Synchronous bilateral laparoscopic adrenalectomy: Surgical technique and perioperative results of a 13-years' experience.

INTRODUCTION AND OBJECTIVES: Laparoscopic surgery is the standard approach for the treatment of adrenal glands. Bilateral synchronous adrenalectomy is rarely performed, and evidence about this procedure is limited. Our objective is to report our 13-year experience with synchronous laparoscopic bilateral adrenalectomy, evaluating its feasibility, safety, and perioperative outcomes. PATIENTS AND METHODS: A total of 23 consecutive patients undergoing synchronous bilateral laparoscopic adrenalectomy between 2007 and 2020 in a single academic center were included. Variables evaluated were operative time, estimated blood loss, conversion to open surgery, postoperative complications, mortality, and postoperative length of stay. RESULTS: Mean operative time was 189.3 ±â€¯48.9 min. Mean estimated blood loss was 163.0 ±â€¯201.3 mL. There were no conversions to open surgery. Five patients had postoperative complications, three of those were major. No patient died in the perioperative period. Median postoperative length of stay was three days (range 1-30). At pathology analysis, 15 patients had bilateral adrenal hyperplasia, 2 unilateral adrenal hyperplasia and a contralateral benign tumor, 1 unilateral adrenal hyperplasia and a normal contralateral gland, 1 unilateral adenoma, 3 bilateral pheochromocytomas and 1 bilateral myelolipoma. CONCLUSION: Synchronous bilateral laparoscopic adrenalectomy is a feasible and safe technique. A multidisciplinary and experienced team involving anesthesiologists and endocrinologists is required.

Leptospirosis: seroprevalencia en poblaciones de equinos y referentes humanos en Uruguay / Leptospirose: Soroprevalência em Equinos e em Referentes Humanos no Uruguai

Introducción: La leptospirosis equina se cree poco común por ser habitualmente subclínica, pero estúdios recientes sugieren que es una infección extendida geográficamente, con diversos perfiles de incidencia y serovares infectantes. Por su elevado nivel poblacional y su empleo en múltiples tareas, corresponde considerar a los equinos como potencial fuente de infección humana. En Uruguay, hasta el momento, no hay registros de leptospirosis en equinos. Esta enfermedad se asocia principalmente con el reservorio bovino, pero determinados equinos comparten espacios con bovinos y otros animales de producción en establecimientos ganaderos, y en establecimientos de cría existen abundantes roedores atraídos por el alimento y forraje. Objetivos: Determinar la prevalencia de infección en poblaciones nacionales de equinos, y su frecuencia en los trabajadores referentes. Determinar aquellos serogrupos más frecuentemente reactivos por MAT.

Leptospirosis: seroprevalencia en poblaciones de equinos y referentes humanos en Uruguay / Leptospirose: Soroprevalência em Equinos e em Referentes Humanos no Uruguai

Introducción: La leptospirosis equina se cree poco común por ser habitualmente subclínica, pero estúdios recientes sugieren que es una infección extendida geográficamente, con diversos perfiles de incidencia y serovares infectantes. Por su elevado nivel poblacional y su empleo en múltiples tareas, corresponde considerar a los equinos como potencial fuente de infección humana. En Uruguay, hasta el momento, no hay registros de leptospirosis en equinos. Esta enfermedad se asocia principalmente con el reservorio bovino, pero determinados equinos comparten espacios con bovinos y otros animales de producción en establecimientos ganaderos, y en establecimientos de cría existen abundantes roedores atraídos por el alimento y forraje. Objetivos: Determinar la prevalencia de infección en poblaciones nacionales de equinos, y su frecuencia en los trabajadores referentes. Determinar aquellos serogrupos más frecuentemente reactivos por MAT.(AU)

Associations of killer cell immunoglobulin- like receptor genes with rheumatoid arthritis.

OBJECTIVE: Rheumatoid Arthritis (RA) is an autoimmune and chronic inflammatory disease of unknown etiology. Killer cell immunoglobulin-like receptors are expressed on the surface of natural killer cells and CD28null T-cells, both present in synovial membrane of RA. Therefore we evaluated the associations of KIR genes with RA. METHODS: 16 KIR genes were genotyped in 100 healthy subjects (HS) and 100 RA patients from Western Mexico using PCR-SSP. Differences in KIR genotypes and gene frequencies were assessed using the X^{2} test. RESULTS: Gene frequency of KIR2DL3 was lower in RA than in HS (p= 0.0019), whereas KIR2DL2 and KIR2DS2 were higher in RA than HS (p =0.0004 and p = 0.0487, respectively). In addition were identified 38 genotypes (from G1-G38) in both studied groups, and the genotype frequencies of G1, G6 and G14 showed significant differences (p =0.0001, p =0.0208 and p =0.0300, respectively). CONCLUSIONS: The presence of KIR2DL2, KIR2DS2 and absence of KIR2DL3 are associated with RA. Moreover, two genotypes BX are associated with RA. These results suggest that KIRs can be involved in RA susceptibility.

The ACTN3 R577X polymorphism is associated with inflammatory myopathies in a Mexican population.

BACKGROUND: The ACTN3 gene encodes the fast muscle protein α-actinin-3. The ACTN3 R577X polymorphism is a premature stop codon and results in absence of α-actinin-3 in 577XX homozygotes. The aim of this study was to determine the ACTN3 genotype in idiopathic inflammatory myopathies (IIMs). METHODS: We performed ACTN3 genotyping on 27 patients with dermatomyositis (DM), 10 with polymyositis (PM), and 85 healthy subjects. Muscle enzyme levels of creatine phosphokinase (CPK), lactic dehydrogenase (LDH), aspartate aminotransferase (AST), and alanine aminotransferase (ALT) were recorded at the time of diagnosis and recruitment. Genotyping was performed by polymerase chain reaction-restriction fragment length polymorphism (PCR-RFLP) and the allele frequency was analysed. RESULTS: A total of 36% of healthy subjects had the ACTN3 577XX polymorphism (α-actinin-3 deficiency), 18% had the 577RR (homozygous wild type) genotype, and 46% 577RX (heterozygous). In DM/PM, 70% had the ACTN3 577XX polymorphism, 6% RR, and 24% RX [odds ratio (OR) 4.12, 95% confidence interval (CI) 1.67-10.33, p < 0.001]. In healthy subjects, the R allele was present in 41% and the X allele in 59% compared to 18% and 82%, respectively, in the IIM group (OR 3.21, 95% CI 1.57-6.66, p < 0.001). Thus, the ACTN3 577X allele seemed to increase the risk of developing IIM, and DM in particular, although this was not related to severity of expression of the phenotype. CONCLUSIONS: The ACTN3 577X allele appeared to increase the risk of developing IIM; 70% of IIM patients were deficient in α-actinin-3. By contrast, ACTN3 577XX patients seemed to have less severe disease as reflected in lower muscle enzyme levels.

T(H)1/T(H)2 cytokine profile, metalloprotease-9 activity and hormonal status in pregnant rheumatoid arthritis and systemic lupus erythematosus patients.

During the course of rheumatoid arthritis (RA) and systemic lupus erythematosus (SLE), several immune and neuroendocrine changes associated with pregnancy may exert positive (amelioration) or negative (exacerbation) effects on the clinical outcome. In order to shed light on the mechanisms underlying these responses, we performed a prospective longitudinal study in RA and SLE pregnant women, including healthy pregnant women as a control group. Cytokine messenger RNA (mRNA) expression assessed by quantitative competitive polymerase chain reaction (PCR) in peripheral blood mononuclear cells (PBMC), cytokine levels and lymphocyte proliferation responses (LPR) following phytohaemagglutinin (PHA) stimulation of PBMC, plasma metalloprotease-9 activity (MMP-9) and hormonal status during pregnancy were determined. TNFa was the most abundant cytokine mRNA expressed in PBMC in all groups studied (healthy pregnant women, RA and SLE pregnant patients). However, a general TH2 response reflected by high IL-10 levels was found in RA, as well as SLE, patients. A significant change in IFN-gamma was observed in RA patients but only during the first trimester of pregnancy. This compared with a major TH1 response in healthy pregnant women. Interestingly, our study showed a homogeneous hormonal pattern in RA and SLE patients. Although decreased cortisol levels were observed in all patients studied, this is possibly related to the remission of disease activity status brought about by steroid treatment before and during pregnancy. In summary, we suggest that complex immune and hormonal networks are involved in pregnancy and that rheumatic diseases are very dynamic immune processes that cannot be described with a clear-cut cytokine profile. Furthermore, the observations in this study may reflect treatment-related immune effects more than those associated with disease.

[Helicobacter pylori infection and gastric cancer in Mexico. A challenge for prevention and population control]. / Infección por Helicobacter pylori y cáncer gástrico en México. Un reto para la prevención y el control poblacional.

The International Agency for Research on Cancer (IARC) of the WHO has recognized a cause-effect relationship between Helicobacter pylori (Hp) infection and gastric cancer of such magnitude that the presence of this infection increases the risk of gastric cancer approximately four times. Gastric cancer is currently the second cause of mortality due to malignant neoplasms in Mexico City. This article explores the association between Hp infection and gastric cancer incidence through an epidemiological study including 109 gastric cancer patients and 177 hospital controls in Mexico City. The study estimates that, in the population studied, Hp infection was present in 87.2% of the cases, compared with 82.5% of the controls. The odds ratio of having gastric cancer if infected with Hp was 1.44 IC95% 0.7-2.8. In addition, it was calculated that with eradication of Hp infection in the general population, gastric cancer incidence would decrease by at least 26.6%. An improvement of the actual sanitary conditions along with the development of an effective vaccine for Hp infection and the existence of increasingly effective treatments to eradicate the bacteria are the necessary next step for populational prevention and control of gastric cancer.

[Diagnostic utility of serum beta-carotenes in intestinal malabsorption syndrome]. / Utilidad diagnóstica de los beta-carotenos séricos en el síndrome de absorción intestinal deficiente.

In order to determine the reference values of serum beta-carotene and its usefulness in the diagnosis of steatorrhea, 140 healthy subjects and 120 patients with suspected malabsorption syndrome were studied. The reference values, established in terms of the percentiles 2.5 and 97.5, were 85-270 micrograms/dL for men and 112-385 micrograms/dL for women. The beta-carotene diagnostic usefulness was determined by comparison with stool fat levels. According to ROC curves, steatorrhea was diagnosed at beta-carotene values of less than 89 micrograms/dL and 103 micrograms/dL for men and women respectively with a 78% sensitivity, 82% specificity, 76% positive and 84% negative predictive values and 80% accuracy. The steatorrhea prevalence (stool fat > 5 g/day) in our patients was 42%. Due to the implicit technical difficulties of the stool fat determinations and the results of this study, we propose the serum quantification of beta-carotene as an useful screening test in patients with chronic diarrhea and malabsorption syndromes.

[Detection of anti-gonococcal antibodies using a dot immunobinding assay in a high risk female population]. / Detección de anticuerpos antigonocócicos por dot immunobinding assay en una población femenina de alto riesgo.

The bacteriological diagnosis of gonorrhea in women has a low efficiency. A dot immunobinding assay, using whole piliated Neisseria gonorrhoeae cells, was used to detect antigonococcal antibodies in 300 prostitutes in whom a parallel Thayer-Martin culture of endocervical secretion was performed. Twenty sera from men with bacteriologically confirmed gonorrhoea were used as positive controls and 20 sera from children without history of gonococcal infections, as negative controls. Antibodies were detected in 49.7% of women and culture was positive in only one. All men with gonorrhea has positive titers and all sera from children were negative, except one that had a cross-reaction. Test sensitivity in the female population was 1 and specificity 0.5. There were no false negative reactions. Although the test detected antibodies in high risk women, there were cross-reactions. Therefore, the technique should be improved, using a more specific antigen.

[Diagnosis of bacterial meningitis by latex agglutination tests]. / Diagnóstico de meningitis bacteriana aguda por aglutinación con partículas de látex.

Fifty samples of cerebrospinal fluid (CSF) from patients with acute bacterial meningitis were studied with direct gram examination, culture and latex agglutination. Twenty one of these samples had previous antimicrobial treatment. In 42 patients, blood cultures were also made. Thirty control CSF samples were also studied. The diagnostic yield of CSF culture was 72%, of direct gram examination 74% and latex agglutination 80%. All the techniques as a whole has a diagnostic yield of 92%. In the 21 CSF samples with previous antimicrobial treatment, culture was positive in 47.6% and latex agglutination in 85.7%. All control CSF samples were negative. It is concluded that the diagnostic yield of latex agglutination test in patients with previous antimicrobial treatment is significantly better than culture.

[Immunofluorescence in the diagnosis of acute bacterial meningitis]. / Diagnostico de meningitis bacteriana aguda por inmunofluorescencia.

We evaluated immunofluorescence techniques to investigate the presence of S pneumoniae, N meningitidis, H influenzae types a and b and L monocytogenes in 85 samples of CSF fluid: 60 were taken from patients suffering meningitis and 25 from a control group. Results were compared to conventional bacteriologic methods. There were no false positive results in the control group. In patients with meningitis, 28 were positive by both methods. Nine additional patients were positive only to immunofluorescence which allowed identification of S pneumoniae in 6, N meningitidis in 2 and H influenzae in 1. 37 samples were positive by immunofluorescence and 28 of them were positive to conventional bacteriology. There was only 1 case of Group B streptococcus identified by bacteriology which was not diagnosed by immunofluorescence. Thus, immunofluorescence increases the ability to make a bacteriologic diagnosis in patients with meningitis.

Análisis de la contaminación bacteriológica del río Cautín / Analysis of the Cautin river bacteriological contamination

En el Laboratorio de Microbiología de la Universidad de La Frontera, Temuco (Chile), se estudió durante el verano de 1984, la calidad bacteriológica del agua del río Cautín y del agua potable de la ciudad de Temuco. Se estableció que su caudal era una fuente apropiada para la planta de agua potable que abastece la ciudad de Temuco y que sería apto además para proporcionar agua de riego y recreación.

Aislamiento de Bacteroides fragilis ssp fragilis en hemocultivos. / Isolation of Bacteroides fragilis ssp fragilis in blood cultures

En el Laboratorio de Microbiologia de la Universidad de la Frontera, se aislos en septiembre de 1983, a partir de hemocultivos, el bacilo anaerobio Gram negativo no esporulado bcteroides fragilis ssp fragilis. Esta determinacion es la primera identificacion de esta especie, efectuada de una muestra de sangre, en la IX region de CHile