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This paper presents a new haploporid digenean that expands the number of species of Saccoccoelioides to 27. The new species, Saccocoelioides kirchneri n. sp. was collected from the intestine of Cnesterodon decemmaculatus (Poeciliidae: Cyprinodontiformes) from Lago del Bosque, La Plata, Argentina. The new species possesses the diagnostic features for Saccocoelioides: a sac like ceca; the vitellarium confined in two irregular groups of follicles distributed between the ventral sucker and the anterior margin of the testis; and a uterus confined largely in the hind-body, but encroaching into the range of the ventral sucker. The new species is differentiated from the 26 congeners by the body size, pharynx size, ventral sucker size, posterior extent of ceca, posterior extent of uterus and egg size. S. kirchneri n. sp. also is supported by the molecular analysis.

This paper describes Diegloglossidium maradonai n. g., n. sp. a parasite of the intestine of Hoplosternum littorale (Hancock) from La Plata River basin. The new genus is morphologically similar to members of Alloglossidiidae and Macroderoidiidae although they also share some traits observed in both families. Those families can be differentiated from each other by the combination of morphological features, including the density and distribution of the tegumental spines, the distribution of the vitelline follicles and the extent of the post-testicular space. The molecular analyses based on the large subunit of the ribosomal RNA gene, and the internal transcribed spacer (ITS) regions including ITS1, 5.8S and ITS2 unequivocally place the new genus in the family Alloglossidiidae which is amended based on new observed features. Diegoglossidium n. g. is characterized by a combination of characteristics, being most notably the presence of a deeply lobed ovary. Lastly, the geographical distribution and host associations of the two closely related Neotropical genera of Alloglossidiidae: Magnivitellinum and Diegoglossidium are discussed, and the host and distribution range of Magnivitellinum saltaensis is expanded into Argentina.

Resumen Objetivo Identificar los factores asociados con el mal control de la anticoagulacion con antagonistas de la vitamina K (AVK) en pacientes con fibrilacion auricular no valvular (FANV) atendidos en consultas de Neurologia y Medicina Interna de Espana. Metodos Estudio transversal, multicentrico, anidado en el estudio ALADIN, de sujetos con FANV, tratados con AVK, atendidos en consultas de Medicina Interna o Neurologia de Espana. El grado de control de la anticoagulacion se estudio mediante el metodo directo y el de Rosendaal, considerando los 6 meses previos a la inclusion. Resultados De los 1.337 pacientes incluidos en ALADIN, 750 estaban tratados con AVK, con informacion completa sobre el INR de los ultimos 6 meses en 383 pacientes. Las puntuaciones medias del indice de Charlson, CHADS2, CHA2DS2-VASc y HAS-BLED fueron 1,94 ± 1,54; 3,10 ± 1,26; 4,63 ± 1,54 y 2,20 ± 0,90, respectivamente. El 46,2% y el 47,0% de los pacientes presentaban un control adecuado de la anticoagulacion por los metodos directo y Rosendaal, respectivamente. El control inadecuado de la anticoagulacion se asocio por el metodo directo con diabetes (OR: 2,511; IC 95%: 1,144-5,659), antecedentes de INR inestable (OR: 35,371; IC 95%: 15,058-83,083) y la realizacion de > 6 controles en los ultimos 6 meses (OR: 4,747; IC 95%: 2,094-10,759), y por el metodo de Rosendaal, con los antecedentes de INR inestable (p Conclusiones Pese al alto riesgo tromboembolico, solo estaban bien controlados algo mas de la mitad. Los factores asociados al mal control de la anticoagulacion fueron la diabetes, INR inestable, > 6 controles de INR y el HAS-BLED.

To identify factors associated with poor anticoagulation control with vitaminK antagonists (VKA) among outpatients with nonvalvular atrial fibrillation (NVAF) attended in Neurology and Internal Medicine in Spain.Cross-sectional and multicenter study, from the ALADIN database, of outpatients with NVAF treated with VKA and attended in Internal Medicine and Neurology in Spain. Rates of anticoagulation control were determined with the direct and Rosendaal methods, considering data from the 6months before the inclusion.Out of 1,337 patients included in the ALADIN study, 750 were taking VKA, and complete information about INR values in the last 6months was available in 383 patients. Mean scores of Charlson Index, CHADSDespite the high thromboembolic risk, only a little more than a half of patients were well controlled. Factors associated with poor anticoagulation control were diabetes, labile INR,6INR controls and HAS-BLED.

To identify possible differences in the early response to intravenous thrombolysis (IVT) or in stroke outcome at 3 months, based on stroke subtype in patients with acute ischaemic stroke (IS).Multicentre stroke registry data were used, with prospective inclusion of consecutive patients with acute IVT-treated IS in five acute stroke units. We compared clinical improvement (National Institutes of Health Stroke Scale, NIHSS) at 24 h and at day 7 as well as functional outcome at 3 months (Modified Rankin Scale, mRS) amongst the different stroke subtypes (ICD-10).In total, 1479 patients were included; 178 (12%) had large vessel disease (LVD) with carotid stenosis ≥ 50%, 175 (11.8%) had other LVD, 638 (43%) had cardioembolism, 60 (4.1%) had lacunar infarction, 72 (4.9%) were patients with IS of other/unusual cause and 356 (24.1%) had unknown/multiple causes. Patients with lacunar infarction had lower stroke severity (median NIHSS 6) whilst cardioembolic IS was the most severe (median NIHSS 14) (P 0.001). No differences in NIHSS improvement were found at 24 h. LVD patients with carotid stenosis (odds ratio 0.544; 95% CI 0.383-0.772; P = 0.001) were less likely to improve at day 7 after adjustment for age, gender, vascular risk factors and stroke severity. However, adjusted multivariate analysis showed no influence of stroke subtype on stroke outcome (mRS) at 3 months. Age, systolic blood pressure on admission and stroke severity were independently associated with mRS 2 at 3 months.Although LVD patients with arterial stenosis ≥ 50% improve less than the other aetiologies at day 7, stroke aetiological subtype does not determine differences in IS outcome at 3 months after IVT.

Alteplase licensing approval in Europe does not advocate intravenous thrombolysis (IVT) for diabetic ischaemic stroke (IS) patients with previous cerebral infarction (PCI). Our aim was to assess whether concomitant diabetes mellitus (DM) and PCI are associated with symptomatic intracerebral haemorrhage (SICH) and poor outcome after IVT.Multicentre prospective registry, which included consecutive IVT-treated, acute IS patients from January 2003 to December 2010. The frequency of SICH (SITS-MOST criteria) and 3-month outcomes (mRS) were compared between the following groups: (i) diabetic patients with PCI (DM+/PCI+); (ii) diabetic patients without PCI (DM+/PCI-); (iii) non-diabetic patients with PCI (DM-/PCI+); and (iv) patients without diabetes or PCI (DM-/PCI-).A total of 1475 patients were included. Thirty-four patients (2.3%) had known DM and PCI, 258 (17.5%) were diabetics without PCI, and 119 (8.1%) had a PCI and no DM. Thirty-six patients (2.6%) developed SICH, with no differences between groups (P = 985). Fifteen (40.9%) DM+/PCI+ patients, 113 (46.5%) DM+/PCI- patients, 47 (42%) DM-/PCI+ patients and 414 (40.9%) DM-/PCI- patients had mRS ≥ 3 at 3 months (P = 427). The presence neither of DM nor of PCI, nor their combination, had any impact on the risk of SICH or on outcome at 3 months after adjusting for age, stroke severity and glucose levels on admission.Acute IS diabetic patients with PCI who were treated with IVT had similar outcomes to patients without such history, with no increase in the rates of SICH. Thus, they should not be excluded from IVT only on the basis of DM and PCI.

As compared to the general population, patients with Barrett's esophagus (BE) present a 30 to 40 times higher risk of developing cancer. Their prognosis is poor and it will only be changed trying to recognize and detect preneoplastic changes early in order to provide these patients with an effective surgical therapy. Although epithelial dysplasia is still the "gold standard" as a marker of increased risk for malignancy, in view of the inter and intraobserver differences for interpreting it, both as regards its existence and grade, we have investigated other markers which can show this increased cancer risk.Our aim has been to analyze which parameters, in addition to dysplasia, can distinguish groups with a higher or lower risk of progression to malignancy for a differentiated follow-up, so that the cost-benefit ratio is adequate and a sufficiently early diagnosis can be achieved which allows for a healing surgical therapy in most patients.Twenty-seven patients have been studied, 9 with BE without dysplasia (control group), 9 with Barrett's esophagus with dysplasia, and 9 adenocarcinomas over BE, in all of which the presence of p53, c-erb-2, PCNA and CEA was established by histochemistry and the existence of aneuploidy by static cytometry.PCNA was positive in the three groups, though it was not at the surface epithelium in 55.5% of the control cases. C-erb-2 was negative in all control cases and positive in 5 cases with dysplasia, and 2 with adenocarcinoma. Protein p53 was positive in one control case, in 2 with dysplasia, and 4 with adenocarcinoma. CEA was positive in 7 control cases and in all cases with dysplasia and adenocarcinoma. Finally, aneuploidy was found by static cytometry in 5 of 9 control cases, in 4 of 9 with dysplasia, and in all adenocarcinomas. From the analysis of the results obtained, it can be concluded that a positive marker, even in the absence of dysplasia, suggests the presence of a "genomic instability" which may lead to progression to malignancy.This study allows us to establish three risk groups (high, low and intermediate) for a differentiated follow-up which allows an early diagnosis, with an adequate cost-benefit ratio.

Among 7015 upper gastrointestinal endoscopies done during five consecutive years (1984-1988) 642 patients were diagnosed as having benign gastric ulcer. Of this group, 213 patients have been followed-up during an adequate period of time. A recurrence was diagnosed endoscopically in 43 (20.18%). The authors analyze the influence on recurrences of general factors (age, sex, alcohol, tobacco and drugs), family history and local factors (site and size of the ulcer, histological lesions, concomitant duodenal ulcer or single or multiple ulcers). The conclusions are that in females and in males over 60 years of age, NSAIDS are the factors which greatly influence recurrences, while in males under 60 years of age, excessive smoking and alcohol. Chronic gastritis and intestinal metaplasia are common in recurrent ulcers. Multiple ulcers as well as those associated with duodenal ulcers have a greater tendency to recur. Recurring ulcers are more common at the incisura angularis. Recurrences are usually located at the site of a previous ulcer.

The incidence of Barrett's esophagus is still little known. Our objective has been to study the incidence of this lesion in our environment as well as the frequency of malignant degeneration in our endoscopic material. Among 12,450 upper digestive endoscopies done in the past 7 years, 945 instances of peptic esophagitis have been diagnosed (7.59%). Among them, 172 cases of endobrachiesophagus (Barrett's esophagus) were detected (1.38% of the entire endoscopy series and 18.2% of all cases of esophagitis). Twenty two of th 172 patients with Barrett's esophagus were diagnosed as having carcinoma (12.79%). Barrett's esophagus is a frequent complication of peptic esophagitis and as the possibilities of malignant changes are as high as 12.79 it should be considered as a precancerous lesion and monitored as such.

The gluthatione transferase activity has been studied in liver biopsies from patients suffering with different hepatic lesion and related to the bromsulphalein (BSP) maximal transport (MT) and the conjugated dye present in serum. Results prove that the MT of BSP is independent of the enzyme activity, but is correlated to the conjugated BSP present in serum during the first perfusion. The enzyme activity, the MT of BSP and BSP conjugated rare in serum are not related to the liver lesion stage. From the analysis of our results we conclude that in the beginning the BSP conjugated proportion is determined by the enzyme activity which is not a restrictive factor of the BSP maximal transport.

Le probleme de la cancerisation de l’ulcere gastrique benin demeure un sujet de controverses. Certains auteurs rejettent cette eventualite tandis que d’autres considerent qu’un quart des cas sont exposes au risque de degenerer. Sur base de criteres corrects, l’evaluation du risque oscille entre 1 % et 4 %. Parmi 240 malades souffrant d’ulcere gastrique benin examines dans notre Unite Centrale d’Endoscopie au cours d’une periode de 2 ans, 110 ont ete suivis selon un protocole pre-etabli, les 130 restants comportent des ulceres operes pour cause de malignite ou d’hemorragie, ou des malades manquant de compliance vis-a-vis du protocole. Parmi les 110 malades surveilles, 7 ont developpe une lesion maligne : 4 furent diagnostiques au stade de cancer « in situ » ou superficiel, 2 au stade intermediaire (le cancer envahissant la couche musculaire sans la depasser), et dans un cas au stade invasif. Par souci de rigueur, 3 cas de transformation maligne dans un intervalle court n’ont pas ete retenus dans l’evaluation du risque, une erreur methodologique lors de la premiere exploration n’etant pas exclue. En considerant les 4 cas de degenerescence a intervalle long, le risque de cancerisation concerne 3,6 % des cas suivis, pourcentage nettement superieur a la frequence du cancer gastrique dans une population normale. L’etude confirme que l’ulcere gastrique est une lesion a haut risque de cancer, et justifie une surveillance selon un protocole approprie.

Growth rate, nitrogen balance, skeletal muscle nitrogen fractions and in vivo intestinal absorption of D-galactose (2 mM) and L-leucine (20 mM) have been measured in male growing rats (90-100 g initial body weight) fed 12% protein diets containing either casein (control) or the raw leafy legume Chamaecytisus proliferus L. (Western Canary Islands). As compared to control casein-fed rats, those fed the raw legume diet exhibited a significant reduction (P less than 0.01) in the rate of growth, nitrogen balance parameters, sarcoplasmic nitrogenous fraction of skeletal musculature and in vivo intestinal absorption of galactose and leucine; however, the non-protein nitrogenous fraction has been found significantly higher (P less than 0.01) than that of control animals, whereas the myofibrillar nitrogenous fraction remained unchanged. The possible nature of these findings is discussed.

Jusqu’il y a quelques annees, le pancreas etait considere comme inaccessible aux methodes d’exploration classiques et sa biopsie etait regardee comme extremement dangereuse en raison du risque d’hemorragie, de fistule, de pancreatite, etc. Recemment une serie de methodes ont ete developpees, rendant possible une excellente etude de son parenchyme et la realisation de biopsies pancreatiques avec un faible risque. Cet article presente les methodes laparoscopiques. 119 patients ont ete etudies: 100 avaient un pancreas normal, six un cancer du pancreas, sept une pancreatite chronique, quatre un faux kyste pancreatique et deux ont ete examines en cours de pancreatite aigue. Bien que cette methode d’exploration doive etre utilisee apres les resultats infructueux de methodes non-invasives, les auteurs soulignent son utilite dans le diagnostic des maladies pancreatiques et en particulier l’absence de complications apres biopsies du pancreas.

In recent years endoscopic sclerotherapy of esophageal varices has proliferated enormously, but the technique is not free of complications, which can be divided into three large areas, depending on the moment when they appear: complications due to technical errors, early complications and late complications. The authors analyze the complications in 105 patients who had a total of 385 sclerosis sessions. After describing the results and discussing them, it is concluded that the use of adequate material and sufficient technical experience are the best guarantee against the first type of complications, that hemorrhage is the most common early complication and that esophageal stenosis is the most frequent late complication. Finally, the existence of postsclerotherapy pseudo-polyps, which are asymptomatic, can pose a differential diagnosis with benign or malignant tumors of the distal third of the esophagus.