Search

The human respiratory syncytial virus (hRSV) is the main etiologic agent of severe lower respiratory tract infections that affect young children throughout the world, associated with significant morbidity and mortality, becoming a serious public health problem globally. Up to date, no licensed vaccines are available to prevent severe hRSV-induced disease, and the generation of safe-effective vaccines has been a challenging task, requiring constant biomedical research aimed to overcome this ailment. Among the difficulties presented by the study of this pathogen, it arises the fact that there is no single animal model that resembles all aspects of the human pathology, which is due to the specificity that this pathogen has for the human host. Thus, for the study of hRSV, different animal models might be employed, depending on the goal of the study. Of all the existing models, the murine model has been the most frequent model of choice for biomedical studies worldwide and has been of great importance at contributing to the development and understanding of vaccines and therapies against hRSV. The most notable use of the murine model is that it is very useful as a first approach in the development of vaccines or therapies such as monoclonal antibodies, suggesting in this way the direction that research could have in other preclinical models that have higher maintenance costs and more complex requirements in its management. However, several additional different models for studying hRSV, such as other rodents, mustelids, ruminants, and non-human primates, have been explored, offering advantages over the murine model. In this review, we discuss the various applications of animal models to the study of hRSV-induced disease and the advantages and disadvantages of each model, highlighting the potential of each model to elucidate different features of the pathology caused by the hRSV infection.

BACKGROUND Cadherin-17 (intestinal peptide-associated transporter) and SATB2 (SATB homeobox 2) immunoexpression has recently been described in surgical pathology to have value in establishing the colorectal origin of metastatic adenocarcinoma. However, to the authors' knowledge, the role of these markers in metastatic colorectal adenocarcinoma (MCA) in cytology has not been addressed to date. In the current study, the authors evaluated the contribution of cadherin-17 and SATB2 to the diagnosis of MCA in cytology specimens and compared these two novel markers with the standard gastrointestinal immunohistochemistry panel in an attempt to identify the optimal panel. METHODS A total of 43 MCA cytology cases and 68 metastatic noncolorectal adenocarcinoma (non-MCA) cytology controls were stained for SATB2; cadherin-17; and the standard panel of cytokeratin (CK) 7, CK20, and Caudal-Type Homeobox Transcription Factor 2 (CDX2). Staining intensity and percentage of positive cells were recorded. Sensitivity and specificity values for immunostains individually and in combination were computed and compared. RESULTS Despite specificities of 83.8% and 91.2%, respectively, for cadherin-17 and SATB2, when critically examining the new immunostains together with the standard panel, there was no significant difference noted with regard to prediction of MCA (vs non-MCA) compared with the standard panel alone (P

The Department of Health of the Government of Andalusia provides professionals of the Andalusian Public Health Care System a collaborative working environment (Entorno colaborativo de trabajo [ECT]) based on the principles of web 2.0. The ECT is organized into communities, understood as sets of people with a common interest who share a space with its own information d collaboration tools. This space is managed and powered autonomously by the communities themselves. This paper analyzes the use and degree of implementation of the ECT, considering the user communities and activity statistics in 2009 and 2010. From the data obtained we deduce that instrumental services have easier acceptance than collaboration and knowledge management services; content generation is focused on a small number of users; and communities associated with organizational units have less development than those associated with work areas or projects.

A variety of surgical procedures is used to correct complete rectal prolapse (RP). We analysed the immediate and long-term results of the Lomas-Cooperman technique in the management of symptomatic RP in elderly patients with severe concomitant diseases.Across a 13-year period, all patients with RP having undergone surgery with this procedure were retrospectively evaluated. The technique consisted in placing a triply folded piece of polypropylene mesh encircling the anal canal through a perineal approach.A total of 22 patients (20 female) with a mean age of 84 years (range, 72-93 years) with severe concomitant pathologies were assessed. Four patients were classified as ASA II and 18 as ASA III. Mean Karnofsky score was 50%, ranging between 40% and 60%. All patients were operated on under regional anaesthesia without incidents. Mean operative time was 35 min(range, 20-60 min) and mean hospital stay was 4.5 days (range, 2-17 days). The most common immediate postoperative complication was urinary tract infection, found in 18% of the cases. Mean follow-up was 32 months (range, 4-84 months). During follow-up, 4 cases (18%) of mesh exteriorisation were detected, requiring mesh trimming at the outpatient clinic. Rectal prolapse recurred in 2 patients; one of them was managed with a new cerclage reaching a satisfactory outcome. Thus, by intention-to-treat basis, the recurrence rate was 4.5%. Constipation was resolved in three out of 4 patients, but in 18% of the cases late faecal impact was recorded. Mean preoperative incontinence score improved from 5.1+/-0.62 to 3.4+/-1.61 (p0.0001) after surgery.Anal cerclage with the Lomas-Cooperman technique constitutes a simple and reproducible surgical technique with an acceptable morbidity and recurrence rate in high-risk elderly patients with RP.

Background Indications for and the prognosis of posterior pelvic exenteration (PPE) in rectal cancer patients are not clearly defined. The aim of this study was to analyse the indications, complications and long-term results of PPE in patients with primary rectal cancer. Methods A retrospective review included patient demographics, tumour and treatment variables, and morbidity, recurrence, and survival statistics. These results were compared with a group of female patients who underwent standard resection for primary rectal cancer in the same period (non PPE group). Results The series included 30 women with an average age of 56.7 years (range 22–78). Tumour location was recorded in three cases in the upper rectum, 13 cases in the medium rectum and 14 cases in the lower rectum. A sphincter-preserving procedure was performed in 70% of the patients. Mean operative time was 4.2 h (range 2–7.5 h). Overall major morbidity rate in this series was 50% and mean hospital stay was 19.7 days (range 9–60 days). There was no hospital mortality. Pathological reports showed direct invasion of uterus, vagina or rectovaginal septum in 19 cases, involvement of perirectal tissue in 25 cases and positive lymph nodes in 18 cases. Comparison between PPE and non PPE groups showed no differences in mean tumour diameter, histological grade and tumour stage, but patients in the first group were younger. Although low tumours were seen more frequently in the PPE group (P = 0.003), the rate of sphincter-preserving procedure was comparable in both groups. Operative time was longer (P = 0.04) and morbidity was higher (P = 0.0058) in the PPE group. Local recurrence with or without distant metastases for the whole series was 30%. Five-year survival rate for patients who underwent curative resections (TNM I–III) was 48% in the PPE group vs 62% in the non PPE group (P = 0.09). Conclusions In the present series, PPE prolonged operative time, increased postoperative complications and showed a trend toward poor prognosis in recurrence and survival. However, PPE offers the only hope for cure to patients with a primary rectal cancer that is adherent or invades reproductive organs.

Langerhan’s cell histiocytosis (LCH) results from the proliferation of immunophenotypically and functionally immature, morphologically rounded Langerhan’s cells along with eosinophils, macrophages, lymphocytes, and, commonly, multinucleated giant cells. Here we report a case in a 6-year-old boy of differential diagnoses including dermatopathic lymphadenitis (DL), parasitic infection, Kimura’s disease, hypersensitivity reactions, cat-scratch disease, sinus histiocytosis with massive lymphadenopathy (SHML), hyperplasic lymph nodes, and lymphoma.

To compare the extent to which 7 different radiotherapy planning techniques for mediastinal lung targets reduces the lung volume receiving low doses of radiation. Thirteen non-small cell lung cancer patients with targets, including the mediastinal nodes, were identified. Treatment plans were generated to both 60- and 74-Gy prescription doses using 7 different planning techniques: conformal, hybrid conformal/intensity-modulated radiation treatment (IMRT), 7 equidistant IMRT beams, 2 restricted beam IMRT plans, a full (360°) modulated arc, and a restricted modulated arc plan. All plans were optimized to reduce total lung V5, V10, and V20 volumes, while meeting normal tissue and target coverage constraints. The mean values for the 13 patients are calculated for V5, V10, V20, V(ave), V0-20, and mean lung dose (MLD) lung parameters. For the 74-Gy prescription dose, the mean lung V10 was 42.7, 43.6, 48.2, 56.6, 57, 55.8, and 54.1% for the restricted ±36° IMRT, restricted modulated arc, restricted ±45° IMRT, full modulated arc, hybrid conformal/IMRT, equidistant IMRT, and conformal plans, respectively. A similar lung sparing hierarchy was found for the 60-Gy prescription dose. For the treatment of central lung targets, the ±36° restricted IMRT and restricted modulated arc planning techniques are superior in lowering the lung volume treated to low dose, as well as in minimizing MLD, followed by the ±45° restricted IMRT plan. All planning techniques that allow the use of lateral or lateral/oblique beams result in spreading the low dose over a higher lung volume. The area under the lung dose-volume histogram curve below 20 Gy, V0-20, is proposed as an alternative to individual V(dose) parameters, both as a measure of lung sparing and as a parameter to be minimized during IMRT optimization.

Antecedentes: El tratamiento del cancer de recto bajo localmente avanzado ha cambiado en la ultima decada hacia la neoadyuvancia con radio quimioterapia (RQT) preoperatoria. Objetivo: Dar a conocer los resultados de una serie prospectiva de casos tratados con RQT preoperatoria mas cirugia radical con reseccion total del mesorrecto. Pacientes y Metodo: se incluye los pacientes con un cancer de recto medio e inferior localmente avanzado (T3-T4 y/o N+) tratados con intencion curativa con radioterapia mas 5-FU con leucovorina. Se detalla el impacto de la RQT en la pieza operatoria comparado con una serie similar sin radioterapia previa. Resultados: Se trata de 76 pacientes (51,3% mujeres) con un promedio etario de 61,9 anos (extremos 28-84). El tiempo de hospitalizacion promedio fue 12,55 dias (DE: 7,19; extremos 4-35), la morbilidad global de la serie fue 37%, no hubo mortalidad operatoria. El efecto del downstaging fue mas marcado en el factor T que en el compromiso linfonodal y en el 21% de los casos se logro una respuesta patologica completa (RPC) o casi completa (RP), sin recidiva en este subgrupo luego de un seguimiento promedio de 59 meses. Conclusion: En esta serie la RQT preoperatoria no aumenta la morbilidad perioperatoria, tiene un impacto marcado en el downstaging patologico y la RPC o RP casi completa se asocia positivamente con la sobrevida a largo plazo.

Antecedentes: La mortalidad por cáncer de colon (CC) se ha duplicado en Chile en los últimos 15 años. El objetivo es analizar los resultados inmediatos y alejados del tratamiento quirúrgico del CC en un hospital público docente. Pacientes y Método: Se incluyen todos los pacientes intervenidos en forma electiva por un CC entre 1991 y 2007. Los pacientes fueron etapificados según el TNM 2002. Los pacientes estadios I a III con R0 son considerados como cirugía con intención curativa. Las curvas de sobrevida fueron estimadas según el método de Kaplan-Meier, las que se comparan con el test log-rank. Para determinar los factores pronósticos más relevantes en el análisis multivariado se utilizó el modelo de regresión de Cox. Resultados: Se trata de 439 pacientes, 55% mujeres, con una edad promedio de 67 años (extremos 22-92). La resecabilidad fue de 86%, el 25% de los casos estaba en estadio IV, la morbilidad fue 21%, la tasa de reoperaciones fue 4% y la mortalidad 1%. La sobrevida global de los estadios I a III fue 82% a 10 años, con una clara inflexión negativa de las curvas a partir del estadio IIIB. El CEA preoperatorio, la permeación vascular, el número de ganglios positivos y la quimioterapia aparecen como factores pronósticos relevantes. Al introducir el TNM en el modelo, la permeación vascular y el índice ganglionar conservan la significancia estadística. Conclusión: La cirugía resectiva del CC puede efectuarse con bajos índices de mortalidad. El índice ganglionar junto al TNM puede ser un factor pronóstico relevante en la toma de decisiones terapéuticas sobre adyuvancia en los pacientes en estadio III.

Antecedentes: El objetivo de este estudio es analizar los resultados del tratamiento quirúrgico de la Fístula Coló Vesical (FCV) de origen diverticular, los que se comparan con la enfermedad diverticular no fistulizada. Pacientes y Método: Análisis retrospectivo de todos los pacientes intervenidos por una FCV de origen diverticular en forma consecutiva. Resultados: De un total de 141 pacientes resecados por una enfermedad diverticular del colon sigmoides, la indicación quirúrgica en 27 (19,3%) fue la presencia de una fístula, de las cuales 18 corresponden a una FCV. El grupo con FCV tiene predominio de hombres (p = 0,0001), más joven (p = 0,027) y con mayor incidencia de enfermedades asociadas (p = 0,0001). La neumaturia se presentó en el 83% y la fecaluria en el 56%. En dos tercios de los casos la FCV se estableció en ausencia de una crisis diverticular previa. El estudio más relevante para demostrar la presencia de una FCV fue la tomografía computada (80%), que se complementa con el enema balitado y la cistoscopia. La resección con anastomosis inmediata, más simple sutura de la vejiga fue el procedimiento empleado en el 94% de los pacientes, sin secuelas ni casos de recidiva, con un seguimiento global promedio de 74,2 meses (extremos 12-158). No hubo reoperaciones ni mortalidad operatoria. Conclusiones: la FCV de origen diverticular es una condición patológica poco frecuente que afecta a pacientes varones en la séptima década de la vida, con múltiples enfermedades asociadas y que frecuentemente se instala en forma silenciosa. La resección primaria es el tratamiento de elección con buenos resultados a largo plazo.

Antecedentes: Se ha debatido si la reseccion paliativa del tumor primario afecta la sobrevida en pacientes con un cancer colorrectal metastasico. El objetivo de este estudio es evaluar esta hipotesis analizando por separado los tumores de colon y de recto. Pacientes y Metodo: Se estudia los pacientes en Estadio IV segun el TNM 2002. Se analiza una serie de variables demograficas e histopatologicas por separado, asi como la morbilidad operatoria y el tiempo de hospitalizacion. Se distingue tres tipos de patron metastasico dentro del estadio IV. El analisis de la sobrevida se realizo mediante el metodo de Kaplan-Meier y para establecer diferencias entre las curvas se utilizo el test log-rank. Resultados: Se trata de 96 pacientes con cancer de colon y 81 con cancer de recto en estadio IV, sin diferencias significativas en cuanto a ASA, tamano tumoral, porcentaje de tumores indiferenciados, relacion entre tumores T3/T4 y CEA preoperatorio, con predominio del patron localmente avanzado en los tumores de recto (p = 0,04). Hubo un 44% de resecciones paliativas en colon y en recto, sin diferencias en la morbilidad (18%) ni la mortalidad operatoria (1%). El promedio de sobrevida en los pacientes de colon sometidos a una reseccion paliativa fue de 15,2 meses (DE: 13,18), y de 4,4 meses (DE: 3,66) en los no resecados (p < 0,0001). El promedio de sobrevida en los pacientes del recto resecados fue 20,5 meses (DE: 19,6), y de 5,06 meses (DE: 3,51) en el grupo no resecado (p < 0,0001). En el analisis multivariado la reseccion paliativa y, en menor medida, la albumina preoperatoria son los factores pronosticos mas relevantes en colon y en recto, con una razon de disparidad de 4 y 5 veces, respectivamente (p < 0,0001). Conclusion: La cirugia paliativa puede realizarse con bajos indices de morbimortalidad en pacientes aptos para soportar un procedimiento quirurgico mayor. En los tumores de recto la reseccion paliativa se asocia con mayor morbilidad y mayor tiempo de hospitalizacion. La reseccion del tumor primario en el contexto de una enfermedad metastasica incurable prolonga en forma significativa la sobrevida de estos pacientes y debe intentarse en los pacientes con un riesgo razonable, exceptuando los casos con carcinomatosis peritoneal masiva y ascitis.

RESUMENAntecedentes: El sistema TNM de estadificacion del cancer de colon y recto (CCR) se basa enestudios de poblacion y es ampliamente utilizado en el mundo occidental. El objetivo de este estudio esevaluar el valor pronostico del TNM 2002 en una serie clinica. Pacientes y metodo: Se incluyen todos lospacientes intervenidos en forma consecutiva por un adenocarcinoma de colon y de recto. Se considero lasobrevida en meses de acuerdo al estadio TNM 2002 y se midieron otras potenciales variables anatomoclinicascomo el CEA preoperatorio, el grado de diferenciacion celular, el tamano y la localizacion del tumor. Parael analisis estadistico descriptivo se utilizo el chi cuadrado, para estimar las curvas de sobrevida se empleoel metodo de Kaplan-Meier y para comparar las curvas de sobrevida se uso el test de log-rank. Paradeterminar los factores pronosticos de mayor impacto en la sobrevida de los pacientes se empleo el modelode regresion de Cox. Resultados: En un periodo 15 anos se intervinieron de 624 pacientes (353 con untumor colon y 271 con un tumor de recto), el 55 % mujeres, con un promedio de edad de 65 anos (desviacionestandar (DE) :13,3; extremos 21-92). El seguimiento promedio de la serie fue 48 meses (extremos 2-186).En los tumores de colon resecados con intencion curativa (estadios I a IIIC), la recidiva global fue 11 %(30/268), cifra que en los tumores de recto se eleva al 30% (61/201) (p

Objetivo: evaluar nuestros Resultados alejados en términos de recidiva local, rescate y sobrevida libre de enfermedad. Método: veintiún pacientes con un cáncer de recto bajo fueron sometidos a una resección transanal completa en un periodo de 18 años (1985-2003). La estadificación preoperatoria incluyó hallazgos clínicos y endoscópicos, estudios por imágenes e histopatológicos. Los especímenes resecados correspondieron a 4 tumores T1, 13 T2 y 4 T3. Los 4 pacientes T1 sólo fueron tratados con cirugía; 6 de los 13 T2 y todos los T3 recibieron quimiorradioterapia postoperatoria. Ninguno de ellos recibió una cirugía radical secuencial. Resultados: el seguimiento (media 75 meses) registró 5 casos (23,8%) de recidiva total y 4 (19%) con falla local (3 T2 de los cuales sólo uno había recibido terapia coadyuvante y un T3 también tratado con quimiorradioterapia). Los cuatro pacientes con recidiva local accedieron a cirugía de rescate, una amputación abdominoperineal en dos casos y a una re-resección local en los otros. Dos de ellos volvieron a recidivar. La sobrevida a 5 años fue de 95,2%, y la sobrevida libre de enfermedad en el mismo periodo alcanzó a un 90,4%. En el periodo de observación hasta agosto de 2006 hay dos pacientes que fallecieron diseminados, y sólo un paciente vivo está recidivado. Conclusiones: esta experiencia confirma que la resección local transanal para cáncer de recto bajo es una buena alternativa en pacientes adecuadamente seleccionados. En tumores T2, la quimiorradioterapia adyuvante será necesaria; en tumores T3, la cirugía radical de rescate debería ser realizada oportunamente.

Background: There are no clear guidelines for the indication of elective surgery in sigmoid diverticular disease. Aim: To analyze the indications and long term results of elective surgery in sigmoid diverticular disease. Material and Methods: Retrospective review of 100 patients (age range 25-86 years, 51 male) with sigmoid diverticular disease, operated in a lapse of 22 years. Sixty seven patients answered a survey about their disease at the end of follow up. Results: Among patients aged more than 70 years, there was a higher proportion of women. The main indication for surgery was recurrent diverticulitis in 54 patients, followed by diverticular fistula in 19. A sigmoidectomy was performed in 91 patients. Stapled anastomosis was performed in half of these patients. No patient died or required reoperation in the immediate postoperative period. During a follow up ranging from 8 to 280 months, 28 patients died for causes not associated with diverticular disease and five were lost. Those patients that answered the survey were free of symptoms related to diverticular disease and did not require new operations. Conclusions: In patients with sigmoid diverticular disease and recurrent diverticulitis or with fistulae, the long term results of surgery are satisfactory (Rev Méd Chile 2005; 133: 1037-42)

Background: CEA is widely used in the follow up of patients with colorectal carcinoma. Aim: To study the value of preoperative CEA as an independent prognostic factor in colorectal carcinoma. Patients and methods: Analysis of 373 operated patients (204 females, age range 21-92 years) with colorectal carcinoma and a mean follow up of 53 months. The cutoff value for CEA was 5 ng/ml. Ninety four percent of patients had an excisable tumor, 79% had involvement of perirectal/pericolonic adipose tissue and 46% had lymph node involvement. Staging was done using Dukes-Turnbull and TNM classifications. Results: CEA was normal in 61% of cases, over 5 ng/ml in 39% and over 15 ng/ml in 22%. There was a strong correlation between mean preoperative CEA and tumor stage, depth and lymph node involvement. During the follow up, 140 patients died, 57 with normal and 83 with elevated CEA. Cancer mortality in patients subjected to a curative excision of the tumor (Dukes A-C2/TNM IIII) was 9% for colonic tumors and 36% for rectal tumors (p

Background: Ten to 22% of lower gastrointestinal bleedings require emergency surgery. The overall mortality of the procedure is 22%. Aim: To report our experience in the management of patients with massive lower gastrointestinal bleeding. Patients and methods: Retrospective analysis of 20 patients (10 male) aged 19 to 79 years old, with lower gastrointestinal bleeding. Results: Nine patients were operated on after the bleeding stopped and 11 were operated while still bleeding. In ten, the cause of bleeding was diverticular disease or angiodysplasia. In four, the bleeding originated in the small bowel and in 7 it was of vascular origin. Two patients with a torrential bleeding, were operated on without prior study. Colonoscopy, done in 18 patients, identified the bleeding site in 66% of cases. Scintigraphy was performed in 7 patients and it was positive in five without operative mortality. Selective angiography was done in four patients and was positive in three. A partial intestinal resection was performed in 15 patients and a total colectomy in five without operative mortality. Six patients had major postoperative complications and mean hospital stay was 18 days. Patients have been followed for 9 to 144 months and six have died. Eleven patients were reassessed and all have complete fecal continence. Conclusions: In this series, the main causes of massive lower gastrointestinal bleeding were diverticulosis and angiodysplasia. In a high percentage of patients, the bleeding originated in the small bowel (Rev Méd Chile 2002; 130: 869-78)

We report a 15 years old girl presenting with severe hematochezia with secondary anemia and hemodynamic decompensation, rectal prolapse and spontaneous anal elimination of polyps. She had no family history of polyposis and a search for the disease in her close relatives was negative. A complete diagnostic work up did not find polyps in other segments of the digestive tract. Colonoscopy showed more than 200 polyps between the cecum and the rectum. Pathological analysis confirmed the presence of retention polyps with adenomatous areas and mild atypia. The patient was subjected to a proctocolectomy with ileal pouch and sphincteric preservation, using a mechanical suture. Postoperative evolution was uneventful and after 24 months of follow up, the patient is asymptomatic, with two stool movements per day and without incontinence.