RESUMO
Introduction: CA 19-9 has been identified as a derivative of sialic Lewis blood group A and is expressed in 95 percent of the population. Several studies have documented an overproduction of CA 19-9 in malignant pancreatic and biliary tree diseases. The objective of this study is to determine the accuracy of the tumor marker CA 19-9 differentiating benign and malignant bilio-pancreatic diseases. Material and Methods: diagnostic test study. We reviewed the records of all patients with malignant bilio-pancreatic diseases and benign biliary calculous diseases evaluated in Hospital Base Osorno between august 2007 and december 2011, with CA 19-9 as part of their study. Results: 71 patients met the inclusion criteria, 17 men and 54 women, with a mean age of 60.7 +/- 15.3 years old. Twenty nine (40.8 percent) cases were benign and 42 (59.2 percent) cases malignant. For a cutoff level of 37 U/ml the sensitivity, specificity, positive predictive value (PPV) and negative predictive value (NPV) to differentiate benign from malignant disease was 81 percent, 72.4 percent, 81 percent and 72.4 percent, respectively. For a cut off level of 130 U/ml specificity and PPV increased to 96.6 percent and 96.4 percent, respectively. Conclusions: the use of CA 19-9 is useful in the diagnosis of patients with suspected bilio-pancreatic malignant disease. The optimization of the normal published value can help to improve accuracy.
Introducción: El CA 19-9 se ha identificado como un derivado siálico del grupo sanguíneo Lewis A y se expresa en el 95 por ciento de la población. Numerosos estudios han documentado una sobreproducción de CA 19-9 en tumores malignos del árbol biliar y páncreas. El objetivo de este estudio es determinar la utilidad del marcador tumoral CA 19-9 en la diferenciación de patología bilio-pancreática benigna y maligna. Material y Métodos: estudio de pruebas diagnósticas. Se revisaron los antecedentes de todos los pacientes con patología bilio-pancreática maligna y enfermedad litiásica biliar benigna, evaluados en el Hospital Base de Osorno entre agosto de 2007 y diciembre de 2011, a los que se les haya solicitado CA 19-9 como parte de su estudio. Resultados: 71 pacientes cumplieron los criterios de inclusión, 17 hombres y 54 mujeres, con una media de 60,7 +/- 15,3 años de edad. Veintinueve (40,8 por ciento) casos correspondieron patología benigna y 42 (59,2 por ciento) casos a patología maligna. Para un valor de corte de 37 U/ml la sensibilidad, especificidad, valor predictivo positivo (VPP) y valor predictivo negativo (VPN) para diferenciar enfermedad benigna de maligna fue de 81 por ciento, 72,4 por ciento, 81 por ciento y 72,4 por ciento, respectivamente. Para un valor de corte de 130 U/ ml la especificidad y el VPP aumentaron a 96,6 por ciento y 96,4 por ciento, respectivamente. Conclusiones: el uso del Ca 19-9 es útil en el proceso diagnóstico de pacientes con sospecha de patología bilio-pancreática maligna. La optimización de los valores sobre el valor de normalidad publicado puede ayudar a mejorar su rendimiento.
Assuntos
Humanos , Masculino , Feminino , Adulto , Pessoa de Meia-Idade , Idoso de 80 Anos ou mais , /sangue , Colangiocarcinoma/diagnóstico , Colecistite/diagnóstico , Coledocolitíase/diagnóstico , Neoplasias Pancreáticas/diagnóstico , Cálculos Biliares/diagnóstico , Diagnóstico Diferencial , Pancreatopatias/diagnóstico , Doenças Biliares/diagnóstico , Modelos Lineares , Biomarcadores/sangue , Valor Preditivo dos Testes , Curva ROC , Sensibilidade e EspecificidadeRESUMO
Background: Acute appendicitis can be the first manifestation of an appendiceal tumor. Aim: To evaluate the incidence of appendiceal tumors among patients operated for acute appendicitis. Material and Methods: All patients operated for acute appendicitis between 1998 and 2008 and whose appendix had a pathological study were included. Survival was calculated using national death register databases. Results: Data from 6.093 patients was analyzed. A malignant tumor was found in 17 patients (0.3 percent). Eleven patients aged 23 +/- 14 years had a carcinoid tumor, that was more commonly located distally, five patients aged 66 +/-18 years had an adenocarcinoma, that was more commonly located proximally, and one patient had a non Hodgkin lymphoma. Curative surgery was carried out in all carcinoid tumors and 40 percent of adenocarcinomas. No patient had regional lymph node involvement. Five years survival of patients with carcinoid tumors was 100 percent. Conclusions: The finding of malignant tumor among patients with acute appendicitis is uncommon.
Introducción: Al enfrentarnos a un paciente con apendicitis aguda, pocas veces pensamos que puede ser la primera manifestación de un cáncer apendicular. Objetivo: Describir el número de casos nuevos de cáncer apendicular en las apendicectomías de urgencia en el Hospital Base Osorno (HBO) durante los años 1998-2008. Material y Métodos: Serie de casos. Se incluyeron pacientes operados por abdomen agudo en el servicio de urgencia del HBO, que en cuyo informe anatomopatológico de la biopsia diferida se informara cáncer apendicular, entre los años 1998 y 2008. Se excluyeron pacientes en los que el apéndice estaba comprometido por contigüidad. Algunas variables incluidas: edad, sexo, diagnóstico preoperatorio, tipo de cirugía, resección completa tumoral, reintervención, características histoanatomopatológicas, terapia adyuvante. Descripción de variables en porcentajes, medias o medianas. Curvas de sobrevida: Kaplan Meier. Programa estadístico Stata 10.0. Resultados: Se analizaron 6.093 pacientes. Se encontró un cáncer en el 0,28 por ciento (17 pacientes) de los casos. 11 (64 por ciento) fueron carcinoides, 5 (29 por ciento) adenocarcinomas y 1 (6 por ciento) linfoma no Hodgkin. Edad promedio 23,45 (DS +/- 14,45) años en los carcinoidesy 65,75 (DS +/- 18,46) en los adenocarcmomas. En los carcinoides predominó el sexo femenino, contrario a lo sucedido en los adenocarcmomas. Se practicó cirugía curativa al 100 por ciento de los carcinoides y al 40 por ciento de los adenocarcinomas. Ubicación más frecuente: Carcinoides en tercio distal y adenocarcinoma en tercio proximal. Ningún tumor tuvo linfonodos comprometidos. 100 por ciento de sobrevida a 5 años en carcinoides. Conclusiones: El número de casos nuevos de cáncer en una apendicitis aguda es bajo. En los carcinoides, la sobrevida a 5 años es alta.
Assuntos
Humanos , Masculino , Feminino , Criança , Adolescente , Adulto , Pessoa de Meia-Idade , Adenocarcinoma/cirurgia , Apendicectomia/estatística & dados numéricos , Neoplasias do Apêndice/cirurgia , Tumor Carcinoide/cirurgia , Adenocarcinoma/mortalidade , Adenocarcinoma/patologia , Emergências , Neoplasias do Apêndice/mortalidade , Neoplasias do Apêndice/patologia , Reoperação , Análise de Sobrevida , Tumor Carcinoide/mortalidade , Tumor Carcinoide/patologiaRESUMO
AIM: To report on the oral comprehension of the non-literal meanings of indirect speech acts and idioms in everyday speech by children with attention deficit hyperactivity disorder (ADHD). SUBJECTS AND METHODS: The subjects in this study consisted of a sample of 29 Chilean schoolchildren aged between 6 and 13 with ADHD and a control group of children without ADHD sharing similar socio-demographic characteristics. A quantitative method was utilised: comprehension was measured individually by means of an interactive instrument. The children listened to a dialogue taken from a cartoon series that included indirect speech acts and idioms and they had to choose one of the three options they were given: literal, non-literal or distracter. RESULTS: The children without ADHD identified the non-literal meaning more often, especially in idioms. Likewise, it should be pointed out that whereas the children without ADHD increased their scores as their ages went up, those with ADHD remained at the same point. CONCLUSIONS: ADHD not only interferes in the inferential comprehension of non-literal meanings but also inhibits the development of this skill in subjects affected by it.
Assuntos
Transtorno do Deficit de Atenção com Hiperatividade/psicologia , Transtornos da Percepção Auditiva/psicologia , Testes de Linguagem , Adolescente , Transtorno do Deficit de Atenção com Hiperatividade/complicações , Transtornos da Percepção Auditiva/etiologia , Criança , Feminino , Humanos , Masculino , SemânticaRESUMO
Aunque la endometriosis es una entidad ampliamente conocida en ginecología, la presentación intestinal es de mucho menor frecuencia. Los síntomas obstructivos, así como otras manifestaciones gastrointestinales como dolor y hemorragia rectal periódica se mencionan en la literatura. En esta revisión presentamos nuestra experiencia en el tratamiento de cuatro pacientes portadoras de endometriosis intestinal en un periodo de tiempo de trece años. Se trata de mujeres jóvenes, que fueron estudiadas con endoscopia baja, TAC de abdomen y enema baritada. En todas se realizó resección anterior de recto sigmoides, con evolución postoperatoria. El estudio histológico postoperatorio confirmó cada caso. Se revisa la literatura y discuten otras opciones terapéuticas.
Assuntos
Humanos , Adulto , Feminino , Endometriose/cirurgia , Endometriose/diagnóstico , Endometriose/terapia , Enteropatias , Chile , Procedimentos Cirúrgicos Operatórios/métodosRESUMO
Se presenta la experiencia acumulada en la Unidad de Coloproctología del Hospital Clínico de la Universidad de Chile en el tratamiento quirúrgico de la colitis ulcerosa idiopática en nuestro medio, en el período comprendido entre 1987 y 2002. El universo comprende a 42 pacientes, 23 mujeres y 19 hombres cuyos datos fueron ingresados a una base de Epilnfo. En promedio se operaron 5 pacientes por año. Se analiza la indicación de cirugía y la técnica empleada considerando que es la proctocolectomía con reservorio ileal protegido con una ileostomía en asa el "gold standard" en el tratamiento quirúrgico de esta patología. La cirugía por etapas en dos o en tres etapas dependiendo de la indicación. En cuanto a las complicaciones destacan las derivadas del reservorio lo que significó la pérdida definitiva del reservorio en el 9,4 por ciento, cifra que está de acuerdo con lo reportado en la literatura. La mortalidad global de esta serie fue de 2,3 por ciento. Esta es una ciurgía de alta complejidad, que se efectúa en nuestro medio en pacientes habitualmente de emergencia o de urgencia, lo que explica la presencia de morbimortalidad, considerando además que al ser en etapas en cada una de ellas pueden presentarse complicaciones.
Assuntos
Humanos , Masculino , Feminino , Bolsas Cólicas , Colite Ulcerativa/cirurgia , Ileostomia , Proctocolectomia RestauradoraRESUMO
Se presenta una serie de 14 pacientes operados por enfermedad diverticular del colon fistulizada, estudiados en forma retrospectiva, analizando el cuadro clínico, los métodos de estudio, la cirugía realizada, los críterios para resolver en un tiempo la patología. La morbilidad fue de 35 por ciento con cuatro complicaciones de tipo quirúrgico y una de orden médico. No hubo mortalidad en este grupo de pacientes. Quedaron curados en forma definitiva 12 de 14 pacientes (85 por ciento)
Assuntos
Humanos , Masculino , Feminino , Pessoa de Meia-Idade , Doença Diverticular do Colo , Fístula , Anastomose Cirúrgica , Colectomia , Doença Diverticular do Colo , Fístula , Estudos RetrospectivosRESUMO
La calidad de atención orientada a la satisfacción del (la) usuario (a) y a la resolución de problemas de salud, encuentra restricciones en establecimientos del primer nivel vinculadas (entre otras) a aspectos de una inadecuada comunicación entre el personal de salud y los usuarios, debido principalmente a factores socioculturales, como el idioma, el trato inadecuado, la idiosincrasia del usuario y del personal de salud, asímismo no existe el suficiente apoyo logístico para el trabajo operativo, la infraestructura es deficitaria y el equipamiento es insuficiente. Es a partir de estas constataciones que se hace necesario ampliar la visión tradicional centralista y paternalista sobre lo social y avanzar hacia el enfoque que tome en cuenta las distintas interrelaciones de las esferas económicas, políticas, legales y del medio ambiente para con el área social, especialmente con el sector salud.
Assuntos
Atenção , Criança , Saúde , Centros de SaúdeRESUMO
Carrageenans extracted from cystocarpic and tetrasporic Stenogramme interrupta were analysed by chemical and spectroscopic methods. The carrageenan from cystocarpic plants is composed predominantly of 0.5 M KCl-insoluble and 1 M KCl-soluble fractions. The insoluble fraction contained iota-carrageenan as the major component with alpha-carrageenan and pyruvated carrageenan as minor components. The soluble fraction is highly heterogeneous and did not contain the precursors mu- and nu-carrageenans. The polysaccharide from tetrasporic plants is composed of zeta- and lambda-carrageenans, and low sulfated galactans. It is soluble in KCl and partly cyclized by alkaline treatment. The antiviral and anticoagulant properties of the insoluble polysaccharide fraction from cystocarpic S. interrupta and the polysaccharide from tetrasporic S. interrupta are reported the results of which suggest promising antiherpetic activity.
Assuntos
Antivirais/química , Carragenina/química , Alga Marinha/química , Animais , Anticoagulantes/química , Anticoagulantes/farmacologia , Antivirais/farmacologia , Carragenina/farmacologia , Chile , Chlorocebus aethiops , Herpesvirus Humano 1/efeitos dos fármacos , Herpesvirus Humano 1/crescimento & desenvolvimento , Herpesvirus Humano 2/efeitos dos fármacos , Herpesvirus Humano 2/crescimento & desenvolvimento , Espectroscopia de Ressonância Magnética , Relação Estrutura-Atividade , Células VeroRESUMO
We have developed RNA probes for the direct identification of wild poliovirus isolates by blot hybridization. The probes are complementary to sequences of the first 30 to 32 codons of VP1, which evolve more extensively (approximately 1.5-fold) than the rest of VP1. To illustrate our general approach, we describe the design of probes specific to each of four major genotypes recently endemic (1981 to 1991) to the Americas: Andean type 1, Brazil type 1, Brazil type 3, and Central America-Mexico type 3. A wild isolate of each genotype was selected according to molecular and epidemiologic criteria to be representative of the principal lineages in circulation. Variable VP1 sequences of the representative isolates were amplified by the reverse transcriptase PCR and were inserted into a plasmid vector containing a T7 promoter. The in vitro transcripts, labeled with digoxigenin, served as probes. These formed stable hybrids only with RNAs of isolates of the corresponding genotypes. Hybrids were detected by a sensitive chemiluminescence assay, capable under normal diagnostic conditions of detecting specific wild poliovirus sequences in samples containing up to a 100-fold excess of Sabin vaccine strain-related sequences of the same serotype.
Assuntos
Poliovirus/genética , Poliovirus/isolamento & purificação , Sondas RNA , Sequência de Bases , Brasil , Capsídeo/genética , Proteínas do Capsídeo , América Central , Códon , Primers do DNA , Genótipo , Humanos , México , Dados de Sequência Molecular , Poliovirus/classificação , Vacina Antipólio de Vírus Inativado , Vacina Antipólio Oral , Reação em Cadeia da Polimerase , Rabdomiossarcoma , América do Sul , Células Tumorais CultivadasRESUMO
Fecal excretion of astroviruses was monitored in 321 children, 0 to 3 years old, living in the rural highlands of Guatemala. During the longitudinal study, from February 1987 to February 1989, we examined 5,000 stool specimens, including 1,805 collected during 1,369 episodes of diarrhea, 830 collected during the convalescent week, and 216 and 244 collected 2 weeks and 1 week, respectively, before the onset of diarrhea. Routine specimens were taken once a month from every child who had been free from diarrhea for at least three consecutive weeks. Of the children, 124 (38.6%) excreted astroviruses during the study. In total, we identified 184 infections by astroviruses. Of the samples collected 2 weeks and 1 week before the initiation of symptoms, 0.9 and 4.9%, respectively, were positive, while 7.3% of the diarrhea episodes were associated with astroviruses. Of the convalescent specimens, 3.4% were shown to be positive; 2.4% of the 1,905 specimens taken in diarrhea-free periods contained astroviruses. Infections by other potential enteropathogens were documented in 54 and 65% of the asymptomatic and symptomatic astrovirus infections, respectively. Diarrhea associated with astroviruses alone had a median duration of 5 days and was associated with vomiting in 8.6%, with fever in 17.1%, with dehydration in 5.7%, and with loss of appetite in 34.3% of the episodes. Diarrhea due to astroviruses was accompanied by negative changes in weight gain. Astrovirus diarrhea contributes to the high morbidity observed in young children living under poor conditions and has a deleterious effect on their nutritional status.
Assuntos
Diarreia/etiologia , Mamastrovirus/isolamento & purificação , Peso Corporal , Pré-Escolar , Diarreia/epidemiologia , Fezes/microbiologia , Feminino , Guatemala/epidemiologia , Humanos , Lactente , Recém-Nascido , Masculino , População Rural , Viroses/epidemiologiaAssuntos
Anticorpos Antibacterianos/análise , Anticorpos Antiprotozoários/análise , Antígenos de Bactérias/imunologia , Antígenos de Protozoários/imunologia , Diarreia/imunologia , Imunidade Materno-Adquirida , Imunoglobulina A Secretora/imunologia , Enteropatias Parasitárias/imunologia , Leite Humano/imunologia , Adulto , Animais , Aleitamento Materno , Diarreia/microbiologia , Diarreia Infantil/imunologia , Diarreia Infantil/microbiologia , Disenteria Bacilar/imunologia , Fezes/microbiologia , Fezes/parasitologia , Feminino , Giardia/imunologia , Giardíase/imunologia , Guatemala , Humanos , Lactente , Recém-Nascido , Absorção Intestinal , Estudos Prospectivos , Shigella/imunologiaRESUMO
The most important risk factor for HIV infection in North América amd Western Europe is homosexual behavior. This article describes a 1988 survey of active male homosexuals in Lima, Perú, that investigated patterns of homosexual behavior and HIV seropositividad
Assuntos
Síndrome da Imunodeficiência Adquirida , Soropositividade para HIV , Comportamento Sexual , Homossexualidade , Peru , Fatores de RiscoRESUMO
Aunque el comportamiento sexual sigue siendo el antecedente más frecuente de los casos de SIDA notificados en América Latina, en pocos trabajos se ha estudiado la relación entre prevalencia de la infección y sus factores de riesgo en homosexuales. Entre enero y abril de 1988, se entrevistó a 124 hombres homosexuales asintomáticos peruanos, para conocer su comportamiento sexual, sus actitudes y conocimientos sobre el SIDA, así como los antecedentes epidemiológicos de la enfermedad. La prevalencia de la infección se estimó obteniendo muestras de sangre y detectando en ellas la presencia de anticuerpos contra el virus de la inmunodeficiencia humana tipo I. Para ello, se utilizaron el enzimoinmunoensayo y la prueba de Western Blot. La media de compañeros sexuales en el último año fue 7,6 (=+1,79). El 97,6 porciento de los entrevistados practicaban el coito anal y 24,8 porciento empleaban preservativos. Ninguno de ellos notificó usar drogas por vía intravenosa. En 8 sujetos se detectaron anticuerpos contra el VIH (6,5 porciento +4,3). Los factores de riesgo asociados con la seropositividad al VIH fueron tener más de 20 compañeros en los últimos 12 meses (razón de productos cruzados (RPC) =11,0), practicar el coito anal receptivo sin condón (P=0,0074), consumir drogas (RPC=9,55) y haber sido reclutado en la vía pública o en un bar (RPC=15,57). Se concluye que la frecuencia de infección en el grupo estudiado era moderadamente alta y que los factores de riesgo de la infección identificados coinciden con los descritos en otros trabajos
Disponible en inglés en Bull. Pan Am. Health Organ 25(4), 1991
Assuntos
Síndrome da Imunodeficiência Adquirida , Comportamento Sexual , Homossexualidade , Peru , Fatores de RiscoRESUMO
Acute respiratory tract infections (ARI) were studied during a 2-year period in 521 preschool children living in a marginal area of Guatemala City. There were 3,646 episodes of ARI detected during 26,329 child-weeks at risk, for an incidence of 14 per 100 child-weeks or 7.2 episodes per child per year. The median duration of ARI episodes was 11 days. The highest incidence of ARI was observed in children 6-23 months old. Boys had more respiratory tract illnesses than did girls; the presence of a cigarette smoker in the household was associated with higher morbidity. Acute lower respiratory tract illnesses (ALRI) were more common among younger infants 0-5 months old, with nutritional status having no apparent effect. Parental formal education and crowding in households were found to be directly related to the incidence of ALRI. In general, ARI morbidity interfered with appropriate physical growth.
Assuntos
Infecções Respiratórias/epidemiologia , Doença Aguda , Pré-Escolar , Escolaridade , Feminino , Guatemala/epidemiologia , Humanos , Incidência , Lactente , Recém-Nascido , Masculino , Estado Nutricional , Prevalência , FumarRESUMO
From March 1987 to February 1988, fecal excretion of adenovirus types 40 and 41 and rotavirus serotypes in 194 children (age, 0 to 3 years) from a rural community of Guatemala was monitored. In total, 458 samples taken during 385 episodes of diarrhea and 191 specimens obtained during symptom-free periods were examined by enzyme-linked immunosorbent assay. Fifty-seven children hospitalized because of diarrhea were also studied. Among the rural children, 43 (22.2%) excreted adenovirus types 40 and 41 and 20 (10.3%) shed rotaviruses. Adenovirus types 40 and 41 were associated with 54 (14.0%) illnesses, and rotaviruses were associated with 18 (4.7%) illnesses. Asymptomatic infections with adenovirus types 40 and 41 were documented in nine children and with rotaviruses in two children. Fifteen typeable rotaviruses were identified as serotype 2. In the hospital population, 36 (63.2%) children had viral infections. Rotaviruses were identified in 29 (50.9%) and adenovirus types 40 and 41 were identified in 15 (31.2%) of 48 subjects tested. Dual infections by these viruses were found in eight children. Of 22 typeable strains of rotaviruses, 9 (34.6%) were serotype 1, 12 (46.1%) were serotype 2, and 1 (3.8%) was serotype 3. All the children infected with serotype 2 rotavirus were coinfected with other enteric pathogens, while only three (37.5%) of those infected with rotavirus serotype 1 excreted another pathogen. Adenovirus types 40 and 41 are an important cause of gastroenteritis in both ambulatory and hospitalized Guatemalan children. There seems to be a difference in the pathogenicity among rotavirus serotypes.