Post-surgical treatment of thyroid carcinoma in dogs with retinoic acid 9 cis improves patient outcome.

The objective of the present study was to compare the effects of isotretinoin 9-cis (RA9-cis) as a post-surgery treatment of thyroid carcinoma to a traditional treatment (doxorubicin) and no treatment. Owners who did not want their dogs to receive treatment were placed into the control group A (GA; n=10). The remaining dogs were randomly placed into either group B (GB; n=12) and received doxorubicin at a dose of 30 mg/m(2) every three weeks, for six complete cycles or group C (GC; n=15) and treated with RA9-cis at a dose of 2 mg/kg/day for 6 months. The time of the recurrence was significantly shorter in the GA and GB compared to GC (P=0.0007; P=0.0015 respectively), while we did not detect differences between GA and GB. The hazard ratio of recurrence between GA and GB compared to GC were 7.25 and 5.60 times shorter, respectively. We did not detect any differences between the other groups. The risk ratio of recurrence was 2.0 times higher in GA compared to GC and 2.1 times higher in GB compared to GC. The type of carcinoma had an effect on time of survival with follicular carcinomas having an increased mean survival time than follicular-compact carcinomas (P<0.0001) and follicular-compact carcinomas had a longer mean survival time than compact carcinomas. The interaction among treatment and type was significant, but survival time in follicular carcinomas did not differ between treatments. In follicular-compact carcinomas the survival time of GC was greater than GB (P<0.05), but we did not detect a difference between GA and GB. In conclusion, this study shows that the use of surgery in combination with RA9-cis treatment significantly increases survival rate and decreases the time to tumor recurrence when compared to doxorubicin treated or untreated dogs. The histological type of carcinoma interacted with treatment for time to recurrence and survival time, with more undifferentiated carcinomas having a worse prognosis than differentiated carcinomas.

Amelogénesis imperfecta: a propósito de un caso / Amelogenesis imperfecta: a case report

Como Amelogénesis Imperfecta (AI) es denominado un grupo de desórdenes hereditarios, clínica y genéticamente heterogéneos, caracterizados por alteraciones en el esmalte dentario. Pueden presentarse acompañados de otras alteraciones en la cavidad oral o fuera de ella. Genéticamente la AI es transmitida ligada al cromosoma X, o de forma autosómica dominante o recesiva. Se clasifica según el fenotipo, el mecanismo de desarrollo y la forma de herencia en cuatro tipos principales: Hipoplásica, Hipocalcificada, Hipomadura e Hipomadura-Hipoplásica con taurodontismo. Objetivo: Revisar aspectos diagnósticos y de tratamiento y describir el manejo terapéutico de una adolescente con Amelogénesis Imperfecta, para restablecer la estética y función a través de un tratamiento conservador de transición. Presentación del caso: Paciente de género femenino, 12 años de edad, consulta por sensibilidad dentaria a los cambios térmicos e insatisfacción con su apariencia. Todos sus dientes presentan un esmalte opaco con manchas amarillo café, sus primeros molares están destruidos debido a fracturas post-eruptivas. Clínica y radiográficamente se diagnostica Amelogénesis Imperfecta de tipo hipomadura, con mordida abierta anterior y gingivitis asociada a placa bacteriana. La planificación de su tratamiento incluye una fase preventiva simultánea a la fase restauradora con carillas de resinas compuestas en incisivos y caninos y coronas metálicas en los primeros molares permanentes. Conclusión: Un diagnóstico oportuno y un tratamiento de transición adecuado, es fundamental para mantener y devolver la estética y función al paciente adolescente afectado con esta condición, contribuyendo a la vez a mejorar su calidad de vida, en espera de la rehabilitación definitiva

Amelogenesis Imperfecta (AI) is the name of a group of inherited disorders, clinically and genetically heterogeneous, characterized by alterations in the enamel. It may be accompanied by other changes in the oral cavity or elsewhere. This condition is transmitted genetically X-linked, or as an autosomal dominant or recessive character. Classified according to phenotype, pathogenesis, and mode of inheritance in four main types: Hypoplastic, Hypocalcified, Hypomaturated and Hypomaturated-Hypoplastic with taurodontism. Objective: To review the diagnostic and treatment and describe the therapeutic management of a teenager with Amelogenesis Imperfecta, to restore aesthetics and function through a transitional conservative treatment. Case Presentation: A female patient, aged 12, referring dental temperature-sensitive changes and unsatisfaction with their appearance. All teeth have a yellow opaque enamel with brown spots, the first molars are destroyed due to post-eruptive fractures. Clinically and radiographically diagnosed type Hypomaturated Amelogenesis Imperfecta with anterior open bite and plaque-associated gingivitis. Planning her treatment includes preventive stage simultaneous phase composite veneer restorations in incisors and canines and metal crowns on the first permanent molars. Conclusion: An early diagnosis and treatment of transition, it is essential to maintain and restore aesthetics and function to the adolescent patient afflicted with this condition, contributing both to improve their quality of life, pending the final restoration

Uso del láser terapéutico en el control del dolor en ortodoncia / Use of laser therapy in pain control in orthodontics

Objetivo: Determinar si el láser de baja frecuencia (LLLT) es efectivo en disminuir la percepción del dolor posterior a la aplicación de separaciones molares para ortodoncia. Material y Método: Se realizó un ensayo clínico aleatorizado con enmascaramiento simple en 30 alumnos entre 16 y 20 años, a quienes se les aplicó separaciones elásticas entre los molares permanentes. Los voluntarios fueron designados en dos grupos: 15 pacientes en el grupo experimental quienes fueron tratados con LLLT (Photon Lase, DMC USA Corp.) por 30 segundos en cada molar permanente derecho y 15 pacientes en el grupo control quienes recibieron como placebo la colocación del láser inactivo con el mismo protocolo empleado en el grupo experimental. En total 30 dientes fueron incluidos en cada grupo. La percepción del dolor fue evaluada a las 3, 12, 24 horas y a los días 2, 3, 4, 5 y 7 posterior a la aplicación de LLLT a través de un cuestionario estándar de autollenado haciendo uso de la escala visual análoga del dolor (EVA). Resultados: El 61.6 por ciento de los pacientes del grupo de control presentó algún grado de dolor durante el periodo de seguimiento en comparación del 38.64 por ciento del grupo experimental (p=0.004). Si bien la intensidad del dolor alcanzó su punto máximo a las 12 horas las diferencias de los promedios entre ambos grupos también fue estadísticamente significativa (<0.001). Conclusión: El LLLT demostró ser una herramienta útil en el control del dolor posterior a la aplicación de separaciones molares.

Objective: To determine the effectiveness of low-level laser therapy (LLLT) to decrease the perception of pain after application of orthodontic molar separations. Material and Methods: We performed a randomized single-blind in 30 students between 16 and 20 years who were administered elastic separation between the permanent molars. Volunteers were assigned into two groups: 15 patients in the experimental group who were treated with LLLT (Photon Lase, DMC USA Corp.) for 30 seconds on each permanent right molar and 15 patients in the control group who received placebo-like placement inactive laser with the same protocol used in the experimental group. Altogether 30 teeth were included in each group. Pain perception was assessed at 3, 12, 24 hours and 2, 3, 4, 5 and 7 after application of LLLT through a standard questionnaire using the visual analogue scale of pain (EVA). Results: 61.6 percent of patients in the control group had some degree of pain during the follow-up period in comparison with the 38.64 percent of the experimental group (p =0.004). Although pain intensity peaked at 12 hours the mean differences between groups was statistically significant (<0.001). Conclusion: LLLT proved to be a useful tool in controlling pain after the application of separation molars.

Analgesic-antiinflammatory properties of Proustia pyrifolia.

The antiinflammatory (per os and topic) and analgesic (per os) properties of the aerial part of Proustia pyrifolia a species in danger of extinction were investigated, and the major compounds of two of its active extracts were isolated. In addition, the evaluation of cytotoxicity in three tumoral cell lines and the acute toxicity of the crude methanol extract were also assayed, together with the antioxidant activity for the different extracts of this species. The results of the evaluation of the topic antiinflammatory activities induced by arachidonic acid, and phorbol 12-myristate 13-acetate of the different extracts showed that this species possesses active constituents that could diminish cyclo-oxygenase and lipoxygenases activities, the enzymes that allow the synthesis of proinflammatory endogenous substances as prostaglandin E(2) and leukotrienes, respectively. Our results corroborate the antiinflammatory and analgesic effects of Proustia pyrifolia, and could justify its use in folk medicine for the treatment of rheumatic and gout illnesses. From bio-active extracts beta-sitosterol, quercetin and dihydroquercetin were obtained, and these compounds could explain in part the antiinflammatory, analgesic and antioxidant activities of this species. The crude methanol extract did not present acute toxicity or cytotoxic activity, however only this extract exhibited antioxidant activity.

Erythromycin-resistant Streptococcus pyogenes in Argentina

Erythromycin (ERY) resistance in Streptococcus pyogenes has recently emerged as a problem of growing concern all through the world. We are presenting the comparison of results of the continuous surveillance of erythromycin resistance in S. pyogenes performed since 1989 in the Hospital de Pediatría J.P.Garrahan of Buenos Aires City, with independently observed rates in other five centers of Buenos Aires and seven centers of six other Argentinian cities, obtained between 1999 and 2001. A significant increase of erythromycin resistance was observed among S. pyogenes isolated in the Hospital Garrahan (6.6% in 1998-1999 to 9.9% in 2000). Similar trends were also detected in other centers of other Argentinian cities when recent data were compared to results of a multicenter study performed in 1995. However, lower rates of resistance were recorded in Mendoza, Cipolletti and Neuquén in comparison with data of 1995, 1998 and 1998 respectively. The reason of such decreasing resistance rates deserves to be investigated. The average of ERY-resistance rates obtained in the surveyed centers was 6.7% (range 0.5-14.1%). Control of antimicrobial use should be performed to warrant the future effectiveness of macrolide antibiotics regarding the positive association between use and resistance. These results also suggest that susceptibility tests for macrolides should be performed whenever S. pyogenes is isolated in Argentina.(AU)

La resistencia a la eritromicina en Streptococcus pyogenes ha emergido en los últimos tiempos como un problema creciente en todo el mundo. En este trabajo se presenta la comparación de los resultados de la vigilancia continua de la resistencia a la eritromicina que se viene realizando en el Hospital de Pediatría J.P.Garrahan de Buenos Aires desde 1989, con resultados independientes de otros cinco centros de la ciudad de Buenos Aires y siete de otras seis ciudades argentinas, obtenidos entre 1999 y 2001. Se observó un aumento significativo en el Hospital Garrahan (6.6% en1998-1999 a 9.9% en el año 2000) y una tendencia similar en otros centros de diversas ciudades argentinas si secomparan estos datos con los de un estudio multicéntrico realizado en 1995. No obstante, se registraron menoresporcentajes de resistencia en Mendoza, Neuquén y Cipolletti, en relación a lo hallado en 1995, 1998 y 1998respectivamente. La razón de esta disminución merece ser investigada. El porcentaje promedio de resistencia aeritromicina obtenido en los distintos centros participantes de este estudio fue de 6.7% (rango 0.5-14.1%). Debeefectuarse un control en el uso de estos antibióticos para garantizar la efectividad futura de los macrólidos, teniendo en cuenta la asociación estrecha entre uso y resistencia. Estos resultados sugieren que deberían realizarse pruebas de sensibilidad a los macrólidos para todos los aislamientos de S. pyogenes en la Argentina.(AU)

Erythromycin-resistant Streptococcus pyogenes in Argentina

Erythromycin (ERY) resistance in Streptococcus pyogenes has recently emerged as a problem of growing concern all through the world. We are presenting the comparison of results of the continuous surveillance of erythromycin resistance in S. pyogenes performed since 1989 in the Hospital de Pediatría J.P.Garrahan of Buenos Aires City, with independently observed rates in other five centers of Buenos Aires and seven centers of six other Argentinian cities, obtained between 1999 and 2001. A significant increase of erythromycin resistance was observed among S. pyogenes isolated in the Hospital Garrahan (6.6% in 1998-1999 to 9.9% in 2000). Similar trends were also detected in other centers of other Argentinian cities when recent data were compared to results of a multicenter study performed in 1995. However, lower rates of resistance were recorded in Mendoza, Cipolletti and Neuquén in comparison with data of 1995, 1998 and 1998 respectively. The reason of such decreasing resistance rates deserves to be investigated. The average of ERY-resistance rates obtained in the surveyed centers was 6.7% (range 0.5-14.1%). Control of antimicrobial use should be performed to warrant the future effectiveness of macrolide antibiotics regarding the positive association between use and resistance. These results also suggest that susceptibility tests for macrolides should be performed whenever S. pyogenes is isolated in Argentina.

La resistencia a la eritromicina en Streptococcus pyogenes ha emergido en los últimos tiempos como un problema creciente en todo el mundo. En este trabajo se presenta la comparación de los resultados de la vigilancia continua de la resistencia a la eritromicina que se viene realizando en el Hospital de Pediatría J.P.Garrahan de Buenos Aires desde 1989, con resultados independientes de otros cinco centros de la ciudad de Buenos Aires y siete de otras seis ciudades argentinas, obtenidos entre 1999 y 2001. Se observó un aumento significativo en el Hospital Garrahan (6.6% en1998-1999 a 9.9% en el año 2000) y una tendencia similar en otros centros de diversas ciudades argentinas si secomparan estos datos con los de un estudio multicéntrico realizado en 1995. No obstante, se registraron menoresporcentajes de resistencia en Mendoza, Neuquén y Cipolletti, en relación a lo hallado en 1995, 1998 y 1998respectivamente. La razón de esta disminución merece ser investigada. El porcentaje promedio de resistencia aeritromicina obtenido en los distintos centros participantes de este estudio fue de 6.7% (rango 0.5-14.1%). Debeefectuarse un control en el uso de estos antibióticos para garantizar la efectividad futura de los macrólidos, teniendo en cuenta la asociación estrecha entre uso y resistencia. Estos resultados sugieren que deberían realizarse pruebas de sensibilidad a los macrólidos para todos los aislamientos de S. pyogenes en la Argentina.

Anomalías de la esteroidogénesis suprarrenal en niños chilenos con micropene / Abnormalities in adrenal steroidogenesis in chilean boys with micropenis

Background: Mutations in type II 3ß hydroxysteroid Dehydrogenase (3ßHSD) are found in male children with severe undervirilized genitalia. Mild undervirilization (isolated micropenis or with distal hypospadia) can be associated with a partial deficit in 3ßHSD activity. Aim: To assess the frequency of abnormal adrenal response to ACTH, suggesting a deficit in adrenal enzymatic activity, in children with mild undervirilization. Patients and methods : We studied 26 male children with micropenis, aged one to eight years. Children with evidences of puberal development or in treatment with drugs that affect steroidal metabolism were excluded from the study. Serum levels of androstenedione (A), dehydroepiandrosterone (DHEA), progesterone (P), 17 hydroxyprogesterone (17 P) and the ratios DHEA/A, P/17 P, 17 P/DHEA were measured after an adrenal stimulation with 0.25 mg/m2 intramuscular ACTH. Results: Two children had DHEA y DHEA/A values suggesting a defective 3ßHSD activity. Other two children had high levels of 17 P, suggesting a deficiency of cytochrome p450c21. A CYP 21 gene mutation was found in one of the later children. Conclusions: A low proportion of children with micropenis have a deficient 3ßHSD activity

Multicenter study on spreading of the tet(M) gene in tetracycline-resistant Streptococcus group G and C isolates in Argentina.

A prospective multicenter study on invasive infections caused by beta-hemolytic streptococci was performed over 6 months and involved 42 centers from 16 cities in Argentina. Among 33 isolates recovered, 9 group G Streptococcus isolates (39.1%) and 2 group C Streptococcus isolates (20%) exhibited resistance to tetracycline and harbored the tet(M) gene. Genealogical analysis revealed that tetracycline resistance has a polyclonal origin in Argentina.

[Infection of ascending aortic graft: treatment with surgical cleaning, graft preservation and transposition of muscle flaps. Report of two cases]. / Infección de prótesis de aorta ascendente: tratamiento con aseo quirúrgico, preservación de prótesis y transposición de colgajo muscular en dos casos.

Mediastinitis with graft infection is a serious complication of ascending aorta replacement. We report two cases of graft infection, treated with surgical cleaning, graft preservation and transposition of muscle flaps. A 62 years old male was admitted 34 days after an ascending aortic grafting due to a sternal dehiscence and mediastinitis. Antimicrobial treatment was started and a surgical cleaning performed, leaving an open sternotomy. Three days later, the thoracic cavity was closed with a rectus abdominis muscle flap. After 23 months of follow up, the patient is well and without evidence of infection. A 74 years old male was subjected to an aortic valve and ascending aorta replacement and a myocardial revascularization. In the postoperative period, the patient developed septic signs, and a purulent drainage. A CAT scan showed a liquid collection surrounding the aortic graft. On tW Sixteenth postoperative day, a surgical cleaning was performed and the thorax was closed with the pectoralis major muscle. After 10 months of follow up, the patient is in Good condition and without evidence of infection.

H-ras and Nm23-H1 gene expression and proteolytic activity in squamous cell carcinoma of the uterine cervix.

BACKGROUND: The invasive and metastatic potential of malignant cells results from complex interactions of numerous factors not yet fully understood. Genomic alterations such as ras overexpression and nm23-H1 inhibition have been found to be frequently associated with increased invasiveness in various cancers. On the other hand, secretion of different proteinases are necessary for malignant cells to traverse a network of matrix macromolecules, but the relationship between the genomic alterations and the proteolytic phenotype is still unclear. Our aim was to investigate whether the appearance of the proteolytic phenotype had any correlation with the expression of H-ras and nm23-H1 genes in carcinoma of the uterine cervix. METHODS: Twenty-five samples from patients with carcinoma of the uterine cervix at different clinical stages were studied. Cathepsin B1, plasminogen activator, and collagenase activity were assessed in tissue cytosols using specific synthetic oligopeptides as substrates. The expression of H-ras and nm23-H1 was investigated by means of immunohistochemistry and in situ hybridization. RESULTS: Our results showed that cathepsin B1 was the most consistently elevated proteinase, demonstrating a linear correlation with clinical staging. H-ras expression was found elevated in 40% of the cases. Nm23-H1 protein immunoreactivity was positive in 40% of the cases. No correlation was found among H-ras, cathepsin B1 activity, and survival rate. Among cases with high cysteine proteinase activity, a different clinical behavior depending on the expression of Nm23-H1 was observed. The cases with Nm23-H1 protein had a markedly better survival rate than those lacking this protein. In contrast, the absence of Nm23-H1 in association with high cathepsin B1 activity was a clear indicator of a poor prognosis. CONCLUSIONS: These findings suggest a complex interaction between the proteolytic phenotype and the expression of H-ras and nm23-H1 genes in carcinoma of the cervix that influences the clinical behavior of the tumor.

[Streptococcus pyogenes: penicillin and erythromycin susceptibility in the cities of Neuquen and Cipolletti]. / Streptococcus pyogenes: sensibilidad a penicilina y eritromicina en las ciudades de Neuquen y Cipolletti.

Penicillin resistance has not yet been detected in Streptococcus pyogenes. However macrolide-resistant streptococci have emerged in several countries. Only low rates of erythromycin-resistant S. pyogenes were reported in Argentina, with the exception of a 11.1% observed in Mendoza. The aim of the present study was to determine the susceptibility to penicillin and to erythromycin of 251 consecutive clinically-significant isolates of S. pyogenes obtained from four centers of Cipolletti and Neuquén during the period April-December 1998. The double disk test with erythromycin and clindamycin disks was employed as a screening method to detect ERY-resistant streptococci and to determine the phenotype of macrolide resistance. Disk diffusion was also employed for determining penicillin susceptibility. Macrolide-resistant isolates were also tested for penicillin, ceftriaxone, erythromycin, clindamycin and azithromycin susceptibility by the agar dilution method. Additionally they were also tested for erythromycin susceptibility by E-test (AB Biodisk, Solna, Sweden). All streptococci studied were susceptible to penicillin and thirty of them (12.0%) were resistant to erythromycin. All these resistant isolates were also resistant to azithromycin but susceptible to ceftriaxone and clindamycin. They showed the phenotype M (probably efflux-mediated mechanism) and the MICs of erythromycin ranged between 8 and 16 micrograms/ml. According to these results we conclude that in spite of universal susceptibility to penicillin in S. pyogenes, macrolide resistance is a matter of concern in Neuquén and Cipolletti. At least in those cities it appears to be necessary to routinely perform macrolide susceptibility tests in beta-hemolytic streptococci.

Streptococcus pyogenes: sensibilidad a penicilina y eritromicina en las ciudades de Neuquen y Cipolletti. / [Streptococcus pyogenes: penicillin and erythromycin susceptibility in the cities of Neuquen and Cipolletti]

Penicillin resistance has not yet been detected in Streptococcus pyogenes. However macrolide-resistant streptococci have emerged in several countries. Only low rates of erythromycin-resistant S. pyogenes were reported in Argentina, with the exception of a 11.1

observed in Mendoza. The aim of the present study was to determine the susceptibility to penicillin and to erythromycin of 251 consecutive clinically-significant isolates of S. pyogenes obtained from four centers of Cipolletti and Neuquén during the period April-December 1998. The double disk test with erythromycin and clindamycin disks was employed as a screening method to detect ERY-resistant streptococci and to determine the phenotype of macrolide resistance. Disk diffusion was also employed for determining penicillin susceptibility. Macrolide-resistant isolates were also tested for penicillin, ceftriaxone, erythromycin, clindamycin and azithromycin susceptibility by the agar dilution method. Additionally they were also tested for erythromycin susceptibility by E-test (AB Biodisk, Solna, Sweden). All streptococci studied were susceptible to penicillin and thirty of them (12.0

) were resistant to erythromycin. All these resistant isolates were also resistant to azithromycin but susceptible to ceftriaxone and clindamycin. They showed the phenotype M (probably efflux-mediated mechanism) and the MICs of erythromycin ranged between 8 and 16 micrograms/ml. According to these results we conclude that in spite of universal susceptibility to penicillin in S. pyogenes, macrolide resistance is a matter of concern in Neuquén and Cipolletti. At least in those cities it appears to be necessary to routinely perform macrolide susceptibility tests in beta-hemolytic streptococci.

Argentinian collaborative study on prevalence of erythromycin and penicillin susceptibility in Streptococcus pyogenes. The Argentinian Streptococcus Study Group.

Two monthly studies on the prevalence of penicillin and erythromycin susceptibility of Streptococcus pyogenes were performed in May and October of 1994 in Argentina. A total of 58 centers from 27 cities participated in these studies. A total of 1072 isolates were tested by a diffusion method, although 595 isolates were tested both by the diffusion and an agar dilution method (n = 1767 isolates). No penicillin-resistant streptococci were found in our study (MIC100 = 0.03 microgram/ml). Only four isolates were confirmed as erythromycin resistant S. pyogenes (prevalence 0.14 and 0.28% in May and October 1994, respectively). Resistance in three isolates was due to an inducible mechanism, although in one strain a different phenotype was observed.

[Lower extremity salvage in diabetics: microsurgical muscle transplantation with and without previous vascular reconstruction]. / Salvataje de extremidad inferior en diabéticos: trasplante muscular microquirúrgico con y sin reconstrucción vascular previa.

Soft tissues wounds with or without bony involvement are a common problem and a cause of limb loss in diabetics. Usually local care, antibiotics, minor debridement and skin grafting are enough for successful handling of these lesions. When there is associated limb ischemia, revascularization is indicated. In patients with large ulcers, proximal bony involvement and tendon exposure, the incidence of primary amputation rises, frequently being considered the only alternative. Two cases of diabetic patients with indication of primary amputation of a lower limb for large infected ulcers are reported. A microvascularized muscle transplant was used to cover large defects of soft tissue, tendons and infected bone. One patient presented also critical ischaemia of the limb, requiring iliac angioplasty and a femoro-distal by-pass with in situ greater saphenous vein previous to the muscle graft. Both patients had no postoperative complications, being able to walk two months after the operation with their useful limb. Microvascularized muscle transplant with or without revascularization is a very useful alternative to amputation in the management of complex wounds of selected diabetic patients.

Streptococcus pyogenes: vigilancia de su resistencia a los antibióticos en un hospital pediátrico / Streptococcus pyogenes: surveillance of resistance to antimicrobial at a pediatric hospital

En varios países del mundo comenzaron a aislarse en forma creciente cepas de Streptococcus pyogenes resistentes a eritromicina. Este trabajo tuvo por objeto verificar la sensibilidad a penicilina, lincosamidas y macrólidos de los estreptococos del grupo A aislados en nuestro hospital entre 1989 y 1994. Se estudió un total de 373 cepas aisladas principalmente de exudados faríngeos por el método de dilución en medio sólido. Ninguna cepa resultó resistente a penicilina y sólo en 1989 se aislaron cepas resistentes a eritromicina (1,6 por ciento para ese año). Las dos cepas resistentes presentaron un patrón de sensibilidad compatible con el mecanismo MLS inducible. En conclusión, S. pyogenes continúa siendo uniformemente sensible a penicilina mientras que tanto la eritromicina como los nuevos macrólidos y las lincosamidas mantienen su efectividad in vitro como para seguir siendo considerados como alternativas para el tratamiento de infecciones estreptocócicas en nuestro medio

Streptococcus pyogenes: vigilancia de su resistencia a los antibióticos en un hospital pediátrico / Streptococcus pyogenes: surveillance of resistance to antimicrobial at a pediatric hospital

En varios países del mundo comenzaron a aislarse en forma creciente cepas de Streptococcus pyogenes resistentes a eritromicina. Este trabajo tuvo por objeto verificar la sensibilidad a penicilina, lincosamidas y macrólidos de los estreptococos del grupo A aislados en nuestro hospital entre 1989 y 1994. Se estudió un total de 373 cepas aisladas principalmente de exudados faríngeos por el método de dilución en medio sólido. Ninguna cepa resultó resistente a penicilina y sólo en 1989 se aislaron cepas resistentes a eritromicina (1,6 por ciento para ese año). Las dos cepas resistentes presentaron un patrón de sensibilidad compatible con el mecanismo MLS inducible. En conclusión, S. pyogenes continúa siendo uniformemente sensible a penicilina mientras que tanto la eritromicina como los nuevos macrólidos y las lincosamidas mantienen su efectividad in vitro como para seguir siendo considerados como alternativas para el tratamiento de infecciones estreptocócicas en nuestro medio (AU)

[Colonoscopic diagnosis]. / Diagnóstico por colonoscopía.

Between 1974 and 1992, we perform 3,054 colonoscopies for diagnosis in 2,770 patients, both of sexes, between the ages of 1 and 101 yr, most of them over the fifth decade of life. In 300 procedures the bowel cleansing was made with the standard method of liquid diet and enemas, and in the other 2,754 with the oral administration of saline solution 9% with optimal results. We get the sedation of patients with the intravenous administration of diazepam 10mg, or pethidine 50 mg, or midazolam 2.5 to 5 mg, and in children with ketamine and the anesthesiologist assistance. In 95% of the procedures we can see the cecum and the ileum; the diagnosis was abnormal in 52.78% of cases, normal in 45.20%, and insufficient in 02.02% specially for a bad cleansing of the bowel. In the abnormal group, the most frequent diseases we diagnose were: polyps, cancer, diverticular disease, and specific inflammatory disease of the bowel like TBC, radiation proctosigmoiditis, amebiasis, and non-specific bowel disease: "colitis", ulcerative proctocolitis, erosive colitis, and Crohn's disease. Colonoscopy is a very important method for diagnosis of colon diseases, alone or complementary of double contrast X-ray of the colon.

Carcinoma suprarrenal congénito / Congenital carcinoma of the adrenal gland

En una niña recién nacida con una masa abdominal derecha y discreta hipertrofia del clítoris, la ultrasonografía abdominal y la cintigrafía hepática sugirieron inicialmente un tumor hepático; sin embargo, las mediciones en el plasma de 17-hidroxiprogesterona (12,5 ng/ml), actividad de renina (> 25 ng/ml * h), DHEA-S (12.500 *g%) y cortisol (8,1 *g/dl), como los de una segunda ecografía abdominal, hicieron evidente la ubicación suprarrenal del tumor. La masa fue extirpada quirúrgicamente en su totalidad, resultando en el estudio anatomopatológico un carcinoma suprarrenal. La paciente recibió tratamiento pre y postoperatorio con hidrocortisona y se encuentra en excelentes condiciones. Existen muy pocos informes en la literatura mundial sobre carcinomas suprarrenales identicados en el período neonatal. Se revisan otras publicaciones, enfatizando los hallazgos clínicos, exámenes que apoyan el diagnóstico y el tratamiento más recomendado actualmente