G.E.N最新文献

Post surgical gastrointestinal fistulas are a frequent problem around the world. We present our experience with a synthetic analog of somatostatin (SMS 201-955) used in 19 patients with gastrointestinal fistulas between January 1992 [corrected] and November 1993. We compare them with 50 patients with gastrointestinal fistulas randomized selected between 1980. The fistulas were classified according to their topographic location in five groups and to their flow in two groups: high and low fistulas. All patients were treated with nutritional support, antibiotic and octreotide (SMS 201-995). In the first 24 hours the fistulas flow where reduced in 51.63% and 72 hours later the reduction was of 70.62%. In 13 patients the fistulas where closed between 36.7 + 0 - 13.94 days (p < 0.01). This difference represent a cost reduction of 1,220,673.96 Bs. for each patient or 45,581.55 Bs. for each day. Two patients died in the study (10.52%) and two patients stop the drug because of adverse reaction. The octreotide reduced the fistulas flow and reduced the time needed to close.

Colorectal cancer affect the 15% of general population in developed countries. Cancer is a multistep process in which multiple genetic alterations must usually occur in several years. The premalignant step consists of one or multiple aberrant crypts due to hyperproliferation of cells and its shift from the deep third of the crypt to its surface. It has been suggested that abnormality in the APC gene is responsible for this. Furthermore, there exists DNA hypometilation, activation of the gene K-ras and ornithine decarboxylase activity. There is also a loss of MCC gene, that seems to interact with the APC gene. Entire alterations described make possible the Class I adenoma formation. This adenoma, needs the loss of the DCC gene (late stage in the carcinogenesis process), to become a Class II adenoma. The following alteration is deleted and mutation of the p53 gene. There is also an activation of the c-myc oncogene. These two genes are important mechanisms for the conversion of a benign adenoma to a malignant one, adenoma with in situ carcinoma or Class III adenoma. This type of adenoma becomes carcinoma and metastatic stage, throughout inactivation of several tumor suppressor genes. Besides the hereditary APC alteration and other acquired genetic changes as described above there are other associated genetics, antigenics, and enzymes that have an important role in the adenoma-carcinoma sequence. Several carcinogenic factors have been described which also contribute in the adenoma and carcinoma formation: ulcerative colitis, acromegaly, familial history of colonic neoplasia, certain professions, smoking and drinking, consumption of red or processed meat, etc.(ABSTRACT TRUNCATED AT 250 WORDS)

Epidemical and morphological studies have show that there is an association between intestinal metaplasia (IM) and gastric carcinoma, and it has been considered by many to be a possible marker of premalignant change. IM is also a common finding in benign disease of the stomach, however, and recent studies have therefore been direct at identifying variants of intestinal metaplasia which may have a more specific association with gastric carcinoma. Also, it has been demonstrated that exist another factors that contribute (as the Helicobacter Pylori), which determine some events like the transformation of chronic gastritis to gastric carcinoma, preceded by the presence of metaplastic changes in gastric mucosa.

In Táchira's State, Venezuela, there is a high incidence of Gastric Cancer. Screening for early gastric cancer (EGC) detection began in 1981. It observes the Japanese model, with Indirect Radiological (IR) as the move to the various Municipalities, offering the screening test. Subjects with IR abnormalities receive an invitation for an endoscopic examination. If lesions at endoscopy, biopsies were taken. Treatable patients went to surgery; the diagnosis on the surgical specimen was fulfilled by trained Pathologists. CGs cases are actively followed up. From 1981 to 1992 we did 150.023 radiological studies 52.562 gastric endoscopies and 18,480 endoscopic biopsies. We diagnosed 612 CGs:450 were advanced: 102 patients with 113 EGCs with confirmation after surgery; 60 cases were suspected by radiology and endoscopy as EGCs but were nor confirmed because the patients were not operated. 89 patients underwent gastroectomies, and 13 endoscopy resections. The EGCs were depressed (Types IIc, III) in 49% elevated (Types I, IIa) 26%, flat (Type IIb) 6% and intermediate (Types IIa + IIc) 19%. The invasion was confined to the mucosa in 60% and to the submucosa in 40%. By histopathology 60% were differentiated and 40% undifferentiated. In 9% we found metastasis in lymph nodes, only in 2% of the mucosal ones. Survival of patients with EGC after 5 year was 93%. We think a secondary prevention can be done in high risk regions through an appropriate screening for EGC.

Unlabelled: In the study we show the usefulness of PCR (polymerase chain reaction) to follow patients with chronic hepatitis, infected with hepatitis C virus (HCV) of Centro Médico de Caracas. The study included 14 patients: 12 anti-HCV positive, 1 with chronic autoimmune hepatitis and 1 classified as non B-non C hepatitis. The patients were divided in 3 groups: Group 1 (5 pretreatment patients, anti-HCV+), 4 with increase in ALT and PCR positive, 1 with normal ALT and PCR negative. Group 2 (7 treated with recombinant interferon alpha 2b), 4 without normalization of ALT and PCR positive, 3 with normalization of ALT and PCR negative. Group 3 (control) 2 patients anti-HCV negative and PCR negative. Two posttreatment patients could be genotyped: one patient was infected with 1a and showed an early relapse with treatment and the other was infected with genotype 1b, which is reported to be more refractory to antiviral treatment.

Conclusions: the results show a 100% correlation between biochemical markers of HCV infected patients and the presence of viral RNA detected by PCR. the usefulness of determination of genotype to assess any prognostic value of this parameter in Venezuela is discussed.

Through a pilot study which includes a clinical, molecular and immunopathological approach to the chronic Hepatitis induced by HBV or by HCV, we determined that 66% of HBsAg carriers are in the "non viremic" phase. The positive HBeAg "viremic" carriers showed HBV-DNA quantitation which varies between > 50 pg to > 100 pg. Both types of carries are infected with the "wild" type HBV. Each subgroup of positive surface antigemia carriers demonstrated a differential immunopathological response. So far, 96% of the HCV carriers investigated, showed HCV-RNA associated to repeatedly positive anti-HCV antibodies. Those patients with increased ALT values uniformly expressed liver histopathological signs of inflammation caused by HCV; demonstrating also the presence of peripheral blood mononuclear cells infected with HCV. At the present, the genotypes investigation indicates a predominance of HCV genotype II (1b). Autoimmune phenomenons associated to HCV have been detected only in 3 patients. The therapeutic approach with interferon alpha applied to the HCV infection preliminary showed similar results to those reported worldwide. Currently, a comprehensive approach to the chronic HBV and chronic HCV infections requires the application of Immunochemistry, Molecular Biology and Cellular Immunology combined technologies.

The hepatitis B virus (HBV) infection is actually a major problem worldwide, due mainly to the high incidence of chronic and acute infection it causes. In order to determinate the HBV incidence in the School of Bioanalysis of the University of Los Andes, we studied the presence of the HBV markers: surface antigen (HBsAg) and anti-Core (a-HBc) by using an ELISA method in randomly selected population of 167 subjects composed by 135 students of the last semester, 12 professors, and 20 employees from the Biochemistry, Haematology, and Immunology's areas. Of all the examined samples, 19 (11.4%) were positive for any of the markers, 3 (1.8%) for HBsAg and 16 (10.2%) for a-HBc. Only one sample was positive for both markers. The posivity was solely observed in the students group were 9.1% were sexually active, 16.7% received blood transfusions and 18.2% suffered early hepatitis.

Chronic Esophageal reflux induces reflux esophagitis, which is a common finding in gastroenterological practice. Reflux esophagitis produce symptoms like pirosis, regurgitation and in some cases respiratory complains resembling asthma or angina-like chest pain. The pathophysiology of this disease is based on a multifactorial origin, which usually results in the chronic evolution of the disease. In recent years, there have appeared new evidences pointing out to alterations in the relaxing mechanisms of the lower esophageal sphincter; however, some patients having reflux esophagitis show normal shincteric pressure. The sweep action of esophageal smooth muscle is a key point for sending back to stomach the eventually refluxed material; it has been demonstrated that this sweeping action is impaired in many patients having reflux esophagitis. Incompetence of lower esophageal sphincter seems to be related a local to neural alteration rather than to smooth muscle functional disturbance. Recent findings stablis a link between local nitric oxide release and relaxation of the lower esophageal sphincter. Esophageal mucosaldisplay an intrinsic resistance to HCL, pepsin, bilis and enzymes deleterious action by a blockade of back-defusion of hydrogen ions contained in the refluxed material. Nevertheless, some other luminal and non-luminal factors are involved in this mucosalprotection. When these intrinsic resistance factors are abated, tisular lesions like ersion, ulcer and Barret's mucosal changes can occur; is of particular interest because its potential malignant evolution. Esophageal reflux usually resolves with medical treatmen, but in some particular cases surgical correction is indicated for improving the antireflux barrier.