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Background: Vitiligo is a pathology that causes the appearance of achromic macules on the skin that can spread on to other areas of the body. It is estimated that it affects 1.2% of the world population and can disrupt the mental state of people in whom this disease has developed, generating negative feelings that can become suicidal in the worst of cases. The present work focuses on the development of a support tool that allows to objectively quantifying the repigmentation of the skin., Methods: We propose a novel method based on artificial neural networks that use characteristics of the interaction of light with the skin to determine areas of healthy skin and skin with vitiligo. We used photographs of specific areas of skin containing vitiligo. We select as independent variables: the type of skin, the amount of skin with vitiligo and the amount of repigmented skin. Considering these variables, the experiments were organized in an orthogonal table. We analyzed the result of the method based on three parameters (sensitivity, specificity, and F1-Score) and finally, its results were compared with other methods proposed in similar research., Results: The proposed method demonstrated the best performance of the three methods, and it also showed its capability to detect healthy skin and skin with vitiligo in areas up to 1 × 1 pixels., Conclusion: The results show that the proposed method has the potential to be used in clinical applications. It should be noted that the performance could be significantly improved by increasing the training patterns., Competing Interests: There are no conflicts of interest.

Pheochromocytoma is a catecholamine-producing neoplasm that may occur sporadically or associated with hereditary diseases, such as multiple endocrine neoplasia. The classic symptoms are headache, sweating, and palpitations and are attributed to the sympathetic nervous system activity, usually presenting as paroxysms. On the other hand, pulmonary tuberculosis is an infectious disease considered a public health problem in many countries, whose incidence depends on risk factors such as immunosuppression. It is well known that endocrine-tumor diseases such as multiple endocrine neoplasia can predispose to chronic inflammation and immunosuppression. We report the case of a 38-year-old male patient who had an episode of arterial hypertension and abdominal pain as the first symptoms of a pheochromocytoma associated with multiple endocrine neoplasia type 2A. The patient developed pulmonary tuberculosis simultaneously, but we managed to treat both entities and achieve a favorable clinical course.

Infectious diseases are an important cause of spinal cord dysfunction. Infectious myelopathies are of growing concern given increasing global travel and migration and expanding prevention and treatment with vaccinations, antibiotics, and antiretrovirals. Clinicians must recognize these pathologies because outcomes can dramatically improve with prompt diagnosis and management. We provide a complete review of the most frequent infectious agents that can affect the spinal cord. For each pathogen we describe epidemiology, pathophysiology, anatomic location, characteristic clinical syndromes, diagnostic approach, treatment, and prognosis. The review includes spinal imaging from selected cases., (Copyright © 2018 Elsevier Inc. All rights reserved.)

Lichens are symbiotic associations of fungi with microalgae and/or cyanobacteria. Lichens belonging to the Parmeliaceae family comprise 2700 species of lichens, including the Parmotrema genus which is composed of 300 species. The metabolites of this genus include depsides, depsidones, phenolics, polysaccharides, lipids, diphenylethers and dibenzofurans, which are responsible for the biological activities reported including antidiabetic, antihelmintic, anticancer, antioxidant, antibacterial, anti-inflammatory, antimitotic, antitumoral, antifungal, and antioxidant enzyme inhibitory. Due to scarce knowledge of metabolomic profiles of Parmotrema species ( P. andinum and P. robustum ), a full metabolome study based on ultra-high performance liquid chromatography- diode array detector-electrospray ionization-quadrupole-orbitrap-mass-spectrometry (UHPLC-DAD-ESI-Q-orbitrap MS) was performed for a comprehensive characterization of their substances. From the methanolic extracts of these species, a total of 54 metabolites were identified for the first time using this hyphenated technique, including thirty compounds in P. andinum , and thirty-seven in P. robustum . Moreover, two compounds were not identified as known compounds, and could be new structures, according to our data. This report shows that this technique is effective and accurate for rapid chemical identification of lichen substances and the compounds identified could serve as chemotaxonomic markers to differentiate these ruffle lichens., Competing Interests: The authors declare no conflict of interest. The funding sponsors had no role in the design of the study; in the collection, analyses, interpretation of data; in the writing of the manuscript; or in the decision to publish the results.

Background: Atrial dysfunction or "cardiopathy" has been recently proposed as a mechanism in cryptogenic stroke. A prolonged PR interval may reflect impaired atrial conduction and thus may be a biomarker of atrial cardiopathy. We aim to compare the prevalence of PR interval prolongation in patients with cryptogenic stroke (CS) when compared with known non-cryptogenic non-cardioembolic stroke (NCNCS) subtypes., Methods: We used prospective ischemic stroke databases of 3 comprehensive stroke centers to identify patients 18 years or older with a discharge diagnosis of ischemic non-cardioembolic stroke between December 1, 2013 and August 31, 2015. The main outcome was ischemic stroke subtype (CS versus NCNCS). We compared PR intervals as a continuous and categorical variable (<200 milliseconds; ≥200 milliseconds) and other clinical and demographic factors between the 2 groups and used multivariate regression analyses to determine the association between PR interval prolongation and CS., Results: We identified 644 patients with ischemic non-cardioembolic stroke (224 CS and 420 NCNCS). Patients with CS were more likely to have a PR of 200 milliseconds or greater when compared with those with NCNCS (23.2% versus 13.8%, P = .009). After adjusting for factors that were significant in univariate analyses, a PR of 200 milliseconds or greater was independently associated with CS (odds ratio [OR] 1.70, 95% CI 1.08-2.70). The association was more pronounced when excluding patients on atrioventricular nodal blocking agents (OR 2.64, 95% CI 1.44-4.83)., Conclusions: A PR of 200 milliseconds or greater is associated with CS and may be a biomarker of atrial cardiopathy in the absence of atrial fibrillation. Prospective studies are needed to confirm this association., (Copyright © 2017 National Stroke Association. Published by Elsevier Inc. All rights reserved.)

Background: Maternal exposure to environmental stressors poses a risk to fetal development. Oxidative stress (OS), microglia activation, and inflammation are three tightly linked mechanisms that emerge as a causal factor of neurodevelopmental anomalies associated with prenatal ethanol exposure. Antioxidants such as glutathione (GSH) and CuZnSOD are perturbed, and their manipulation provides evidence for neuroprotection. However, the cellular and molecular effects of GSH alteration in utero on fetal microglia activation and inflammation remain elusive., Methods: Ethanol (EtOH) (2.5 g/kg) was administered to pregnant mice at gestational days 16-17. One hour prior to ethanol treatment, N-acetylcysteine (NAC) and L-buthionine sulfoximine (BSO) were administered to modulate glutathione (GSH) content in fetal and maternal brain. Twenty-four hours following ethanol exposure, GSH content and OS in brain tissues were analyzed. Cytokines and chemokines were selected based on their association with distinctive microglia phenotype M1-like (IL-1β, IFN γ, IL-6, CCL3, CCL4, CCL-7, CCL9,) or M2-like (TGF-β, IL-4, IL-10, CCL2, CCL22, CXCL10, Arg1, Chi1, CCR2 and CXCR2) and measured in the brain by qRT-PCR and ELISA. In addition, Western blot and confocal microscopy techniques in conjunction with EOC13.31 cells exposed to similar ethanol-induced oxidative stress and redox conditions were used to determine the underlying mechanism of microglia activation associated with the observed phenotypic changes., Results: We show that a single episode of mild to moderate OS in the last trimester of gestation causes GSH depletion, increased protein and lipid peroxidation and inflammatory responses inclined towards a M1-like microglial phenotype (IL-1β, IFN-γ) in fetal brain tissue observed at 6-24 h post exposure. Maternal brain is resistant to many of these marked changes. Using EOC 13.31 cells, we show that GSH homeostasis in microglia is crucial to restore its anti-inflammatory state and modulate inflammation. Microglia under oxidative stress maintain a predominantly M1 activation state. Additionally, GSH depletion prevents the appearance of the M2-like phenotype, while enhancing morphological changes associated with a M1-like phenotype. This observation is also validated by an increased expression of inflammatory signatures (IL-1β, IFN-γ, IL-6, CCL9, CXCR2). In contrast, conserving intracellular GSH concentrations eliminates OS which precludes the nuclear translocation and more importantly the phosphorylation of the NFkB p105 subunit. These cells show significantly more pronounced elongations, ramifications, and the enhanced expression of M2-like microglial phenotype markers (IL-10, IL-4, TGF-β, CXCL10, CCL22, Chi, Arg, and CCR2)., Conclusions: Taken together, our data show that maintaining GSH homeostasis is not only important for quenching OS in the developing fetal brain, but equally critical to enhance M2 like microglia phenotype, thus suppressing inflammatory responses elicited by environmental stressors.

Background: Multimorbidity is associated with negative effects both on people's health and on healthcare systems. A key problem linked to multimorbidity is polypharmacy, which in turn is associated with increased risk of partly preventable adverse effects, including mortality. The Ariadne principles describe a model of care based on a thorough assessment of diseases, treatments (and potential interactions), clinical status, context and preferences of patients with multimorbidity, with the aim of prioritizing and sharing realistic treatment goals that guide an individualized management. The aim of this study is to evaluate the effectiveness of a complex intervention that implements the Ariadne principles in a population of young-old patients with multimorbidity and polypharmacy. The intervention seeks to improve the appropriateness of prescribing in primary care (PC), as measured by the medication appropriateness index (MAI) score at 6 and 12 months, as compared with usual care., Methods/design: Design: pragmatic cluster randomized clinical trial. Unit of randomization: family physician (FP). Unit of analysis: patient., Scope: PC health centres in three autonomous communities: Aragon, Madrid, and Andalusia (Spain)., Population: patients aged 65-74 years with multimorbidity (≥3 chronic diseases) and polypharmacy (≥5 drugs prescribed in ≥3 months)., Sample Size: n = 400 (200 per study arm)., Intervention: complex intervention based on the implementation of the Ariadne principles with two components: (1) FP training and (2) FP-patient interview., Outcomes: MAI score, health services use, quality of life (Euroqol 5D-5L), pharmacotherapy and adherence to treatment (Morisky-Green, Haynes-Sackett), and clinical and socio-demographic variables., Statistical Analysis: primary outcome is the difference in MAI score between T0 and T1 and corresponding 95% confidence interval. Adjustment for confounding factors will be performed by multilevel analysis. All analyses will be carried out in accordance with the intention-to-treat principle., Discussion: It is essential to provide evidence concerning interventions on PC patients with polypharmacy and multimorbidity, conducted in the context of routine clinical practice, and involving young-old patients with significant potential for preventing negative health outcomes., Trial Registration: Clinicaltrials.gov, NCT02866799.

Cryptogenic stroke and transient ischemic attack (TIA) account for approximately one-third of stroke patients [1]. Paroxys-mal atrial fibrillation (PAF) has been suggested as a major etiology of these cryptogenic strokes [2, 3]. PAF can be difficult to diagnose because it is intermittent, often brief, and asymptomatic. PAF might be more prevalent than persistent atrial fibrillation in stroke and TIA patients, especially in younger populations [4, 5]. In patients with atrial fibrillation, anticoagulation provides significant risk reduction [6]. A new generation of oral anticoagulants has been approved for non-valvular atrial fibrillation, providing a variety of therapeutic options for patients with atrial fibrillation and risk of stroke [7]. Prior practice included an admission electrocardiogram (ECG) and continuous telemetry monitoring while in hospital [8]. However, this approach can lead to under-detection of brief asymptomatic events, which can occur at variable intervals, often outside of the hospital setting. Technological advancements have led to devices that can monitor cardiac rhythms outside of the hospital for longer durations resulting in higher yield of detection of atrial fibrillation events. Moreover, recent studies show that the normal monitoring time for arrhythmias may be shorter than ideal in order to detect atrial fibrillation, and increasing this interval could significantly improve detection of atrial fibrillation in these patients [9, 10]. The aim of this study is to review the literature in order to define what subgroup of patients, with what methodologies, and for how long monitoring for atrial fibrillation should occur in patients presenting with cryptogenic stroke.

Background: Dengue disease is a global disease that has no effective treatment. The dengue virus (DENV) NS2B/NS3 protease complex is a target for designing specific antivirals due to its importance in viral replication and its high degree of conservation., Methods: NS2B/NS3 protease complex structural information was employed to find small molecules that are capable of inhibiting the activity of the enzyme complex. This inhibitory activity was probed with in vitro assays using a fluorescent substrate and the complex NS2B/NS3 obtained by recombinant DNA techniques. HepG2 cells infected with dengue virus serotype 2 were used to test the activity against dengue virus replication., Results: A total of 210,903 small molecules from PubChem were docked in silico to the NS2B/NS3 structure (PDB: 2FOM) to find molecules that were capable of inhibiting this protein complex. Five of the best 500 leading compounds, according to their affinity values (-11.6 and -13.5 kcal/mol), were purchased. The inhibitory protease activity on the recombinant protein and antiviral assays was tested., Conclusions: Chemicals CID 54681617, CID 54692801 and CID 54715399 were strong inhibitors of NS2B/NS3, with IC50 values (μM) and percentages of viral titer reductions of 19.9, 79.9%; 17.5, 69.8%; and 9.1, 73.9%, respectively. Multivariate methods applied to the molecular descriptors showed two compounds that were structurally different from other DENV inhibitors., General Significance: This discovery opens new possibilities for obtaining drug candidates against Dengue virus., (Copyright © 2016 Elsevier Masson SAS. All rights reserved.)

The definitive acceptance of an organ as valid for transplant depends on the surgical team performing the multiorgan recovery; and unexpected difficulties can occur. The demographic characteristics of donors has changed, and some accepted donors can present difficulties in surgical technique and risky decisions on the validity of the retrieved organ or organs. An alternative method to the cannulation of the abdominal aorta is proposed when there is evidence of disease in the infrarenal aorta during the multiorgan procurement. The retrocardiac descending thoracic aorta is cannulated using an antegrade perfusion; this technique allows an increase in organ recovery., (Copyright © 2014 AEC. Publicado por Elsevier España, S.L.U. All rights reserved.)

Recent studies suggest amyotrophic lateral sclerosis (ALS) prevalence, incidence, and age of onset are heterogeneous across populations. These include studies from South America (SA) where lower prevalence, earlier onset, and reduced survival time of ALS are reported. However, the scarcity of epidemiological and clinical data confounds effective comparison. To investigate ALS incidence in the predominantly admixed population of Ecuador, we analyzed patient data. We analyzed case data from two major hospitals. To confirm diagnosis, we evaluated clinical and EMG examinations in a cohort of patients. For 2000-2012, we found 116 patients with ALS diagnosis in the two hospitals. Crude incidence was 0.2-0.6 per 100,000. Median age of onset was 54.3 (+ 15.06 SD). Clinical re-evaluation found misdiagnosis in three cases in the cohort. In conclusion, ALS incidence in the Ecuadorian hospital population is in accord with rates reported in recent studies for other admixed populations, and lower than that in the United States and Europe. Our study found that appropriate EMG administration and interpretation for the purposes of supporting a diagnosis of ALS with current consensus guidelines prevent adequate use of this test as an essential tool in the evaluation and diagnosis of ALS. Training for required standardization in Ecuador is recommended.

The models of anoxic/methanogenic processes in biofilm reactors published until now have supposed that pH does not change between the bulk liquid and biofilm. These assumptions are not necessarily valid for processes in reactors with biofilms. The present work studied an anoxic/methanogenic biofilm reactor incorporating the pH variation in both bulk and biofilm. Two dynamic models, one including the calculation of pH throughout the biofilm, were solved numerically and compared with each other. The results showed that the inclusion of a pH algorithm calculation produces different profiles and efficiencies on an anoxic/methanogenic biofilm system. Values of C/N ratio higher than 20 mg TOC/mg NO3-N and values of HRT lower than 4.5 h produce differences of up to 46 % with a traditional model that does not include pH calculation inside the biofilm. Thus, the assumption of a constant pH within the biofilm when using the traditional model does not accurately describe the performance of the system under these conditions, and pH calculation inside the biofilm should be included.

Coal mining generates negative effects on environment, human health, hydrodynamics of mining areas and biodiversity. However, the impacts of this activity are less known in plants. Lemna minor is one of the most commonly used plants in aquatic toxicity tests due to its ubiquitous distribution in ponds and lakes, culture conditions and the free-floating habitat that exposes it to hydrophobic as well as dissolved compounds. The goal of this research was to evaluate the effects of a methanolic coal dust extract on L. minor. Macrophytes were exposed to six different concentrations of coal extract (from 7.81 to 250 mg/L) for 5 days, following the OECD test guideline 221. The coal extract had a half inhibitory concentration (IC50) of 99.66 (184.95-54.59) mg/L for the number of fronds. Several signs of toxicity such as chlorosis, reduction in the size of the fronds, abscission of fronds and roots, and the presence of necrotic tissues were observed at concentrations lower than the IC50. Preliminary Gas Chromatography-Mass Spectrometry analysis of the coal dust extract revealed the presence of several compounds, including, among others, alkanes, carboxylic acids and polycyclic aromatic hydrocarbons (PAHs), these lasts, may be responsible for some of the observed effects. These results demonstrated that coal dust has phytotoxic effects and should not be considered as an inert material., (Copyright © 2013 Elsevier Inc. All rights reserved.)

In Precision Agriculture, images coming from camera-based sensors are commonly used for weed identification and crop line detection, either to apply specific treatments or for vehicle guidance purposes. Accuracy of identification and detection is an important issue to be addressed in image processing. There are two main types of parameters affecting the accuracy of the images, namely: (a) extrinsic, related to the sensor's positioning in the tractor; (b) intrinsic, related to the sensor specifications, such as CCD resolution, focal length or iris aperture, among others. Moreover, in agricultural applications, the uncontrolled illumination, existing in outdoor environments, is also an important factor affecting the image accuracy. This paper is exclusively focused on two main issues, always with the goal to achieve the highest image accuracy in Precision Agriculture applications, making the following two main contributions: (a) camera sensor arrangement, to adjust extrinsic parameters and (b) design of strategies for controlling the adverse illumination effects.

Background: Non-invasive mechanical ventilation (NIV) in patients with acute respiratory failure has been traditionally determined based on clinical assessment and changes in blood gases, with NIV support pressures manually adjusted by an operator. Bilevel positive airway pressure-spontaneous/timed (BiPAP S/T) with average volume assured pressure support (AVAPS) uses a fixed tidal volume that automatically adjusts to a patient's needs. Our study assessed the use of BiPAP S/T with AVAPS in patients with chronic obstructive pulmonary disease (COPD) and hypercapnic encephalopathy as compared to BiPAP S/T alone, upon immediate arrival in the Emergency-ICU., Methods: We carried out a prospective interventional match-controlled study in Guayaquil, Ecuador. A total of 22 patients were analyzed. Eleven with COPD exacerbations and hypercapnic encephalopathy with a Glasgow Coma Scale (GCS) <10 and a pH of 7.25-7.35 were assigned to receive NIV via BiPAP S/T with AVAPS. Eleven patients were selected as paired controls for the initial group by physicians who were unfamiliar with our study, and these patients were administered BiPAP S/T. Arterial blood gases, GCS, vital signs, and ventilatory parameters were then measured and compared between the two groups., Results: We observed statistically significant differences in favor of the BiPAP S/T + AVAPS group in GCS (P = .00001), pCO(2) (P = .03) and maximum inspiratory positive airway pressure (IPAP) (P = .005), among others. However, no significant differences in terms of length of stay or days on NIV were observed., Conclusions: BiPAP S/T with AVAPS facilitates rapid recovery of consciousness when compared to traditional BiPAP S/T in patients with chronic obstructive pulmonary disease and hypercapnic encephalopathy., Trial Registration: Current Controlled Trials application ref is ISRCTN05135218.

Coal is a mixture of chemicals with the capacity of promoting biochemical changes that may lead to DNA damage. In this study, the comet assay in peripheral blood cells, and the micronucleus test in blood smears were used to evaluate potential genotoxic effects derived from exposure to coal mining activities on wild populations of Mus musculus and Iguana iguana. Four locations from Colombia were evaluated: La Loma and La Jagua de Ibirico, two municipalities located near coal mining fields at the Department of Cesar; and Valledupar and Arjona, cities used as reference sites, both localized at least 100 and 200km far from the mines, respectively. Compared to Valledupar and Arjona, animals collected in close proximity to coal mining areas showed highest percentages of DNA damage for both species, evidencing that living around coal mining fields may result in an increase of DNA lesions in blood cells of rodents and reptiles. The results for micronucleus test were conflicting. Mice from Arjona had greater number of cells with micronucleus than those from the other studied locations, probably as a result of infection found by blood parasites. In summary, it was demonstrated that animals living around coal mining areas have a greater chance of having DNA damage, as measured by the comet assay, than those from sites far from the coal dust source., (Copyright © 2011 Elsevier B.V. All rights reserved.)

This paper proposes a new method, oriented to image real-time processing, for identifying crop rows in maize fields in the images. The vision system is designed to be installed onboard a mobile agricultural vehicle, that is, submitted to gyros, vibrations, and undesired movements. The images are captured under image perspective, being affected by the above undesired effects. The image processing consists of two main processes: image segmentation and crop row detection. The first one applies a threshold to separate green plants or pixels (crops and weeds) from the rest (soil, stones, and others). It is based on a fuzzy clustering process, which allows obtaining the threshold to be applied during the normal operation process. The crop row detection applies a method based on image perspective projection that searches for maximum accumulation of segmented green pixels along straight alignments. They determine the expected crop lines in the images. The method is robust enough to work under the above-mentioned undesired effects. It is favorably compared against the well-tested Hough transformation for line detection.

Meckel's diverticulum is the most common congenital anomaly of the gastrointestinal tract. The presence of malignant lesions arising in the diverticulum is very rare, the most common malignant lesion being sarcoma, followed by carcinoid tumors, and less frequently by adenocarcinomas. We present the case of an 86-year-old man who developed acute abdomen. Surgery revealed a perforated Meckel's diverticulum. Histology identified a poorly-differentiated adenocarcinoma arising in Meckel's diverticulum. We provide a review of the literature., (Copyright © 2010 Elsevier España, S.L. All rights reserved.)

Dioxins are a group of highly toxic molecules that exert their toxicity through the activation of the aryl hydrocarbon receptor (AhR). The most important agonist of the AhR, 2,3,7,8-tetrachlorodibenzo-p-dioxin (TCDD) is a highly toxic compound. Although most of the effects related to TCDD exposure have been linked to the activation of AhR, the objective of this work was to use a bioinformatics approach to identify possible new targets for TCDD. The Target Fishing Docking (TarFisDock) Server was used to find target proteins for TCDD. This virtual screening allowed the identification of binding sites with high affinity for TCDD in diverse proteins, such as metallopeptidases 8 and 3, oxidosqualene cyclase, and myeloperoxidase. Some of these proteins are well known for their biochemical role in some pathological effects of dioxin exposure, including endometriosis, diabetes, inflammation and liver damage. These results suggest that TCDD could also be interacting with cellular targets though AhR-independent pathways., (Copyright (c) 2010 Elsevier Ltd. All rights reserved.)

Pain management is a central issue in the care of cancer patients in hospice services. Morphine is at present the first line opioid recommended. But when morphine is used in large doses, especially in renal patients, an active metabolite of morphine, morphine-6-glucoronide, may cause delirium and myoclonus and sometimes antagonize the analgesic effect of morphine. Both fentanyl and methadone have some potential advantages over morphine since they are longer-acting and have no active metabolites. However, large doses of fentanyl or long-acting morphine are expensive while methadone has an extremely low cost. We present our retroactive comparative observations in 50 cancer patients. Methadone was found to be as effective as morphine, transdermal fentanyl and common combinations of other opioids in controlling the types of cancer pain presented by patients in a hospice in the Northwestern Region of Puerto Rico. The use of methadone on elderly patients with cancer pain as first line therapy is growing in European and North-American hospices. Hospitals should add methadone to their therapeutic armamentarium and physicians should develop skills to use this long acting opioid.

Objectives: The aim of this study is to present an analysis of 30 patients with major bile duct injuries in a single hospital centre., Material and Method: From January 2001 to December 2006, a prospective database was kept of all patients with a bile duct injury (BDI) following laparoscopic cholecystectomy (LC). Patients' charts were reviewed to analyse perioperative surgical management., Results: Over 6 years, 30 patients were treated for a major BDI. Patient demographics were not notable for 16 women (53%) and 14 men (47%) with a mean age of 58.9 years. Twenty of them sustained their BDI at another hospital. The mean interval from the time of BDI to referral was 17.4 days. A total of 30 patients underwent definitive biliary reconstruction, including 17 hepaticojejunostomies (56.7%), 8 end-to-end repairs (20%), 2 choledochoduodenostomies (6.7%), 3 liver transplantations (10%), 1 hepatectomy and 1 Whipple (3.3%). There were 2 deaths in the postoperative period (6.7%). Thirteen (43.3%) sustained at least 1 postoperative complication. The most common complications were cholangitis (20%), and intra-abdominal abscess/biloma (23.3%). The mean postoperative length of stay was 17.46 days., Conclusions: Bile duct injury is a serious complication that affects mostly individuals with benign disease. Various subsequent procedures (surgical and/or endoscopic) are almost always necessary for its correction, with a high socioeconomic cost that imposes great suffering on the patients and their relatives. Clearly, all efforts should be made to prevent such accidents.

We present the case of a 42-year-old male patient with a large hepatic cyst, simulating a hydatid cyst. Subtotal cystectomy was performed. Thirteen months after this procedure the patient relapsed and a second laparotomy and total cystectomy were performed. A histopathological diagnosis of epidermoid cyst of the liver was made. The differential diagnosis of epidermoid cysts of the liver is broad and definitive diagnosis is usually only obtained after pathological examination of the surgical specimen. For this reason, and because of the potential for neoplasia, complete resection of the hepatic lesion should be attempted.

Objective: To examine the relationship between total parenteral nutrition(TPN) and complication and death rates in surgical patients., Data Sources: A computer search of published research on MEDLINE, personal files and a review of relevant reference lists., Study Selection: A review of 237 titles, abstracts or papers. Primary studies were included if they were randomized clinical trials of surgical patients that evaluated the effect of TPN (compared to no TPN or standard care) on complication and death rates. Studies comparing TPN to enteral nutrition (EN) were excluded., Data Extraction: Relevant data were abstracted on the methodology and outcomes of primary studies. Data were independently abstracted in duplicate., Data Synthesis: There were 27 randomized trials in surgical patients that compared the use of TPN to standard care (usual oral diet plus intravenous dextrose). When the results of these trials were aggregated, there was no effect on mortality (risk ratio = 0.97, 95% confidence intervals, 0.76 to 1.24). There were fewer major complications in patients who received TPN, although there was significant heterogeneity in the overall estimate (risk ratio = 0.81, 95% CI, 0.65 to 1.01). Because of this significant heterogeneity, several a priori hypotheses were examined. Studies that included only malnourished patients demonstrated a trend to a reduction in complication rates but no difference in death rate when compared with studies of patients who were not malnourished. Studies published in 1988 or earlier and studies with a lower methods score were associated with a significant reduction in complication rates and a trend to a reduction in death rate when compared with studies published after 1988 and studies with a higher methods score. There was no difference in studies that provided lipids as a component of TPN when compared with studies that did not. Studies that initiated TPN preoperatively demonstrated a trend to a reduction in complication rates but no difference in death rate when compared with studies that initiated TPN postoperatively., Conclusions: TPN does not influence the death rate of surgical patients. It may reduce the complication rate, especially in malnourished patients, but study results are influenced by methodologic quality and year of publication.

Scintigraphic studies carried out in melanoma patients have demonstrated that the 99mTc-HMPAO complex makes it possible to locate the lesion. A biodistribution and pharmacokinetic study of the 99mTc-HMPAO complex was carried out in B16-melanoma tumor healthy and carrier mice after an intravenous injection. Radioactivity was measured in the liver, kidneys, spleen, stomach, brain, blood and tumor. It was seen that at 15 minutes of the injections, 40% of the total activity distributed in the animal body was recorded in the tumor. An interesting effect observed is an increase in the tissue distribution curves in both experimental groups at 1-2 hours post-injection. According to the seriated imaging study results with 99mTc-HMPAO in B16 melanoma bearing mice, the best image is obtained 10-30 minutes after the injection.

Objective: To explore whether antiphospholipid antibodies (aPL) are markers of vascular related damage or merely evidence of toxic related autoimmunity, we investigated the presence of different aPL in patients with toxic oil syndrome (TOS) and compared the profile with patients with eosinophilia myalgia syndrome (EMS)., Methods: Reactivity against cardiolipin, P-serine, P-inositol, and P-choline was investigated by ELISA in the blood of 266 patients with acute and chronic TOS, 25 healthy relatives of TOS patients, and 48 patients with EMS., Results: 32% of TOS and 13% of EMS patients had IgG antibodies against cardiolipin and other polyanions. 20% of both TOS and EMS patients presented IgM antibodies against anionic and zwitterionic phospholipids. 36% of TOS healthy relatives had IgM antibodies against differently charged phospholipids. Among 200 patients with chronic TOS, there was no significant association between antibodies and clinical manifestations., Conclusion: aPL with different specificity are present in a high percentage of patients with TOS and EMS. The significance of these antibodies remains unclear.

The nutritional status of 111 elderly men and women aged 60 to 99 years in two institutions in the Ecuadorian Andes was evaluated using dietary, anthropometric and biochemical measurements. Mean daily energy intakes of men and women were 1720 and 1650 kcal, respectively (7.2 and 6.9 MJ), corresponding to 1.5 times the calculated basal metabolic rate (BMR). 6% of subjects had intakes less than 1.2 x BMR and 40% less than 1.5 x BMR. Body mass index (BMI) was below 20 kg/m2 in 21% of subjects; 45% were between 20 and 24. Only one subject had a BMI over 29. Intakes of protein, calcium, iron, riboflavin and vitamin C were satisfactory, in contrast to those of zinc, vitamin A, niacin and thiamin. Using sex- and altitude-specific cutoffs for hemoglobin, anemia was observed in 11% of subjects. Nutritional status, evaluated using biochemical indicators, was satisfactory with respect to riboflavin, vitamin A, vitamin E and copper. 14% of subjects had low serum zinc levels and 17% had serum albumin values below 35 g/L. Low physical activity was associated with low energy intake and low serum albumin levels.

The tumor response in solid neoplasias can be evaluated through volumetric measurements. The advance of the technology and the appearance of new therapeutic alternatives as: hyperthermia, immunotherapy, photodynamic therapy have originated discrepancy with the volumetric measurement of the tumor because the tumor mass can increase or remain in the same size but with tissue modification and increase of the inflammatory and necrotic reaction. There are also other types of morphometric measurement, for the evaluation of the amount of hypoxic cells in the tumor tissue through indirect methods that measure the metabolic level of the tumor tissue; one of this morphometric measurement quantitates apoptosis by light microscopy as tumor regression response. This technique could facilitate experimental studies because of the use of peripheral tumoral tissue obtained with thin needles directed through image equipment.

Objective: The aim of this paper is to determine which is the best early prognostic score in acute pancreatitis among those we have studied., Design: Prospective study of acute pancreatitis cases during a 5 year period., Patients: 113 patients, biliary etiology in 93 cases, (average age: 63 years) and 66% females. The diagnostic accuracy of Ranson, Imrie, Osborne and apache II scores was analyzed., Results: There were complications in 12%, and mortality was 8%. Among all the systems analyzed the Ranson criteria achieved the highest sensitivity (79%), although sensitivity was improved with Apache II at admission to the hospital (86%). We have obtained the best specificity with the Apache II (89%) and with the Osborne criteria (88%). The modification of Ranson's criteria for biliary etiology didn't improve the sensitivity (56%) to detect severe cases of acute pancreatitis., Conclusions: The Apache II system was the best for the early detection of severe acute pancreatitis. Its diagnostic sensitivity was higher than the multiple laboratory criteria analyzed.

Major air shows are potentially extremely hazardous events. They may attract large crowds numbering in the hundreds of thousands, and the communities in which they are held are usually not equipped to provide emergency services for so many individuals. It is not unusual for several hundred spectators to develop symptoms of medical illness substantial enough to require some elements of medical intervention. Added to this is the potential for and very real hazard of a major airplane crash or vehicular crash. Effective planning for such events is a complex process requiring coordination among various agencies. The Royal Air Force Mildenhall Medical Emergency Support Plan is an example of an approach used successfully to provide support for one of the largest military air shows in the world. We present a comprehensive approach to providing urgent services for up to 700 potential casualties including on-scene definitive stabilization for those most seriously injured.

A randomized trial was conducted to compare cefixime (400 mg or 800 mg single oral dose) with ceftriaxone (250 mg single intramuscular dose) in terms of efficacy and safety for the treatment of uncomplicated Neisseria gonorrhoeae urethritis or cervicitis. Of 75 men and 150 women screened, 187 had positive culture results for N. gonorrhoeae. The course of treatment was evaluable in 155 cases (59 men, 96 women). Bacteriologic eradication was evident in 97% (105 out of 108) of the patients treated with cefixime and in 100% (47 out of 47) of the patients treated with ceftriaxone. N. gonorrhoeae was eliminated at 98% (143 out of 146) and 100% (72 out of 72) of the infection sites in the respective treatment groups. Of the 187 isolates, 8 were penicillinase-producing (PPNG) and 20 had high-level tetracycline resistance (TRNG). The cefixime and ceftriaxone MIC90 for all 187 study isolates was 0.008 micrograms/ml. The adverse clinical experiences reported by the patients treated with cefixime (10%) were self-limiting; no adverse experiences occurred in the patients treated with ceftriaxone. Cefixime was as well tolerated and efficacious as ceftriaxone in the treatment of the patients with uncomplicated N. gonorrhoeae urethritis or cervicitis reported here.