theta) and twist angle (phi) of the nitroxide principal axes relative to the fiber axis. A single-Gaussian distribution resulted in inadequate fits, but a two-component model gave excellent results. ADP induces a small (less than 5 degrees) rotation of the major components for both spin labels, along with a similarly small increase of disorder about the average positions.