[Prevention of thromboembolism in bariatric surgery]. / Prevencíon del tromboembolismo en cirugía bariátrica.

Disease thromboembolic (ETEV) is one of the major complications that can occur after surgery, and is the leading cause of death in the postoperative period of Bariatric Surgery. Among other factors, should be aware that these patients are at additional risk of ETEV due to own obesity (IMC > 30). After Bariatric Surgery the risk of thromboembolic events varies according to the surveyed series. In general, it is estimated that danger EP (pulmonary embolism) is 0.8% and DVT (deep vein thrombosis) of 1.7%. ETEV global mortality estimates of 0.1 to 2%.

AM3, a natural glycoconjugate, induces the functional maturation of human dendritic cells.

BACKGROUND AND PURPOSE: Dendritic cells (DCs) are dedicated antigen-presenting cells able to initiate specific immune responses and their maturation is critical for the induction of antigen-specific T-lymphocyte responses. Here, we have investigated the effects of Inmunoferon-active principle (AM3), the active agent of a commercial immunomodulatory drug, on human monocyte-derived DCs (MDDCs). EXPERIMENTAL APPROACH: MDDCs derived from healthy and hepatitis C virus (HCV)-infected patients were stimulated with AM3. We analysed the expression of cell surface proteins by flow cytometry, that of cytokine production by ELISA, and the expression of chemokines and chemokine receptors by RNase protection assays. T-lymphocyte proliferation was assessed in mixed lymphocyte reactions, protein expression by western blot and luciferase-based reporter methods, and Toll-like receptor (TLR)-blocking antibodies were employed to analyse TLR activity. KEY RESULTS: In MDDCs, AM3 induced or enhanced expression of CD54, CD83, CD86, HLA-DR, chemokines and chemokine receptors, interleukin (IL)-12p70 and IL-10. Furthermore, AM3 stimulated MDDCs to increase proliferation of allogenic T cells. AM3 triggered nuclear translocation of NF-kappaB and phosphorylation of p38 mitogen-activated protein kinase. AM3 promoted NF-kappaB activation in a TLR-4-dependent manner, and blocking TLR-4 activity attenuated the enhanced expression of CD80, CD83 and CD86 induced by AM3. AM3 enhanced the expression of maturation-associated markers in MDDCs from HCV-infected patients and increased the proliferation of T lymphocytes induced by these MDDCs. CONCLUSIONS AND IMPLICATIONS: These results underline the effects of AM3 in promoting maturation of MDDCs and suggest that AM3 might be useful in regulating immune responses in pathophysiological situations requiring DC maturation.

[Evoked potentials in a population of children below 1,500 grams at birth: a description and probabilities]. / Potenciales evocados en una población de niños menores de 1.500 gramos: descripción y probabilidades.

INTRODUCTION: Bioelectrical behaviour was studied in a group of low birth weight children. AIM: To evaluate whether the characteristics of the waves of the brain potentials in these children, who weighed less than 1500 g at birth and experienced anomalous circumstances and events during their perinatal period, would help reach an early diagnosis of the possible developmental disorders they might suffer later on in life. SUBJECTS AND METHODS: Both visual and auditory cerebral evoked potentials were recorded in a group of children born underweight and the results were compared with the findings from another group of healthy children who were born in normal physiological conditions and were apparently free of any kind of pathology. RESULTS: In the waves and locations that were examined, the problem group displayed latencies that were longer than those of the control group; in contrast, no statistically significant differences were found in the amplitude, regardless of the location. Low gestational age and lower weight made latencies longer, but no relationship was found between latencies and the other perinatal features that were studied. CONCLUSIONS: Children with low weight at birth have slower wave latencies than normal children. This slowing, which is inversely proportional to the weight and weeks of gestation, is considered to be an anomalous sign that could be related to brain immaturity, delayed development or to disorders affecting myelination. Moreover, the amplitude, which has received far less attention from researchers, is usually shorter in these processes, although in our study we found no differences with the group of healthy children--only very slightly in the P300, in the weeks and the weight, and the N100 only in one location with respect to weight. Since these children usually have developmental disorders, the use of evoked potentials could be a very useful tool in their detection and ensuing therapy.

A pilot study on the endoscopic surveillance of colorectal dysplasia and cancer in long-standing ulcerative colitis.

INTRODUCTION: Patients with ulcerative colitis (UC) have a greater risk of developing colorectal cancer (CRC) when compared to the general population. Epithelial dysplasia comes before this neoplasm, and thus endoscopic surveillance is recommended to these patients. This pilot study aims at establishing the incidence of dysplasia and CRC in patients with long-standing UC in our hospital. MATERIAL AND METHODS: This is a prospective observational study performed in patients with a definite diagnosis of UC for more than 8 years. These patients were encouraged to enroll in an endoscopic surveillance program for CRC. All patients underwent colonoscopy and multiple biopsies every 18 to 24 months in order to detect epithelial dysplasia. RESULTS: Thirty-nine patients were included from January 1994 to December 2003. Half of them were males. Mean age was 52 +/- 13 years. Mean duration of UC was 15 +/- 8 years. Thirteen (35%) patients had left colitis, and 26 (65%) had pancolitis or extensive colitis. The presence of mild dysplasia was detected in four patients, on two occasions in one of them (13%; 95% CI: 6.1-33.5); the incidence of mild dysplasia was 1.3% patients per surveillance year. No severe dysplasia or CRCs were identified. CONCLUSION: The incidence of dysplasia in our area is lower than expected, and does not support surveillance programs for these patients. However, no definite conclusions may be drawn from such a small number of patients.

Maintenance of T1 response as induced during PEG-IFNalpha plus ribavirin therapy controls viral replication in genotype-1 patients with chronic hepatitis C.

OBJECTIVES: To analyze the T1/T2 cytokine profile in CD8 T cells from peripheral blood mononuclear cells from patients with genotype-1 CHC during treatment with pegylated interferon (Peg-IFN) alpha2a plus ribavirin (RBV). To correlate Th1/Th2 balance with virological response. PATIENTS AND METHODS: In this prospective longitudinal study, a total of 28 naïve genotype-1 CHC patients received Peg-IFNalpha2a (180 microg/week) plus RBV (1-1.2 g/day) for 48 weeks. All patients (mean age 45 +/- 8 years) completed treatment and follow-up: 12 (43%) achieved a sustained virological response (SVR), 13 relapsed after end of treatment (47%), and only 3 (10%) were non-responders. Sixteen healthy controls were also analyzed (mean age 39 +/- 17 years). The production of IL-4, IFNgamma, and TNFalpha by CD8 T cells was measured by intracytoplasmic detection using flow cytometry in both resting and stimulated cells with a phorbol ester. STATISTICS: Student's t test for independent values, chi2 test, and ANOVA test were used; relapsers and non-responders were joined to achieve a higher statistical power. RESULTS: At third month during treatment, phorbol ester-stimulated-IL-4 levels tend to be lower in patients who presented with SVR versus those who did not (0.97 vs 2.58; p = 0.1). No statistically significant differences were found in IFNgamma and TNFalpha levels at month 3. At EOT, the stimulated-IFNgamma production was significantly higher in patients with SVR (20 vs. 8; p < 0.05). Conversely, IL-4 production was higher in NR patients although these data did not reach statistical significance (p < 0.1). No significant differences were found in TNFalpha (14 vs. 7; p < 0.2). CONCLUSIONS: Cytokine T1 induced-response maintenance during combination treatment, measured as IFNgamma production by CD8+ T lymphocytes, is associated with SVR and suggests the replication control and later clearance of patients infected by genotype-1 HCV.

Evaluation of 3 different tests for the detection of stool antigens to confirm Helicobacter pylori eradication after treatment. A pilot study.

INTRODUCTION: Recently, several new diagnostic methods aimed to detect Helicobacter pylori stool antigens have been developed. Our aim was to evaluate the accuracy of 3 different stool tests to confirm H. pylori eradication. PATIENTS AND METHODS: Twenty-six patients received H. pylori eradication treatment. Eradication was confirmed with 13C-urea breath test 6-8 weeks later, when stool samples were analyzed by polyclonal (Premier-Platinum-HpSATM), monoclonal (Amplified-IDEIATM-HpStARTM), and rapid test (ImmunoCard-STAT-HpSATM). RESULTS: H. pylori was eradicated in 85% of the cases. Sensitivity, specificity, positive predictive value and negative predictive value with the polyclonal test were: 25%, 91%, 33% and 87%. Corresponding results with the monoclonal test, using the cut-off point recommended by the manufacturer, were 100%, 46%, 25% and 100%. However, the best cut-off point in our study had 100% sensitivity and 91% specificity. The area under ROC curve for the polyclonal and the monoclonal tests was 0.65 and 0.95. Diagnostic accuracy with the rapid test was 75%, 90%, 60% and 95%. CONCLUSION: Neither the polyclonal stool antigen test nor the rapid stool antigen test can be recommended to confirm H. pylori eradication after treatment. The monoclonal test has better diagnostic accuracy, although more studies are necessary to definitively recommend its use for the confirmation of H. pylori eradication success.

Evaluation of three different tests for the detection of stool antigens to diagnose Helicobacter pylori infection in patients with upper gastrointestinal bleeding.

AIM: To evaluate the accuracy of several methods aimed to detect Helicobacter pylori stool antigens in patients with upper gastrointestinal bleeding. METHODS: Thirty-four patients with upper gastrointestinal bleeding because of peptic ulcer were included. The first stool sample during hospitalization was collected, and stool antigens were determined with: polyclonal enzyme-linked immunosorbent assay (Premier-Platinum-HpSA); monoclonal enzyme-linked immunosorbent assay (Amplified-IDEIA-HpStAR); and rapid monoclonal immunochromatographic test (ImmunoCard-STAT HpSA). A patient was considered infected when H. pylori was diagnosed with invasive tests (rapid urease test or histology) or with (13)C-urea breath test. When all tests were negative, a new breath test was repeated after stopping proton pump inhibitors. RESULTS: All patients were infected and, therefore, only sensitivity of the tests could be calculated: polyclonal enzyme-linked immunosorbent assay (74%), monoclonal enzyme-linked immunosorbent assay (94%), and rapid monoclonal immunochromatographic test (60%; concordance between the two observers was high, kappa = 0.9). Neither the presence of maelena nor the delay in obtaining stool samples explained false negatives. CONCLUSIONS: Neither the polyclonal enzyme-linked immunosorbent assay stool antigen test nor the rapid immunochromatographic stool antigen test can be recommended to diagnose H. pylori infection in patients with upper gastrointestinal bleeding. However, the monoclonal enzyme-linked immunosorbent assay stool antigen test is highly sensitive for detecting the infection in patients with this complication, although more studies are necessary to evaluate the specificity of the method.

[A study of evoked potentials in the brains of very low birth weight infants]. / Estudio de potenciales evocados cerebrales en niños de muy bajo peso al nacimiento.

INTRODUCTION: This work studies the behaviour of the N200 and P300 waves of the brain evoked potentials (BEP) in a group of very low birth weight infants and results are compared with a second group of children whose weight was normal at birth. AIMS: The objective of this study was to determine whether the N200 and, more especially, the P300 waves in children under the age of 3 could be used to assess the development and prognosis of their disorders. PATIENTS AND METHODS: BEP were performed in very low birth weight infants (taken as the test group) and in others whose weight at birth was normal (control group); the difference in ages when the potentials were recorded was not statistically significant. RESULTS: The EEG index was evaluated for both the test and the control group, and a difference was found with a significance of p < 0.001. Latency, in milliseconds, of the N200 wave and the P300 wave was recorded at the same sites for the test and control groups and showed differences with a significance of p < 0.001. CONCLUSIONS: The findings from the EEG and the latencies of the N200 and P300 waves in the BEP of very low birth weight infants are pathological and are linked to immaturity of the brain, which is characteristic of this population. This tool could help to detect developmental disorders and to facilitate a better approach to attending these children.

Transient elastography to assess hepatic fibrosis in primary biliary cirrhosis.

BACKGROUND: Liver stiffness measurements may have potential for detecting and monitoring hepatic fibrosis in chronic liver disease. AIM: To study the detection, quantification and progression of hepatic fibrosis in primary biliary cirrhosis by liver stiffness measurements. METHODS: Liver stiffness measurements were generated in 80 patients with primary biliary cirrhosis by applying transient elastography; however, as there were 55 with liver biopsy, histological stage (METAVIR) and liver stiffness measurements were compared only in these 55 patients. The efficiency of liver stiffness measurements in predicting stage of fibrosis was determined from the area under receiver operating characteristics curve analysis. RESULTS: Of the 80 patients included, 91, 4% were women and their mean age was 56 +/- 12 (s.d.) years. A significant correlation was found (P < 0.05) between histological fibrosis stage (METAVIR) and liver stiffness measurements. The values obtained from area under receiver operating characteristic curve analysis of liver stiffness measurement data were 0.89 for F > 2 and 0.96 for F = 4. Liver stiffness measurements were 9.0 +/- 5.3 and 7.9 +/- 6.0 kPa for patients followed up more than 5 years and less than 5 years, respectively (P > 0.05). CONCLUSIONS: In patients with primary biliary cirrhosis, median values of liver stiffness measurements correlated with histological severity of hepatic fibrosis. Liver stiffness measurements appear to be promising for liver fibrosis detection and quantification, as well as monitoring its progression, in patients with primary biliary cirrhosis. The progression rate of hepatic fibrosis in our primary biliary cirrhosis patients appears to be slow.

Prolapsed hyperplastic gastric polyp causing pancreatitis: case report.

A huge hyperplastic gastric polyp prolapsed into the duodenum. The compression and obstruction of the ampulla of Vater by this polyp caused acute pancreatitis. An overview of imaging findings, general considerations about hyperplastic gastric polyps, and a review of the literature are provided.