Oral delivery of Hyperimmune bovine serum antibodies against CS6-expressing enterotoxigenic Escherichia coli as a prophylactic against diarrhea.

BACKGROUND: . Oral administration of bovine antibodies active against enterotoxigenic Escherichia coli (ETEC) have demonstrated safety and efficacy against diarrhea in human challenge trials. The efficacy of bovine serum immunoglobulins (BSIgG) against recombinant colonization factor CS6 or whole cell ETEC strain B7A was assessed against challenge with the CS6-expressing B7A. METHODS: . This was a randomized, double-blind, placebo-controlled trial in which healthy adults received oral hyperimmune BSIgG anti-CS6, anti-B7A whole cell killed or non-hyperimmune BSIgG (placebo) in a 1:1:1 ratio then challenged with ETEC B7A. Two days pre-challenge, volunteers began a thrice daily, seven day course of immunoprophylaxis. On day 3, subjects received 1 × 1010 CFUs of B7A. Subjects were observed for safety and the primary endpoint of moderate-severe diarrhea (MSD). RESULTS: . A total of 59 volunteers received product and underwent ETEC challenge. The BSIgG products were well-tolerated across all subjects. Upon challenge, 14/20 (70%) placebo recipients developed MSD, compared to 12/19 (63%; p = .74) receiving anti-CS6 BSIgG and 7/20 (35%; p = .06) receiving anti-B7A BSIgG. Immune responses to the ETEC infection were modest across all groups. CONCLUSIONS: . Bovine-derived serum antibodies appear safe and well tolerated. Antibodies derived from cattle immunized with whole cell B7A provided 50% protection against MSD following B7A challenge; however, no protection was observed in subjects receiving serum antibodies targeting CS6. The lack of observed efficacy in this group may be due to low CS6 surface expression on B7A, the high dose challenge inoculum and/or the use of serum derived antibodies versus colostrum-derived antibodies.

Guía SEOM-SERAM-SEMNIM sobre el empleo de las técnicas de imagen funcional y molecular en el cáncer de pulmón no microcítico avanzado / SEOM-SERAM-SEMNIM guidelines on the use of functional and molecular imaging techniques in advanced non-small-cell lung cancer

En oncología, las técnicas de imagen son una herramienta esencial para el manejo de los pacientes, pero su potencial está enormemente infrautilizado. Cada una de las modalidades que se utilizan en el proceso diagnóstico ofrece, también, información funcional que puede ser relevante para el proceso de toma de decisiones en torno al tratamiento. Nuevos algoritmos y técnicas de imagen acentúan lo que ya sabemos del fenotipo del tumor y de su posible respuesta a diferentes tratamientos. Las modalidades de imagen funcional se definen como aquellas que ofrecen información más allá de los meros datos morfológicos e incluyen todas las técnicas que hacen posible medir funciones fisiológicas específicas del tumor, mientras que las modalidades de imagen molecular se refieren a técnicas que nos permiten medir cambios a nivel metabólico. Las técnicas funcionales y moleculares incluidas en el presente documento se basan en la tomografía computarizada (TC) multidetector, la tomografía por emisión de positrones con 18-fluorodesoxiglucosa (18F-FDG PET), la resonancia magnética (RM) y los equipos híbridos que integran la PET y la TC (PET/TC) o la PET y la RM (PET/RM). El cáncer de pulmón es uno de los tumores más comunes y letales que existen, aunque la supervivencia va en aumento gracias a los avances realizados en los métodos diagnósticos y a los nuevos tratamientos. Esta mayor supervivencia plantea retos en torno a un adecuado seguimiento y a las definiciones de respuesta y progresión de la enfermedad, tal y como ejemplifica la seudoprogresión de la enfermedad asociada a las terapias inmunológicas. En este documento de consenso abordamos el uso de las técnicas de imagen funcional y molecular a fin de poder explotar todo su potencial en la actualidad, y explorar futuras aplicaciones en el diagnóstico, evaluación de la respuesta al tratamiento y detección de la recurrencia del cáncer de pulmón no microcítico en fase avanzada

Imaging in oncology is an essential tool for patient management but its potential is being profoundly underutilized. Each of the techniques used in the diagnostic process also conveys functional information that can be relevant in treatment decision making. New imaging algorithms and techniques enhance our knowledge about the phenotype of the tumor and its potential response to different therapies. Functional imaging can be defined as the one that provides information beyond the purely morphological data, and include all the techniques that make it possible to measure specific physiological functions of the tumor, whereas molecular imaging would include techniques that allow us to measure metabolic changes. Functional and molecular techniques included in this document are based on multi-detector computed tomography (CT), 18F-fluorodeoxyglucose positron emission tomography (18F-FDG PET), magnetic resonance imaging (MRI), and hybrid equipments, integrating PET with CT (PET/CT) or MRI (PET-MRI). Lung cancer is one of the most frequent and deadly tumors although survival is increasing thanks to advances in diagnostic methods and new treatments. This increased survival poises challenges in terms of proper follow-up and definitions of response and progression, as exemplified by immune therapy-related pseudoprogression. In this consensus document, the use of functional and molecular imaging techniques will be addressed to exploit their current potential and explore future applications in the diagnosis, evaluation of response and detection of recurrence of advanced NSCLC

SEOM-SERAM-SEMNIM guidelines on the use of functional and molecular imaging techniques in advanced non-small-cell lung cancer

Imaging in oncology is an essential tool for patient management but its potential is being profoundly underutilized. Each of the techniques used in the diagnostic process also conveys functional information that can be relevant in treatment decision-making. New imaging algorithms and techniques enhance our knowledge about the phenotype of the tumor and its potential response to different therapies. Functional imaging can be defined as the one that provides information beyond the purely morphological data, and include all the techniques that make it possible to measure specific physiological functions of the tumor, whereas molecular imaging would include techniques that allow us to measure metabolic changes. Functional and molecular techniques included in this document are based on multi-detector computed tomography (CT), 18F-fluorodeoxyglucose positron emission tomography (18F-FDG PET), magnetic resonance imaging (MRI), and hybrid equipments, integrating PET with CT (PET/CT) or MRI (PET-MRI). Lung cancer is one of the most frequent and deadly tumors although survival is increasing thanks to advances in diagnostic methods and new treatments. This increased survival poises challenges in terms of proper follow-up and definitions of response and progression, as exemplified by immune therapy-related pseudoprogression. In this consensus document, the use of functional and molecular imaging techniques will be addressed to exploit their current potential and explore future applications in the diagnosis, evaluation of response and detection of recurrence of advanced NSCLC

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SEOM-SERAM-SEMNIM guidelines on the use of functional and molecular imaging techniques in advanced non-small-cell lung cancer. / Guía SEOM-SERAM-SEMNIM sobre el empleo de las técnicas de imagen funcional y molecular en el cáncer de pulmón no microcítico avanzado.

Imaging in oncology is an essential tool for patient management but its potential is being profoundly underutilized. Each of the techniques used in the diagnostic process also conveys functional information that can be relevant in treatment decision making. New imaging algorithms and techniques enhance our knowledge about the phenotype of the tumor and its potential response to different therapies. Functional imaging can be defined as the one that provides information beyond the purely morphological data, and include all the techniques that make it possible to measure specific physiological functions of the tumor, whereas molecular imaging would include techniques that allow us to measure metabolic changes. Functional and molecular techniques included in this document are based on multi-detector computed tomography (CT), 18F-fluorodeoxyglucose positron emission tomography (18F-FDG PET), magnetic resonance imaging (MRI), and hybrid equipments, integrating PET with CT (PET/CT) or MRI (PET-MRI). Lung cancer is one of the most frequent and deadly tumors although survival is increasing thanks to advances in diagnostic methods and new treatments. This increased survival poises challenges in terms of proper follow-up and definitions of response and progression, as exemplified by immune therapy-related pseudoprogression. In this consensus document, the use of functional and molecular imaging techniques will be addressed to exploit their current potential and explore future applications in the diagnosis, evaluation of response and detection of recurrence of advanced NSCLC.

SEOM-SERAM-SEMNIM guidelines on the use of functional and molecular imaging techniques in advanced non-small-cell lung cancer.

Imaging in oncology is an essential tool for patient management but its potential is being profoundly underutilized. Each of the techniques used in the diagnostic process also conveys functional information that can be relevant in treatment decision-making. New imaging algorithms and techniques enhance our knowledge about the phenotype of the tumor and its potential response to different therapies. Functional imaging can be defined as the one that provides information beyond the purely morphological data, and include all the techniques that make it possible to measure specific physiological functions of the tumor, whereas molecular imaging would include techniques that allow us to measure metabolic changes. Functional and molecular techniques included in this document are based on multi-detector computed tomography (CT), 18F-fluorodeoxyglucose positron emission tomography (18F-FDG PET), magnetic resonance imaging (MRI), and hybrid equipments, integrating PET with CT (PET/CT) or MRI (PET-MRI). Lung cancer is one of the most frequent and deadly tumors although survival is increasing thanks to advances in diagnostic methods and new treatments. This increased survival poises challenges in terms of proper follow-up and definitions of response and progression, as exemplified by immune therapy-related pseudoprogression. In this consensus document, the use of functional and molecular imaging techniques will be addressed to exploit their current potential and explore future applications in the diagnosis, evaluation of response and detection of recurrence of advanced NSCLC.

First Report of Pythium sulcatum Causing Cavity Spot in Processing Carrot Crops in the Columbia Basin of Washington State.

In October 2012, symptoms of cavity spot (1) were observed on roots of two 50 ha, Red Core Chantenay processing carrot (Daucus carota L. subsp. sativus (Hoffm.)) crops in the Columbia Basin of central Washington. Symptoms consisted of sunken, elliptical lesions (3 to 15 mm long) on the root surface. Approximately 6% of the roots in each crop were affected, which was sufficient to present sorting problems for the processor. Symptomatic roots were washed thoroughly in tap water, and then small sections of tissue from the lesion margins were removed aseptically and plated onto water agar (WA) without surface-sterilization. Isolates with morphological characteristics typical of Pythium sulcatum Pratt & Mitchell (2) were obtained consistently from the symptomatic tissue. The genus and species identity of seven isolates was confirmed by sequence analysis of the internal transcribed spacer (ITS) 1-5.8S-ITS2 region of ribosomal DNA (rDNA) using universal eukaryotic primers UN-UP18S42 and UN-LO28S576B with the PCR protocol described by Schroeder et al. (3). The ITS consensus sequences of the seven isolates (Accession Nos. KF509939 to KF509945) were 98 to 99% homologous to ITS sequences of P. sulcatum in GenBank. Pathogenicity of all seven isolates was confirmed by inoculating mature carrot roots of cv. Bolero. Each root was washed with tap water, sprayed to runoff with 70% isopropanol, and dried in a laminar flow hood on sterilized paper toweling. The roots were then placed in plastic bins lined with paper toweling moistened with sterilized, deionized water. Each root was inoculated by placing two 5 mm-diameter agar plugs, taken from the edge of an actively growing WA culture of the appropriate isolate, on the root surface approximately 3 cm apart. Non-colonized agar plugs were used for a non-inoculated control treatment. Four replicate roots were inoculated for each isolate and the control treatment. After inoculation, the roots were misted with sterilized, deionized water, a lid was placed on each bin, and the roots were incubated in the dark at 22°C. Roots were misted daily to maintain high relative humidity. Dark, sunken lesions were first observed 3 days post-inoculation on roots inoculated with the P. sulcatum isolates, and all inoculated roots displayed cavity spot lesions by 7 days. No symptoms were observed on the non-inoculated control roots. Colonies with morphology typical of P. sulcatum were re-isolated from the symptomatic tissue of roots inoculated with the P. sulcatum isolates, and the species identity of the re-isolates was confirmed by ITS rDNA sequence analysis, as described above. Although P. sulcatum is one of several Pythium species that can cause cavity spot of carrot (1), to our knowledge, this is the first report of P. sulcatum causing cavity spot in Washington State, which has the largest acreage of processing carrot crops in the United States (4). References: (1) R. M. Davis and R. N. Raid. Compendium of Umbelliferous Crop Diseases. The American Phytopathological Society, St. Paul, MN, 2002. (2) A. J. van der Plaats-Niterink. Monograph of the Genus Pythium. Stud. Mycol. No. 21. CBS, Baarn, The Netherlands, 1981. (3) K. L. Schroeder et al. Phytopathology 96:637, 2006. (4) E. J. Sorensen. Crop Profile for Carrots in Washington State. U.S. Dept. Agric. National Pest Manage. Centers, 2000.

Decadal trends in marine reserves reveal differential rates of change in direct and indirect effects.

Decadal-scale observations of marine reserves suggest that indirect effects on taxa that occur through cascading trophic interactions take longer to develop than direct effects on target species. Combining and analyzing a unique set of long-term time series of ecologic data in and out of fisheries closures from disparate regions, we found that the time to initial detection of direct effects on target species (±SE) was 5.13 ± 1.9 years, whereas initial detection of indirect effects on other taxa, which were often trait mediated, took significantly longer (13.1 ± 2.0 years). Most target species showed initial direct effects, but their trajectories over time were highly variable. Many target species continued to increase, some leveled off, and others decreased. Decreases were due to natural fluctuations, fishing impacts from outside reserves, or indirect effects from target species at higher trophic levels. The average duration of stable periods for direct effects was 6.2 ± 1.2 years, even in studies of more than 15 years. For indirect effects, stable periods averaged 9.1 ± 1.6 years, although this was not significantly different from direct effects. Populations of directly targeted species were more stable in reserves than in fished areas, suggesting increased ecologic resilience. This is an important benefit of marine reserves with respect to their function as a tool for conservation and restoration.

Calicivirus infection in human immunodeficiency virus seropositive children and adults.

BACKGROUND: The importance of enteric viral infections in HIV-related diarrhea is uncertain. Human caliciviruses have emerged as a leading cause of acute diarrhea worldwide. OBJECTIVES: To evaluate the importance of calicivirus infections in HIV-related diarrhea. Study design 151 fecal samples collected from children and adults infected with HIV, with and without diarrhea, were examined. In addition, 89 fecal samples from non HIV-infected children and adults were also tested. Samples were analyzed by RT-PCR using primer sets specific to Norovirus genogroup I or genogroup II as well as primers designed to react with both Noroviruses and Sapovirus genus. RESULTS: Viruses were detected with equal frequencies in stools from HIV infected and non-infected adults (12%). However, specimens from HIV infected children were more likely than those of HIV-negative children to have caliciviruses (51% versus 24%, P<0.05). Viral infections were not significantly associated with diarrhea neither in children nor in adults, regardless of HIV status. Viruses genetically related to the common Lordsdale virus (Norovirus genogroup II) and London/92 virus (Sapovirus) clusters were detected circulating among children. CONCLUSIONS: These results suggest that caliciviruses may be an important opportunistic pathogen in children infected with HIV.

[Acute renal failure secondary to hepatic veno-occlusive disease in a bone marrow transplant patient]. / Insuficiencia renal aguda secundaria a enfermedad veno-oclusiva hepática en un paciente con trasplante de médula ósea.

Acute renal failure following bone marrow transplantation is a frequent complication with an incidence ranging 15-30% and with high rates of morbidity and mortality. Numerous potential etiologies can be implicated as chemotherapy regimen, use of nephrotoxic antibiotics, sepsis-induced damage, cyclosporine toxicity and other especific pathologies as graft-v-host disease or veno-occlusive disease of the liver. We report the case of a 41-year-old man who underwent autologous peripheral blood stem cell transplantation and developed and acute renal failure secondary to a fatal veno-occlusive disease of the liver. Incidence, potential predisposing factors, outcome and possibilities of treatment are reviewed.

Insuficiencia renal aguda secundaria a enfermedad veno-oclusiva hepática en un paciente con trasplante de médula ósea / Acute renal failure secondary to hepatic veno-occlusive disease in a bone marrow transplant patient

La incidencia de insuficiencia renal aguda es frecuente en el trasplante de médula ósea con frecuencias que alcanzan 25-30% en algunos trabajos. Entre las causas de insuficiencia renal aguda está la enfermedad veno-oclusiva hepática, entidad con alta mortalidad y con tratamientos en discusión. Presentamos un caso de enfermedad veno-oclusiva hepática con insuficiencia renal aguda y con evolución desfavorable. Se revisa esta patología centrándose en los criterios diagnósticos, las formas de presentación, las medidas preventivas y tratamientos ensayados

Acute renal failure following bone marrow transplantation is a frequent complication with an incidence ranging 15-30% and with high rates of morbidity and mortality. Numerous potential etiologies can be implicated as chemotherapy regimen, use of nephrotoxic antibiotics, sepsis-induced dammage, cyclosporine toxicity and other especific pathologies as graft-v-host disease or veno-occlusive disease of the liver. We report the case of a 41-year-old man who underwent autologous peripheral blood stem cell transplantation and developed and acute renal failure secondary to a fatal veno-occlusive disease of the liver. Incidence, potential predisposing factors, outcome and posibilities of treatment are reviewed

Early and delayed consolidation chemotherapy significantly improves the outcome of children with intermediate risk acute lymphoblastic leukemia. Final results of the prospective randomized PETHEMA ALL-89 TRIAL.

BACKGROUND AND OBJECTIVES: To evaluate the impact of early and delayed consolidation chemotherapy on the outcome of children with acute lymphoblastic leukemia (ALL) stratified according to risk groups. DESIGN AND METHODS: From 1989 to 1994, 195 children (< or = 15 years old) diagnosed as having ALL (ALL-L3 excluded) in 15 Spanish hospitals entered the prospective, randomized PETHEMA ALL-89 trial. Patients were stratified into low-risk (LR), intermediate-risk (IR) and high-risk (HR) groups according to their initial features and the rate of response to induction therapy. LR-ALL patients were randomized to receive or not early consolidation chemotherapy (C-1). After receiving C-1, IR patients were randomized to receive or not delayed consolidation chemotherapy (C-2). HR patients received C-1 and C-2 chemotherapy. Standard maintenance chemotherapy was administered to all patients for 2 years. High doses of intravenous methotrexate and 12 triple intrathecal doses were given as prophylaxis against central nervous system (CNS) disease. RESULTS: The mean (and standard deviation) age was 6 (4) years and 120 patients were males. Fourteen patients had early pre-B-ALL, 149 common or pre-B-ALL, and 32 T-ALL. Complete remission (CR) was attained in 189 patients (97%), 11 of whom (6%) had a slow response. Risk group stratification after CR was: LR 89, IR 50 and HR 56 patients (including a subset of 26 patients at very high risk). Ten-year event-free survival (EFS) and overall survival (OS) probabilities for the whole series were 58% (95% CI: 52-64%) and 69% (61-77), respectively, with a median follow-up of 8.7 years. Dividing the patients according to risk group, the 10-year EFS and OS probabilities in the LR group were 71% (63-79) and 86% (80-92), respectively; in the IR group 69% (57-81) and 76% (64-88), respectively, and in the HR group 30% (18-42) and 44% (32-57), respectively. For LR patients receiving C-1, EFS and OS were 79% (57-92) and 90% (82-98), respectively, versus 62% (48-76) and 66% (51-81) in patients not receiving C-1 (p= 0.06). For IR patients, EFS and OS were significantly improved in those receiving early and delayed consolidation (EFS 87% (74-88) vs. 52% (41-70), and OS 92% (87-97) vs. 61% (51-71)(p=0.036). Prognostic factors for EFS identified in multivariable analyses were: age >10 years in the LR group (OR 3.5, 95% CI 1.3-9.5, p=0.01), and treatment with C-2 in IR patients (OR 5.0, 95% CI 1.4-17.8, p=0.01). The CNS relapse rate was 4% for all the series (including the HR subset). Tolerance to treatment was good. INTERPRETATION AND CONCLUSIONS: In this study, early consolidation seemed to improve the prognosis of children with LR-ALL, but differences in EFS were not significant. Delayed consolidation had a favorable influence on the outcome of IR-ALL. CNS preventive treatment without cranial irradiation was effective in all the groups of ALL patients.

[Chromatic computerized analysis is an early predictor of cardiovascular risk associated to hypercholesterolemia]. / El análisis computarizado cromático es un predictor precoz de riesgo cardiovascular asociado a hipercolesterolemia.

INTRODUCTION AND OBJECTIVES: Early detection of cardiovascular disease is a major goal of contemporary medicine in efforts to prevent coronary heart disease. The goal of this study was to look for a number of changes that could be detected in the neurons of the 19 Brodman area by means of chromatic computerized analysis (CCA) as a consequence of a neurobiological dysfunction, which induced a failure in the chromatic perception, which, in turn, expressed the existence of hypercholesterolemia through numeric qualification and therefore, a cardiovascular risk. PATIENTS AND METHOD: . We studied 208 patients (Group 1) (153 men and 55 women) with pre-study plasma cholesterol levels in excess of 200 mg/dl. The control group (Group 2) also consisted of 208 subjects (153 men and 55 women) but with a cholesterol level below 200 mg/dl. They were performed by CCA, previously ruling out any systemic or ophthalmological pathology. RESULTS: All global indexes were highly correlated in both groups. The direct relation between cholesterol levels and 19 area, reached a canonical correlation of 0.825 with a sensitivity of 90% and especifity of 93%. The results of the multiple regression taking total cholesterol as a dependent variable and the most significative parameter of CCA, as an independent variable was R = 0.89 (p < 0.001), with a test variability of 81%. CONCLUSIONS: This study determines a strong association between hypercholesterolemia and the visual areas of the cerebral cortex.

Increased conventional chemotherapy does not improve survival in multiple myeloma: long-term results of two PETHEMA trials including 914 patients.

BACKGROUND: Melphalan and prednisone (MP) has been the standard treatment for multiple myeloma (MM) for the last 30 years. Combination chemotherapy at conventional doses has not shown a significant prolongation of survival when compared to MP. There are few data comparing conventional chemotherapy at standard doses with conventional treatment at higher doses. We present the long-term outcome of 914 patients from two randomized trials comparing three different dose intensity regimens. METHODS: From 1 January, 1985 to 31 December, 1989, 487 patients were randomized between MP (melphalan 9 mg/m(2) p.o. and prednisone 60 mg/m(2) days 1-4) and alternating VCMP (vincristine 1 mg i.v. on day 1, cyclophosphamide 500 mg/m(2) i.v. on day 1, melphalan 6 mg/m(2) p.o. on days 1-4, and prednisone 60 mg/m(2) on days 1-4) and VBAP (vincristine 1 mg i.v. on day 1, BCNU and doxorubicin 30 mg/m(2) i.v. each on day 1, and prednisone 60 mg/m(2) on days 1-4). From 1 January, 1990 to 31 May, 1994, 427 patients were randomized between VCMP/VBAP at the above detailed doses (VCMP/VBAP 'SD') and the same regimen increasing the doses of cyclophosphamide and doxorubicin from 500 to 1200 mg/m(2) and from 30 to 50 mg/m(2), respectively (VCMP/VBAP 'HD'). RESULTS: Increasing dose intensity produced a significantly higher partial response rate (31% vs 45% vs 51% for MP, VCMP/VBAP 'SD', and VCMP/VBAP 'HD', respectively; P < 0.01). However, a significantly early death rate was observed in the HD arm (7.7, 7.5 and 12.1% for MP, VCMP/VBAP 'SD', and VCMP/VBAP 'HD', respectively; P = 0.05). Median duration of response (20 vs 18 vs 19 months for MP, VCMP/VBAP 'SD', and VCMP/VBAP 'HD', respectively; P = NS) and median survival (25 vs 31 vs 29 months for MP, VCMP/VBAP 'SD', and VCMP/VBAP 'HD', respectively; P = NS) were similar in the three groups. MP produced a higher degree of thrombocytopenia than combination chemotherapy at standard (P = 0.002) or high dose (P = 0.01), this leading to a significantly higher dose reduction in the MP arm (P < 0.001 and P = 0.003 for VCMP/VBAP 'SD' and VCMP/VBAP 'HD', respectively). CONCLUSION: In these trials the response rate significantly correlated with the regimen intensity. However, no significant differences in response duration and survival were found. This highlights the limited role of conventional chemotherapy in MM and the need for further trials, aimed at determining the impact of new treatment approaches such as high-dose therapy/autotransplantation.

[Characteristics of peritoneal fluid in children with severe diarrhea]. / Características del líquido peritoneal en niños con diarrea grave.

BACKGROUND: A significant number of acute diarrheal diseases produce severe damage to the bowel wall that can lead the patient to death. Peritoneal fluid (PF) analysis has been proposed as a tool to establish an early diagnosis of these injuries. MATERIAL AND METHOD: Thirty patients with a diagnosis of acute diarrhea and suspected enteric perforation or gangrene were submitted to paracentesis. LP was classified according to its appearance immediately after obtention by the surgeon, and determinations of leukocytes, proteins, glucose, and chloride were done. Clinical diagnosis was established during laparotomy or necropsy, or after an uneventual recovery. Data were analyzed by means of diagnostic test statistics. RESULTS: Clear and yellow PF was considered a sign of the absence of enteric perforation or gangrene, with a sensitivity (S) of 87%, specificity (SP) and positive predictive value (PPV) of 100%, and a negative predictive value (NPV) of 91.6%, with a predictive accuracy (PA) of 95%. A bloody PF was considered a sign of enteric gangrene, with an S of 54%, SP and PPV of 100%, and NPV of 72% (PA 80%). More than 1000 leukocytes per mm3 of PF were considered an sign of some kind of macroscopic injury of the bowel wall, with an S of 68%, a SP of 88%, a PPV of 91% and a NPV of 61% (PA 76%). PF glucose level less than 40 mg/dl was considered a sign of enteric gangrene (S 42%, SP 78%, PPV 71%, NPV 50%, with a PA of 57%), and also of bacteria viability in PF cultures (S and NPV 100%, SP 80%, PPV 67% and PA of 86%). Chloride levels greater than 90 meq/L were considered a sign of enteric perforation or gangrene, with an S and NPV of 100%, a SP of 60%, and a PPV de 82% (PA 86%). CONCLUSION: PF analysis is of great value in the evaluation of the child with acute severe diarrhea in which enteric perforation or gangrene is suspected. A clear yellow fluid with less than 1000 leukocytes per mm3, more than 40 mg/dL of glucose, and less than 90 meq/L of chloride suggest that enteritis has not caused irreversible injury to the bowel wall.

[Male predominance and birth weight in hypertrophic pyloric stenosis]. / Predominio masculino y peso al nacer en estenosis hipertrófica del píloro.

BACKGROUND: Infantile hypertrophic pyloric stenosis (IHPS), although fairly frequent, is still an enigmatic disease. Its incidence is increased among relatives of a case and among infants of male sex (M) and of high birthweight. The purpose of this paper is to analyze the pattern of IHPS M predominance according to birthweight (BW). METHODS: 115 consecutive cases charts of IHPS were reviewed and stratified by gender and BW rank (500 g each, beginning at 1,500 g and ending at 3,500 g). Statistical analysis was done by means of chi square and comparation of proportions tests. RESULTS: M predominance was not observed in IHPS patients with a BW of 2,500 g or less (n = 11, 6M). Female infants (F) did not increase their number of cases as the BW rose, but M did, reaching an 8.8 to 1 M to F ratio among those with a BW of 3,500 9 or more (p < 0.005). The proportion of M with a BW of 3,000 g or more was significantly higher than in F (0.826 vs. 0.521, p < 0.005). CONCLUSIONS: In IHPS, the excess of M cases, which is responsible of the M/F disparity, is present only among newborns with a BW of 3,000 g or more. The disease does not show this relation to BW in F.

[Langerhans cell histiocytosis in the central nervous system: meningeal involvement]. / Histiocitosis de células de Langerhans en el sistema nervioso central: afectación meníngea.

The clinical manifestations of Langerhans cell histiocytosis in the central nervous system include not only the classical involvement of the hypothalamus-hypophyseal axis, but also of other anatomic locations, with the corresponding variability of symptoms. We report here two patients with meningeal lesions. In both patients, the onset of the disease was systemic, and neurological symptoms developed some years later. Imaging studies, particularly magnetic resonance, are very sensitive tools for the diagnosis and follow-up of these lesions. The natural history of this disease is still poorly understood. In this paper we related the clinical manifestations to the morphological changes observed in imaging studies.

[Chronic prescription of drugs for geriatric patients at an urban health center]. / Prescripción crónica de fármacos en pacientes geriátricos de un centro de salud urbano.

OBJECTIVE: To find the chronic prescription of medication in older people, associated variables and its quality. DESIGN: Observation, descriptive-crossover study. SETTING: Urban health district. PATIENTS: Sample stratified in age and sex groups of 385 people of 65 and over registered at the health centre and not in institutions. MEASUREMENTS AND MAIN RESULTS: Social and demographic data, self-perception of health and functional capacity were obtained through interview; and pathology and medication records, from the clinical records and authorized medication cards. 349 people, average age 73 (SD +/- 6.5), were interviewed. There were 210 women and 139 men. 12% perceived their health as bad/very bad. Barthel's index and the Lawton scale were disturbed in 13.8% and 30.4%, respectively. 93% suffered some chronic pathology (average 2.7). 81.4% habitually took medication (average 3.1). The most commonly consumed drugs belonged to the cardiovascular (32%), nervous system (21%) and digestive apparatus and metabolism (17%) groups. For the first group, the main drugs were ACEIs and diuretics; for the second, analgesics and neuroleptics; for the third, antacid and antiulcer drugs. 86% had high intrinsic value, the most prescribed drugs of those with low intrinsic value belonged to the antivaricose, cerebral and peripheral vasotherapy, and urological drugs groups. Multiple medications was related significantly to having more than two chronic pathologies (OR = 7.89, 95% CI 4.40-14.15) and self-perception of worse health (OR = 2.51, 95% CI 1.13-5.59). CONCLUSION: The elderly persons with a greater number of pathologies and perception of worse health took more medication. We thought that our quality of prescription was acceptable, although we should review the indications for neuroleptics and reduce prescription for medication of low therapeutic value.

[Comparison of chemotherapy CHOP vs. CHOP/VIA in the treatment of aggressive non-Hodgkin's lymphoma: a randomized multicenter study of 132 patients. The PETHEMA group. Program for Study and Therapeutics of malignant hemopathies. Spanish Association of Hematology and Hemotherapy]. / Comparación de la quimioterapia CHOP frente a CHOP/VIA para el tratamiento de los linfomas no hodgkinianos agresivos: estudio multicéntrico aleatorizado en 132 pacientes. Grupo PETHEMA. Programa para el Estudio y la Terapéutica de las Hemopatías Malignas. Asociación Española de Hematología y Hemoterapia.

BACKGROUND: To compare standard chemotherapy CHOP (cyclophosphamide, adriamycin, vincristine and prednisone) with the regimen CHOP/VIA (VP-16, iphosphamide and cytarabine) in terms of response to therapy, response duration, survival and toxicity in patients with aggressive lymphoma. PATIENTS AND METHODS: 132 patients (84 males and 48 females; median age, 55 years) were included from 12 Spanish Institutions, diagnosed of non-Hodgkin's lymphoma of intermediate or high grade, in stages II-IV and previously untreated. Patients were randomized to receive CHOP or CHOP/VIA. RESULTS: After excluding 14 not assessable cases, 62 patients (52.5%) received CHOP, and 56 (47.5%) CHOP/VIA. No significant differences were found on main prognostic factors between such groups. Response was assessable in 114 cases (CHOP: 61; CHOP/VIA: 53) 39 patients (64%) receiving CHOP achieved complete response (CR), and 2 (3%) partial response (PR), whereas in the CHOP/VIA group CR and PR rates were 63% (34/53), and 7% (4/53), respectively. 14 patients (36%) treated with CHOP and 12 (35%) treated with CHOP/VIA eventually relapsed, with an actuarial risk of relapse at 36 months of 43% and 40%, respectively. Median survival was 37 months. No differences were found between both therapeutic groups, with an overall survival at 36 months from diagnosis of 53.5% (CI 95%: 40-67) for CHOP and 48% (CI 95%: 34-62) for CHOP/VIA. Finally, toxicity was not different for both arms. CONCLUSION: In the present study in patients with aggressive NHL chemotherapy regimens CHOP and CHOP/VIA showed similar results in terms of response, response duration, survival and toxicity.

A new breast cancer cell line of epithelial origin is tumorigenic in athymic mice.

We have established a newly derived breast cell line, called G8. This line was obtained by means of the neoplastic transformation of murine breast cells through exposure to the carcinogen NMU and its subsequent inoculation in athymic nude mice. This cell line is highly tumorigenic in nude mice. The tumors that developed in the mice were mammary adenocarcinomas. The morphological and ultrastructural pattern suggested that these cells are of epithelial origin. Immunocytochemical studies revealed that the cells express desmoplakin, vimentin, epithelial membrane antigen, fibronectin and actin. The possibility of maintaining this cell line in vivo by means of xenografts provides very valuable material for breast cancer research, as not only does tumor growth in vivo provide the ideal material for the testing of new therapies, but it also enables the study of various important interactions between the tumor and the host tissues including tumor-stroma interactions such as angiogenesis.