Prognostic value of lymph node micrometastasis in patients with colorectal cancer in Dukes stages A and B (T1-T4, N0, M0).

BACKGROUND: 30% of patients with colorectal cancer (CRC) in Dukes stages A and B (T1-T4, N0, M0) present tumor recurrence and die after 5 years follow up. This unexpectedly poor evolution might be attributable to the presence of lymph node micrometastasis undetected in routine examination with haematoxilin-eosine (H&E). OBJECTIVE: To assess the presence of undetected micrometastasis. PATIENTS AND METHODS: we conducted a retrospective study of the locoregional lymph nodes in 85 patients operated for CRC in Dukes stages A and B (T1-T4, N0, M0), using immunohistochemistry with anticytokeratin antibodies AE1/AE3. In this descriptive, inferential bivariant and survival study, we analyzed different risk factors, including local infiltration T1/T4, Dukes A/B, number of dissected lymph nodes, vascular invasion, micrometastasis, tumor recurrence and death in the context of the presence or absence of micrometastases. RESULTS: Dukes stage and neoplastic angioinvasion are influential in patient prognosis; however, lymph node micrometastases were not associated with a poorer outcome of CRC. CONCLUSIONS: Locorregional lymph node micrometastases detected with anticytokeratine antibodies AE1/AE3 in Dukes A and B CRC patients are not associated with reduced survival.

Valor pronóstico de las micrometástasis linfoganglionares en pacientes con cáncer colorrectal en estadios A y B de Dukes (T1-T4, N0, M0) / Prognostic value of lymph node micrometastases in patients with colorectal cancer in Dukes stages A and B (T1-T4, N0, M0)

Introducción: un 30% de los pacientes con cáncer colorrectal(CCR) en estadios A y B de Dukes (T1-T4, N0, M0) presentan recidivatumoral y/o fallecen a los 5 años. Esta inesperada malaevolución, en casos presumiblemente curados podría deberse, entreotras causas, a la presencia de micrometástasis linfoganglionaresno detectadas en el estudio de rutina: hematoxilina-eosina(H&E).Objetivo: determinar si la presencia de micrometástasis linfoganglionaresdetectadas mediante inmunohistoquímica con anticuerposanticitoqueratina AE1/AE3, influyen en la evolución delCCR.Pacientes y métodos: se han estudiado los ganglios linfáticoslocorregionales de 85 pacientes con CCR en estadios A y Bde Dukes (T1-T4, N0, M0), mediante técnicas de inmunohistoquímicacon anticuerpos anticitoqueratinas AE1/AE3, para poner demanifiesto la presencia de micrometástasis. Se ha realizado un estudiodescriptivo, inferencial bivariante y de supervivencia, segúndistintos factores de riesgo, centrado en la presencia o no de micrometástasis.Resultados: hemos observado que el estadio de Dukes y laangioinvasión neoplásica son factores que influyen en el pronósticode estos pacientes. Sin embargo, no se ha demostrado que lapresencia de micrometástasis linfoganglionares se asocie a unapeor evolución en el CCR.Conclusiones: las micrometástasis linfoganglionares locorregionalesdetectadas mediante anticuerpos anticitoqueratinaAE1/AE3, en pacientes con CCR en estadios A y B de Dukes, nose asocian a una menor supervivencia(au9

Background: 30% of patients with colorectal cancer (CRC) inDukes stages A and B (T1-T4, N0, M0) present tumor recurrenceand die after 5 years follow up. This unexpectedly poor evolutionmight be attributable to the presence of lymph node micrometastasisundetected in routine examination with haematoxilin-eosine(H&E).Objective: to assess the presence of undetected micrometastasis.Patients and methods: we conducted a retrospective studyof the locoregional lymph nodes in 85 patients operated for CRCin Dukes stages A and B (T1-T4, N0, M0), using immunohistochemistrywith anticytokeratin antibodies AE1/AE3. In this descriptive,inferential bivariant and survival study, we analyzed differentrisk factors, including local infiltration T1/T4, Dukes A/B,number of dissected lymph nodes, vascular invasion, micrometastasis,tumor recurrence and death in the context of the presenceor absence of micrometastases.Results: Dukes stage and neoplastic angioinvasion are influentialin patient prognosis; however, lymph node micrometastaseswere not associated with a poorer outcome of CRC.Conclusions: locorregional lymph node micrometastases detectedwith anticytokeratine antibodies AE1/AE3 in Dukes A andB CRC patients are not associated with reduced survival(AU)

Modelling the effect of ascorbic acid, sodium metabisulphite and sodium chloride on the kinetic responses of lactic acid bacteria and yeasts in table olive storage using a specifically implemented Quasi-chemical primary model.

The goal of this work was to apply the Quasi-chemical primary model (a system of four ordinary differential equations that derives from a hypothetical four-step chemical mechanism involving an antagonistic metabolite) in the study of the evolution of yeast and lactic acid bacteria populations during the storage of Manzanilla-Aloreña table olives subjected to different mixtures of ascorbic acid, sodium metabisulphite and NaCl. Firstly, the Quasi-chemical model was applied to microbial count data to estimate the growth-decay biological parameters. The model accurately described the evolution of both populations during storage, providing detailed information on the microbial behaviour. Secondly, these parameters were used as responses and analysed according to a mixture design experiment (secondary model). The contour lines of the corresponding response surfaces clearly disclosed the relationships between growth and environmental conditions, showing the stimulating and inhibitory effect of ascorbic acid and sodium metabisulphite, respectively, on both populations of microorganisms. This work opens new possibilities for the potential use of the Quasi-chemical primary model in the study of table olive fermentations.

El tiempo de psicosis no tratada como factor predictivo y pronóstico en el curso de los primeros episodios psicóticos / Duration of untreated psychosis as predictive and prognostic factor in the course of first episode psychosis

Introducción. El tiempo de psicosis no tratada ha estado en el punto de mira de numerosos artículos que intentan clarificar si podría resultar ser uno de los factores que condicionaría el pronóstico final de la enfermedad psicótica. Material y métodos. Presentamos un estudio realizado en 90 pacientes con un primer episodio psicótico que no habían tomado medicación previamente en el que se evaluaron los posibles factores pronósticos que influirían en la evolución de la enfermedad. A tal efecto se utilizó un protocolo que incluía las siguientes escalas: PANSS, escala de valoración global de estrés psicosocial (DSM IIIR), evaluación de actividad global (GAF-EEAG), impresión clínica global (ICG), escala de Montgomery-Asberg para la depresión, escala de manía de Young, escala de movimientos anormales, escala UKU para síntomas extrapiramidales y la escala de ajuste premórbido (Cannon-Spoor). El seguimiento se realizó durante 1 año con evaluaciones cada 3 meses. Resultados. Tras el análisis estadístico de los datos se concluyó que un tiempo de psicosis prolongado no se asociaba en nuestra muestra a una peor evolución de la enfermedad. Los únicos factores relacionados con dicho pronóstico resultaron ser el ajuste premórbido y el tipo de comienzo de la enfermedad. Así, pacientes con un mejor ajuste premórbido y un inicio de enfermedad agudo presentaban una mejor evolución. Conclusiones. Nuestro trabajo muestra una evidencia más en favor de la independencia del pronóstico final y el tiempo de psicosis sin tratar

Introduction. Recently, many studies have focused on the duration of untreated psychosis (DUP) in order to clarify if DUP could be one of the factors that would influence prognosis of psychotic disease. Material and methods. We present a one year follow - up study with 90 medication native, first episode psychotic patients. The likely prognosis factors that could influence in the outcome of the disease were measured. Therefore, we used a protocol including the following scales: PANSS, Psychosocial Stress Global Assessment scale (DSM IIIR), Global Assessment of Functioning scale (GAF-EEAG), Clinical Global Impression (CGI), Montgomery-Asberg scale for the depression, Young mania rating scale, abnormal involuntary movements scale, UKU scale for extrapyramidal symptoms and Premorbid Adjustment scale (Cannon-Spoor). Assessments were made every three months for 1 year. A statistical analysis of data was performed. Results. As a result, it was concluded that there was no relationship between a long duration untreated psychosis and a worse outcome of the illness in our sample. The only related factors with the prognosis were premorbid adjustment and the type of disease onset. Hence, the patients with a better premorbid adjustment and an acute onset of psychosis had a better outcome. Conclusion. Our study represents more evidence in favor of the independence of DUP and disease outcome

[Risperidone in the early treatment of first-episode psychosis: a two-year follow-up study]. / Tratamiento precoz con risperidona de primeros episodios psicóticos: dos años de seguimiento.

INTRODUCTION: The main goals of any antipsychotic pharmacological treatment are the improvement of negative, positive, behavioral, affective and cognitive symptoms related to psychotic disorders, a good side-effects profile and again an improvement in patients quality of life and social - environmental relationships. The development of new atypical antipsychotic drugs has opened new therapeutical bias. Nevertheless only a few clinical studies have been developed studying new atypical antipsychotic role on first psychotic episodes. MATERIALS AND METHODS: We developed an open, observational, multicenter and prospective study in order to evaluate effectiveness, tolerability and security of early treatment with risperidone in patients affected by a first psychotic episode (DSM IV diagnostic criteria) and the long-term effect of this treatment on the clinical evolution of these patients. We recruited 436 patients (age 18-65) who had never before received any antipsychotic drug. RESULTS: The most prevalent diagnosis was schizophrenia and other psychotic disorders no substance abuse related (90.6%). The average dosage of risperidone used during this study was 5.12 mg/d and most of the patients remained on risperidone monotherapy. We observed a statistically significant improvement in psychopathological scale PANSS (total; positive, negative and general subescales), Global Activity Scale (EEAG) and Clinical Global Impression Scale (CGI) scores from first month treatment on. This improvement was maintained during the two-year follow up period. We also observed an improvement in Young Mania Scale and Hamilton Depression Scale scores sustained from first month up to the end of the study. The number of patients hospitalized importantly decreased and most of them (95.9%) were ambulatory patients at the end of the study. We also observed a decrease on UKU neurological side-effects scale scores (including parkinsonism) from sixth month up to the end of the study and from basal to final evaluation. Other side effects related were amenorrhea (2.1%) and weight gain (1.6%). Investigators' opinion about risperidone efficacy and tolerability was good or very good in 84.4% and 91.6% respectively. DISCUSSION: This study concludes that risperidone is an effective, well tolerated an secure antipsychotic drug in the treatment of patients with a first psychotic episode, and in our opinion is a first rank therapeutical alternative in these kind of patients.

Tratamiento precoz con risperidona de primeros episodios psicóticos: dos años de seguimiento / Risperidone in the early treatment of first-episode psychosis: a two-year follow-up study

Introducción. Entre los objetivos de todo tratamiento antipsicótico se encuentran la mejoría tanto de los síntomas psicóticos positivos y negativos como de los síntomas conductuales, afectivos y cognitivos que acompañan a la mayor parte de las psicosis, todo ello con la menor incidencia posible de efectos adversos y con la intención de mejorar la calidad de vida del paciente y sus relaciones con el entorno. Con el advenimiento de los nuevos antipsicóticos atípicos se ha venido a ampliar el horizonte del tratamiento farmacológico de las psicosis. Sin embargo, se han realizado pocos estudios clínicos prospectivos sobre los efectos de los fármacos antipsicóticos en pacientes afectados por un primer episodio psicótico. Material y método. Nuestro objetivo era mediante un estudio multicéntrico, observacional, abierto y prospectivo valorar la efectividad, tolerabilidad y seguridad del tratamiento precoz con risperidona en pacientes afectados por un primer episodio psicótico (criterios DSM IV), así como evaluar a largo plazo (dos años) el efecto de dicho tratamiento en la evolución clínica de estos pacientes. Se incluyeron 436 pacientes de entre 18 y 65 años a los que se instauró tratamiento antipsicótico por primera vez. Resultados. El diagnóstico realizado con mayor frecuencia fue el de esquizofrenia y otros trastornos psicóticos no inducidos por sustancias (90,6 por ciento). La dosis media de risperidona utilizada a lo largo del estudio fue de 5,12 mg/día, permaneciendo la mayoría de los pacientes en monoterapia con dicho fármaco. La mejoría de estos pacientes en las escalas PANSS (psicopatología total y subescalas positiva, negativa y general), de actividad global del paciente (EEAG) e impresión clínica global (ICG) fue estadísticamente significativa a partir del primer mes del tratamiento y mantenida durante los dos años de seguimiento. También se observó una mejoría en las escalas de manía de Young y de depresión de Hamilton de forma sostenida desde el primer mes y durante los dos años de evaluación. Se redujo significativamente el número de pacientes hospitalizados, manteniéndose en régimen ambulatorio un 95,9 por ciento de los pacientes a los dos años de tratamiento y en la escala UKU de efectos adversos de tipo neurológico se observó una disminución significativa de la puntuación de los síntomas parkinsonianos a partir del sexto mes de tratamiento y entre la visita basal y final. Otros efectos adversos notificados fueron la amenorrea (2,1 por ciento) y el aumento de peso (1,61 por ciento), siendo la opinión global del investigador sobre la eficacia y la tolerancia de la risperidona buena o muy buena en el 84,4 por ciento y 91,6 por ciento de los casos respectivamente. Discusión. Según los resultados obtenidos en el presente estudio podemos concluir que la risperidona es un antipsicótico que presenta un buen perfil de efectividad clínica, de tolerancia y de seguridad en el tratamiento de los primeros episodios psicóticos, constituyendo una alternativa farmacológica de primera línea en este tipo de trastornos (AU)

Community health services in a rural island setting to complement medical education in the Philippines

This project was conducted to upgrade health care in a rural community and to help realize a more realistic medical education tailored to meet the needs of a developing country. A maternal and child health program was undertaken in Marinduque based on its rural settingPreliminary findings showed an increased consciousness of health and health education was observed in the community. Medical interns and residents expressed a greater sense of responsibility, understanding, interest, and compassion for the less privilege resulting from community involvement

Pharmaceutical services in the United States Army.

The status of pharmaceutical services in the United States Army is described. The Army Medical Department (AMEDD) has 157 commissioned pharmacy officers and 399 civilian pharmacists working in the United States and overseas. Pharmaceutical services are provided from fixed medical treatment facilities on Army installations and, during war and other field operations, field hospitals. Reductions in personnel and facility closures have helped align the AMEDD with the size of the Army's activeduty force, but there has been only a 15% reduction in the number of eligible beneficiaries. Measures such as the interservice TRICARE program have been implemented to help meet the continued high demand for pharmaceutical services cost-effectively. Army pharmacy is similar to civilian pharmacy, except that Army hospitals often include high-volume outpatient pharmacies not usually found in civilian institutions. Pharmacists are being given direct patient care roles on multidisciplinary teams. Army pharmacists participate in field exercises so that they will be prepared to provide services under combat conditions. The AMEDD trains its own pharmacy technicians in a highly structured 18-week course. A triservice Pharmacoeconomic Center (PEC) has been established with the goal of providing prescribers with the tools for making cost-effective decisions about drug therapy, including a formulary. Army pharmacy officers have broad opportunities to further their education and training. In preparing for the next century, Army pharmacists need to continue to prove their value to the AMEDD, the Army, and the Department of Defense.

[Hemorrhagic diathesis as initial clinical manifestation of celiac disease]. / Diátesis hemorrágica como manifestación clínica inicial de la enfermedad celíaca.

Coeliac disease is the most frequent malabsortive syndrome in daily practice. However, its true prevalence is not exactly known. The symptoms vary from patient to patient, ranging from the classic presentation with diarrhea, weight loss and fatigue to oligosymptomatic forms, being the latter more common in adults. We report two patients in which urinary and skin spontaneous hemorrhage were the only symptoms, and led to the diagnosis. We insist on the importance of considering the diagnosis of coeliac disease in patients with this kind of clinical manifestations. The early diagnosis will allow us to reduce both the morbidity and mortality in coeliac patients.

Mesotelioma maligno difuso : presentación de 10 casos y revisión de literatura / Study of 10 Cases in Malignant Mesothelioma Diffuse and Revition of Literature

Se revisó la historia clínica y el material de las biopsias y de la autopsia (un paciente) de 10 casos de mesotelioma maligno difuso, que fueron diagnosticados histológicamente en el Complejo Hospitalario Dr. Arnulfo Arias Madrid de la Caja de Seguro Social. De estos diez casos, 8 eran hombres y 2 mujeres, entre los 22 y 73 años de edad. Por sus ocupaciones y sitio de procedencia no se hizo evidente la exposición al asbesto. El cuadro clínico en todos ellos era semejante al descrito en esta variedad de casos; los hallazgos radiológicos fueron : efusión pleural, fibrosis pulmonar y masa pulmonar. Para hacer el diagnóstico definitivo fue necesario recurrir a un procedimiento invasivo. Los exámenes de esputo, los lavados bronquiales y las biopsias endobronquiales no ayudaron en el diagnóstico. La citología del líquido pleural y del líquido ascítico dió el diagnóstico de malignidad. En cuatro casos el diagnóstico se hizo por medio de la biopsia pleural cerrada, en otros cinco casos se practicó la toracotomía y biopsia a cielo abierto; y en el último, fue necesario recurrir a la autopsia. Con el objeto de evaluar estos casos se revisaron las preparaciones histológicas originales y se realizaron preparaciones adicionales de los bloques; se hizo lo mismo con el material de la autopsia. Se corroboró el diagnóstico hecho por los patólogos y se registró de acuerdo con la clasificación de la AFIP

False-negative gallbladder scintigram in acute cholecystitis.

Two cases of acute cholecystitis are described, in which the gallbladder was visualized in the hepatobiliary scintigram. While most cases of acute cholecystitis are due to cystic-duct occlusion by calculi, in a small percentage the acute gallbladder inflammation results from other pathogenic mechanisms. These cannot be excluded by gallbladder scintigram alone.

Value of routine abdominal nuclide angiography as part of liver scan.

Routine performance of a dynamic study as part of the liver scan results in a significant rate of discovery (19%) of intraabdominal abnormalities such as aortic aneurysms, cystic masses, ischemic intestinal diseases and collateral circulation. The procedure aids in the demonstration of space-occupying hepatic lesions and is often decisive in the diagnosis of chronic liver disease. Alterations in the perfusion of the liver as reflected in the dynamic scan may have a predictive value in the course of alcoholic hepatic disease as to the ultimate development of cirrhosis. Therefore, the dynamic study assumes an important role in the management of the alcoholic patient.

Hepatic tumors of long duration with eventual metastases. Two cases of leiomyosarcomatosis possibly arising from hamartomas of liver.

The cases of two patients who had hepatic tumors of long duration interpreted as hamartomas in whom, after many years, widespread metastases of malignant smooth muscle cells developed in a pattern of "carcinomatous lymphangitis" in the lungs are described. In one of the cases calcification of the hepatic nodules was prominent. The smooth muscle origin of the malignant cells was established only on electron microscopic examination. These cases appear similar to others variously reported as mixed tumors, hepatic cell carcinomas, and mesotheliomas.