RECERCAT - Articles publicats en revistes (Obstetrícia i Ginecologia, Pediatria i Radiologia i Medicina Física)

Lestaurtinib inhibition of the JAK/STAT signaling pathway in Hodgkin lymphoma inhibits proliferation and induces apoptosis

Lestaurtinib inhibition of the JAK/STAT signaling pathway in Hodgkin lymphoma inhibits proliferation and induces apoptosis Diaz, T; Navarro Ponz, Alfons; Ferrer, G; Gel, B; Gaya, A; Artells i Prats, Rosa; Bellosillo, B; Garcia-Garcia, M; Serrano, S; Martínez Pozo, Antonio; Monzó Planella, Mariano Standard cytotoxic chemotherapy for Hodgkin Lymphoma (HL) has changed little in 30 years; the treatment for patients with relapsed or refractory disease remains challenging and novel agents are under development. JAK/STAT constitutive activation plays an important role in the pathogenesis of HL. Lestaurtinib is an orally bioavailable multikinase inhibitor that has recently been shown to inhibit JAK2 in myeloproliferative disorders. The potential role of Lestaurtinib in HL therapy is unknown. We have analyzed the effect of Lestaurtinib treatment in five HL cell lines from refractory patients, L-428, L-1236, L-540, HDML-2 and HD-MY-Z. At 48 h, a dose-dependent cell growth inhibition (23%
66% at 300 nM) and apoptotic increment (10%
64% at 300 nM) were observed. Moreover, Lestaurtinib inhibited JAK2, STAT5 and STAT3 phosphorylation and reduced the mRNA expression of its downstream antiapoptotic target Bcl-xL. In addition, we have analyzed the effect of Lestaurtinib treatment in lymph nodes from four classic HL patients. We observed a decrease in cell viability at 24 hours of treatment in three patients (mean decrease of 27% at 300 nM). Our findings provide, for the first time, a molecular rationale for testing JAK2 inhibitors, specifically Lestaurtinib, in HL patients.

Validation of an automatic dose injection system for Ictal SPECT in epilepsy

Validation of an automatic dose injection system for Ictal SPECT in epilepsy Setoain X; Pavía Segura, Javier; Serés E; Garcia R; Carreño MM; Donaire A; Rubí S; Bargalló N; Rumià Arboix, Jordi; Boget Llucià, Teresa; Pintor L; Fuster D; Pons Pons, Francisca The purpose of our study was to evaluate the performance and clinical usefulness of an automated injector system (AIS) that administers an automated injection for ictal SPECT after calculating the volume of tracer to be injected over time. Methods: To test the AIS, repeated injections were performed at different times after tracer preparation. The clinical study consisted of 56 patients with drug-resistant, complex partial seizures. Tracer for ictal SPECT was injected using automated injection in 27 patients and manual injection (MI) in the remaining 29. Injection time (TI) was measured in seconds from seizure onset to the end of volume injection. The SISCOM (Subtraction Ictal Spect Co-registered to MRI) procedure was used to locate the epileptogenic seizure focus with SPECT. The definition of seizure focus was made by consensus of the epilepsy unit using conventional diagnostic methods. Results: During the experimental phase, there were no system failures, and the error in injected doses when using automated injection was lower than with MI. During the clinical phase, TI using manual injection was 41 s with a range of 14&br&103 s, compared with an AIS average of 33 s with a range of 19&br&63 s (P , 0.05). Ictal SPECT and SISCOM successfully localized the seizure focus in 21 of the 27 patients (78%) by AIS and in 19 of the 29 patients (65%) by MI (P 5 0.14). Furthermore, nursing staff found the AIS method more convenient than the MI method. Conclusion: An AIS can improve the quality of work of the nursing staff in the neurology ward and allow a finer adjustment of the injection dose. Early results using an AIS would indicate a reduction in injection time and improved SPECT accuracy.

Added value of intraoperative real-time imaging in searches for difficult-to-locate sentinel nodes.

Added value of intraoperative real-time imaging in searches for difficult-to-locate sentinel nodes. Vidal-Sicart S; Paredes P; Zanón G; Pahisa Fábregas, Jaume.; Martinez-Román S; Caparrós X; Vilalta A; Rull Ortuño, Antonio Ramón; Pons F. Localization of sentinel lymph nodes can be challenging if they are in difficult anatomic locations or near high radiotracer activity. The purpose of this study was to assess the value of intraoperative real-time imaging using a portable gamma-camera in conjunction with a conventional gamma-counting probe when it is difficult to localize the sentinel node.

Accuracy and Reproducibility of Lymphoscintigraphy for Sentinel Node Detection in Patients with Cutaneous Melanoma.

Accuracy and Reproducibility of Lymphoscintigraphy for Sentinel Node Detection in Patients with Cutaneous Melanoma. Vidal M; Vidal-Sicart S; Torrents A; Perissinotti A; Navales I; Paredes P; Pons Pons, Francisca Lymphoscintigraphy is an important part of the mapping and identification of sentinel lymph nodes (SLNs). However, few studies report its reproducibility, and some concerns prevail. The aim of the study was to determine the reproducibility of lymphoscintigraphy performed by different team members following a strict protocol to assess lymphatic drainage and the location and number of SLNs. Methods: Sixty-eight melanoma patients were included. All underwent 2 separate lymphoscintigraphy studies, which followed the same acquisition protocol. Discordance was defined as a change in localization or a failure to identify the SLN in one of the studies. Results: All patients showed lymphatic drainage, and in all cases at least 1 sentinel node was identified. In 65 of 68 patients (96%), the findings of the first lymphoscintigraphy study were similar to those of the second. This similarity was also found in the number of sentinel nodes (171 in the first study and 173 in the second). Eighty percent of patients showed 1&br&3 SLNs in both lymphoscintigraphy studies. The 2 studies differed in 3 patients (4%): 2 melanomas were located on the trunk and 1 on the head and neck. Drainage was visualized to more than 1 lymphatic basin in 19 patients (28%) in the first study versus 18 patients in the second study. Conclusion: Lymphoscintigraphy is highly reproducible in the detection of sentinel nodes in melanoma patients. The classic protocol of radiotracer injection is reproducible and reliable enough to guarantee SLN identification, although a slight variation in isolated cases (especially when primary lesions are located on the trunk or the head and neck regions) is inevitable.

Experiencia con la dieta cetogénica como tratamiento en la epilepsia refractaria

Experiencia con la dieta cetogénica como tratamiento en la epilepsia refractaria Ramírez Camacho, Alia; Meavilla, Silvia; Catalán, Natalia; Gutiérrez, Alejandra; Campistol Plana, Jaume Introducción: La epilepsia es una enfermedad neurológica que se controla con fármacos antiepilépticos en la mayoría de casos. Sin embargo, aproximadamente un 25% de epilepsias son refractarias al tratamiento farmacológico. La dieta cetogénica es una de las opciones terapéuticas para este tipo de epilepsia. A pesar del aumento en los últimos años de la popularidad de ésta como tratamiento anticonvulsivo, no se ha establecido un consenso internacional para sus indicaciones y manejo. Objetivo: Evaluar la respuesta, tolerancia y efectos secundarios en los pacientes con epilepsias refractarias que han recibido dieta cetogénica en nuestra institución en un período de 20 años. Pacientes y métodos: Se revisaron las historias clínicas de 30 pacientes que utilizaron dieta cetogénica como coadyuvante al tratamiento de epilepsia refractaria seguidos en nuestro centro. Se obtuvo información completa para el estudio en 27 casos. Resultados: Diez pacientes (35,7%) presentaron una respuesta positiva en la reducción del número de crisis por más de seis meses; cinco de ellos con una disminución del 50-75% de las crisis y cinco de más del 75%. Los efectos adversos más frecuentes a corto plazo fueron diarrea, vómitos e hipoglucemias, y a largo plazo, estreñimiento y aumento de peso. Conclusiones: Existe una respuesta positiva con la dieta cetogénica en una tercera parte de nuestros pacientes con epilepsia refractaria. La tolerancia es aceptable y los efectos adversos existentes pueden prevenirse o corregirse. Puede considerarse una opción terapéutica frente a epilepsias refractarias antes de iniciar otras medidas más agresivas o cuando no es factible la opción quirúrgica.

Trombosis venosas cerebrales en la edad pediátrica: presentación clínica, factores de riesgo, diagnóstico y tratamiento

Trombosis venosas cerebrales en la edad pediátrica: presentación clínica, factores de riesgo, diagnóstico y tratamiento Russi, M Eugenia; González, Verónica; Campistol Plana, Jaume Introducción: Desde su primera descripción a mediados del siglo xix, mucho se ha avanzado en el conocimiento de esta entidad, que constituye una reconocida, aunque desestimada, causa de ictus en la infancia. Objetivo: Analizar la presentación clínica, factores de riesgo, evolución y tratamiento de una población de niños con trombosis venosa cerebral. Pacientes y métodos: Se llevó a cabo un estudio descriptivo, retrospectivo y longitudinal, de niños entre 0 y 17 años con trombosis venosa cerebral, en un período de cinco años. Resultados: Se identificaron 31 casos, de los cuales 18 fueron varones. Dieciocho pacientes comenzaron con convulsiones y 13 con síndrome de hipertensión endocraneal. Se identificaron 23 pacientes con procesos infecciosos, cuatro con patología de base previa, cinco con factores protrombóticos, tres neonatos con traumatismo obstétrico, cinco con más de un factor de riesgo y uno sin marcadores de riesgo. Se realizó diagnóstico por resonancia magnética en 18 pacientes, por tomografía computarizada con contraste en 11 y por angiorresonancia en los dos restantes. Dieciséis presentaron trombosis del seno transverso, cuatro del longitudinal superior, cuatro del sigmoides, cinco afectación de más de un seno y dos del seno cavernoso. Se inició anticoagulación en 21 niños y no se trataron los 10 restantes. Doce pacientes manifestaron déficit neurológico a largo plazo, mientras que 18 se mantuvieron asintomáticos. No hubo fallecimientos o complicaciones graves por la trombosis ni la anticoagulación, así como tampoco recurrencias sintomáticas en el seguimiento. Conclusiones: Las trombosis venosas cerebrales son una causa importante de ictus en la infancia. La sospecha clínica debe ser elevada ante todo paciente con clínica de hipertensión endocraneal o convulsiones en presencia de factores de riesgo conocidos.

MRI at 12 ± 2 months' corrected age without sedation

MRI at 12 ± 2 months' corrected age without sedation Padilla Gomes, Nelly; Botet Mussons, Francisco; Gratacós Solsona, Eduard (Letter to the Editor) Sir, We read with interest the article by Edwards and Arthurs [1] about the methodological challenges of acquiring highquality MRI in young children. Although the use of anaesthesia and sedation is often a possibility, parents are often hesitant. Consequently, we have developed a protocol for performing MRI in infants at 12 ± 2 months corrected age...

Pro-adrenomedullin usefulness in the management of children with community-acquired pneumonia, a preliminary prospective observational study

Pro-adrenomedullin usefulness in the management of children with community-acquired pneumonia, a preliminary prospective observational study Sardà Sánchez, Marta; Calzada Hernández, Joan; Hernández Bou, Susanna; Claret Teruel, Gemma; Velasco Rodríguez, Jesús; Luaces Cubells, Carles BackgroundIn adult population with community acquired pneumonia high levels of pro-adrenomedullin (pro-ADM) have been shown to be predictors of worse prognosis. The role of this biomarker in pediatric patients had not been analyzed to date. The objective of this study is to know the levels of pro-ADM in children with community acquired pneumonia (CAP) and analyze the relation between these levels and the patients¿ prognosis.FindingsProspective observational study including patients attended in the emergency service (January to October 2009) admitted to hospital with CAP and no complications at admission. The values for pro-ADM were analyzed in relation to: need for oxygen therapy, duration of oxygen therapy, fever and antibiotic therapy, complications, admission to the intensive care unit, and length of hospital stay. Fifty patients were included. Ten presented complications (7 pleural effusion). The median level of pro-ADM was 1.0065¿nmol/L (range 0.3715 to 7.2840¿nmol/L). The patients presenting complications had higher levels of pro-ADM (2.3190 vs. 1.1758¿nmol/L, p¿=¿0.013). Specifically, the presence of pleural effusion was associated with higher levels of pro-ADM (2.9440 vs. 1.1373¿nmol/L, p¿&¿0.001).ConclusionsIn our sample of patients admitted to hospital with CAP, pro-ADM levels are related to the development of complications during hospitalization.

Clinical evolution of sacral stress fractures: influence of additional pelvic fractures

Clinical evolution of sacral stress fractures: influence of additional pelvic fractures Peris Bernal, Pilar; Guañabens Gay, Núria; Pons Pons, Francisca; Herranz, R.; Monegal Brancós, Ana; Suris, X.; Muñoz Gómez, José To evaluate the clinical evolution of sacral stress fractures in relation to the scintigraphic pattern and the presence of additional pelvic fractures. METHODS--This was a retrospective study of 14 patients with sacral fractures. RESULTS--Six patients had additional pelvic fractures. Four bone scintigraphic patterns were found. The resolution of symptoms was longer in patients with associated pelvic fractures (30 weeks v three weeks). No relation was found between the bone scintigraphic pattern and the time of evolution. CONCLUSION--Associated pelvic fractures delay the resolution of symptoms in patients with sacral fractures, regardless of scintigraphic pattern.

Posterior vaginal wall repair with synthetic absorbable mesh: A new technique for and old procedure

Posterior vaginal wall repair with synthetic absorbable mesh: A new technique for and old procedure Castelo-Branco Flores, Camil; Garrido, Julio F.; Ribas, Carlos; Iglesias Guiu, Xavier, 1936- The objective of this study was to assess the applicability of posterior wall repair with a synthetic absorbable mesh. Between January and September 1996, five posterior repairs using absorbable synthetic meshes were performed. Five posterior wall repairs in patients matched for age, parity, and rectocele degree were performed according to usual procedures during the same period, and were used as controls. No febrile morbidity, cuff or posterior vaginal wall infections, thrombophlebitis, rectal injury, or hemorrhagic complications were observed in the 10 women who entered the study. In summary, posterior wall repair can be easily performed with an absorbable soft tissue patch, theoretically preserving sexual activity, and probably offers better functional results with longer experience, thus providing a safe and useful procedure in sexually active women.

Vaginal hysterectomy with the autosuture stapler

Vaginal hysterectomy with the autosuture stapler Iglesias Guiu, Xavier, 1936-; Castelo-Branco Flores, Camil; Ribas, Carlos Our objective was to assess the applicability of hysterectomy by the vaginal route completely performed with Autosuture staples. Between January 1992 and September 1993, 5 vaginal hysterectomies using Autosuture staplers were performed by the authors. Five vaginal hysterectomies matched for age, parity, and uterine size performed by the same surgeons using reabsorbable sutures during the same period were used as case controls. No febrile morbidity, cuff infections, thrombophlebitis, bladder injury, or hemorrhage complications were observed in the 10 women who entered the study. In summary, vaginal hysterectomy can be performed with Autosutures easily, probably faster with experience, and with less oozing from the operative field, thus providing a safe procedure.

Upper gastrointestinal bleeding in cirrhosis: clinical and endoscopic correlations

Upper gastrointestinal bleeding in cirrhosis: clinical and endoscopic correlations Terés Quiles, José; Bordas Alsina, Josep M.; Brú i Saumell, Concepció; Díaz, F.; Bruguera i Cortada, Miquel, 1942-; Rodés, J. The clinical data of 180 episodes of upper gastrointestinal bleeding in 168 patients with cirrhosis of the liver are examined. The source of bleeding had been determined by early endoscopy in all cases. In men under the age of 50 years, and without symptoms of liver failure, bleeding was due to ruptured gastro-oesophageal varices in 84% of cases. Severe liver failure was associated with acute lesions of gastric mucosa in many cases. No presumptive diagnosis of the source of haemorrhage could be based on the examination of other clinical data (presence of ascites, mode of presentation and pattern of bleeding, history of ulcer disease, alcoholism, and previous medication.

Magnetic resonance for assessment of disease activity and severity in ileocolonic Crohn's disease.

Magnetic resonance for assessment of disease activity and severity in ileocolonic Crohn's disease. Rimola, J.; Rodríguez, S.; García Bosch, O.; Ordás, I.; Ayala, E.; Aceituno, M.; Pellisé Urquiza, Maria; Ayuso Colella, Carmen; Ricart, Elena; Donoso Bach, Lluís; Panés Díaz, Julià

Combination of diffusion tensor and functional magnetic resonance imaging during recovery from the vegetative state

Combination of diffusion tensor and functional magnetic resonance imaging during recovery from the vegetative state Fernández-Espejo, Davinia; Junqué i Plaja, Carme, 1955-; Cruse, Damian; Bernabeu, Montserrat; Roig-Rovira, Teresa; Fàbregas Julià, Neus; Rivas, Eva; Mercader, José M. Background: The rate of recovery from the vegetative state (VS) is low. Currently, little is known of the mechanisms and cerebral changes that accompany those relatively rare cases of good recovery. Here, we combined functional magnetic resonance imaging (fMRI) and diffusion tensor imaging (DTI) to study the evolution of one VS patient at one month post-ictus and again twelve months later when he had recovered consciousness. Methods fMRI was used to investigate cortical responses to passive language stimulation as well as task-induced deactivations related to the default-mode network. DTI was used to assess the integrity of the global white matter and the arcuate fasciculus. We also performed a neuropsychological assessment at the time of the second MRI examination in order to characterize the profile of cognitive deficits. Results: fMRI analysis revealed anatomically appropriate activation to speech in both the first and the second scans but a reduced pattern of task-induced deactivations in the first scan. In the second scan, following the recovery of consciousness, this pattern became more similar to that classically described for the default-mode network. DTI analysis revealed relative preservation of the arcuate fasciculus and of the global normal-appearing white matter at both time points. The neuropsychological assessment revealed recovery of receptive linguistic functioning by 12-months post-ictus. Conclusions: These results suggest that the combination of different structural and functional imaging modalities may provide a powerful means for assessing the mechanisms involved in the recovery from the VS.

Identification by Real-time PCR of 13 mature microRNAs differentially expressed in colorectal cancer and non-tumoral tissues

Identification by Real-time PCR of 13 mature microRNAs differentially expressed in colorectal cancer and non-tumoral tissues Bandrés, E.; Cubedo, E.; Aguirre, X.; Malumbres, R.; Zárate, R.; Ramirez, N.; Abajo, A.; Navarro, A.; Moreno, I.; Monzó Planella, Mariano; García-Foncillas, J. MicroRNAs (miRNAs) are short non-coding RNA molecules playing regulatory roles by repressing translation or cleaving RNA transcripts. Although the number of verified human miRNA is still expanding, only few have been functionally described. However, emerging evidences suggest the potential involvement of altered regulation of miRNA in pathogenesis of cancers and these genes are thought to function as both tumours suppressor and oncogenes. In our study, we examined by Real-Time PCR the expression of 156 mature miRNA in colorectal cancer. The analysis by several bioinformatics algorithms of colorectal tumours and adjacent non-neoplastic tissues from patients and colorectal cancer cell lines allowed identifying a group of 13 miRNA whose expression is significantly altered in this tumor. The most significantly deregulated miRNA being miR-31, miR-96, miR-133b, miR-135b, miR-145, and miR-183. In addition, the expression level of miR-31 was correlated with the stage of CRC tumor. Our results suggest that miRNA expression profile could have relevance to the biological and clinical behavior of colorectal neoplasia.