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We describe a case of long-term administration of nitric oxide (NO) in a 32-year-old man who was admitted with exertional dyspnea and anasarca. A diagnosis of primary pulmonary hypertension was made. An acute vasodilator trial with inhaled NO showed a 5% reduction of the mean pulmonary artery pressure. Long-term NO inhalation therapy was initiated. Twenty days later, the dyspnea improved, the anasarca resolved, and the PaO(2) level increased. After 12 months of NO therapy, the patient remained stable and no signs of toxicity or tachyphylaxis were observed. To our knowledge, this is the first report of 1 year of continuously inhaled NO in an adult patient with primary pulmonary hypertension. These findings suggest that prolonged NO therapy might be an effective alternative, at a lower cost, to the continuous IV infusion of epoprostenol. [ABSTRACT FROM AUTHOR]

Background: Administration of allergen mixtures of many components comprises the most common approach for American allergists regarding the management of polyallergic patients. European allergists, however, are more reluctant to this type of treatment due to the potential drawbacks of mixing extracts., Research Design and Methods: To assess the efficacy and safety of subcutaneous immunotherapy (SCIT) with polymerized allergen mixtures without dilutional effect in polyallergic patients.This observational, prospective, multicenter study included patients (between 5 and 60 years) with respiratory allergic diseases that had been prescribed with SCIT with mixtures of two pollen or mite extracts. Changes in Symptoms and Medication Score (SMS) and in rhinitis quality of life questionnaire (RQLQ), subjective clinical improvement, treatment satisfaction and tolerability were assessed after the 1-year treatment., Results: A total of 115 patients were included in the assessment. Mean global SMS decreased from 3.5 (SD = 1.1) to 1.6 (SD = 1.2) points, with a mean absolute reduction of 1.6 (SD = 1.3) points in the RQLQ score ( p  < 0.001, Wilcoxon test). General subjective clinical improvements and a good treatment satisfaction and tolerability were observed., Conclusion: SCIT with polymerized allergen mixtures from either pollen or mite extracts proved to be an effective and safe treatment option for polyallergic patients suffering from allergic respiratory diseases.

Aptamers are single-stranded oligonucleotide sequences capable of binding to specific ligands with high affinity. In this manner, they are like antibodies but have advantages such as lower manufacturing costs, lower immunogenicity, fewer batch-to-batch differences, a longer shelf life, high tolerance to different molecular milieus, and a greater number of potential targets. Due to their special features, they have been used in drug delivery, biosensor technology, therapy, and diagnostics. The methodology that allowed its production was the "Systematic Evolution of Ligands by Exponential enrichment" (SELEX). Unfortunately, the traditional protocol is time-consuming and laborious. Therefore, numerous variants with considerable optimization steps have been developed, nonetheless, there are still challenges to achieving real applications in the clinical field. Among them, are control of in vivo activities, fast renal filtration, degradation by nucleases and toxicity testing. This review focuses on current technologies based on SELEX, the critical factors for successful aptamer selection, and its upcoming biomedical and biotechnological applications., Competing Interests: Declaration of competing interest The authors declare the following financial interests/personal relationships which may be considered as potential competing interests: Danny Jair Chinchilla Cardenas reports financial support was provided by Laboratorio de genética animal MASCOLAB S.A.S. If there are other authors, they declare that they have no known competing financial interests or personal relationships that could have appeared to influence the work reported in this paper., (Copyright © 2024 The Author(s). Published by Elsevier Inc. All rights reserved.)

Background and Aim: Salmonella spp. is frequently found in the digestive tract of birds and reptiles and transmitted to humans through food. Salmonellosis is a public health problem because of pathogenicity variability in strains for virulence factors. This study aimed to identify the virulence genes in Salmonella isolates from humans, crocodiles, broiler cloacas, and broiler carcasses from two departments of Colombia., Materials and Methods: This study was conducted on 31 Salmonella enterica strains from humans with gastroenteritis (seven), crocodiles (seven), broiler cloacas (six), and broiler carcasses (12) from Tolima and Santander departments of Colombia, belonging to 21 serotypes. All samples were tested for Salmonella spp. using culture method on selective and non-selective mediums. Extraction of genomic DNA was performed from fresh colonies, DNA quality was verified by spectrophotometry and confirmed by amplification of InvA gene using conventional polymerase chain reaction (PCR). bapA , fimA , icmF , IroB , marT , mgtC , nlpI , oafA , pagN , siiD , spvC , spvR , spvB , Stn , and vexA genes were amplified by PCR., Results: The most prevalent gene was bapA (100%), followed by marT (96.77%), mgtC (93.55%), and fimA (83.87%). Likewise, IroB (70.97%), Stn (67.74%), spvR (61.29%), pagN (54.84%), icmF (54.8%), and SiiD (45.16%) were positive for more than 50% of the strains. Furthermore, none of the isolates tested positive for the vexA gene. Salmonella isolates presented 26 virulence profiles., Conclusion: This study reported 14 virulence genes in Salmonella spp. isolates from humans with gastroenteritis, crocodiles, and broiler cloacas and carcasses. The distribution of virulence genes differed among sources. This study could help in decision-making by health and sanitary authorities., Competing Interests: The authors declare that they have no competing interests., (Copyright: © Petano-Duque, et al.)

The division of linguistic labour (DLL), initially theorized by philosophers, has gained the attention of cognitive scientists in the last decade. Contrary to some controversial philosophical accounts of DLL, we propose that it is an extended mind strategy of offloading conceptual understanding onto other people. In this article, we empirically explore this proposal by providing an exploratory experimental paradigm to search for the mechanisms underwriting DLL and how they may work in practice. We developed a between-subjects experiment in which participants had to categorize two pairs of highly confusable dog breeds after receiving categorization training on just one pair of breeds. In the treatment group, participants were grouped in dyads and were allowed to interact with each other by means of the labels of these four dog breeds. In their queries to trained 'experts', novices frequently used labels to refer to breeds that they could not identify themselves. Experts were highly responsive to their paired novices' queries, and the rates of querying for the two members within a dyad were positively correlated. Independent categorization failure and offloading categorization success lead to subsequent increases in querying by novices, indicating adaptive use of offloading. Self-reports of breed knowledge were higher for experts within a dyad compared to isolated experts. This article is part of the theme issue 'Concepts in interaction: social engagement and inner experiences'.

Background and Aim: Canine vector-borne diseases represent an important issue for the welfare and health of animals, but also have great zoonotic potential. These diseases are caused by bacteria, nematodes such as filariae, and other parasites such as Leishmania spp. Given the difficulty in differentiating common microfilariae in dogs by microscopy and serological methods, molecular techniques such as polymerase chain reaction (PCR) and sequencing should be valuable for reaching a reliable diagnosis. This study aimed to use microscopy and PCR to identify the microfilarial species in dogs from Valle del Cauca, Colombia, and a possible association with Leishmania infantum parasites., Materials and Methods: This study was conducted on 270 dogs from Pradera and Florida municipalities. Microfilariae were detected in dogs by optical microscopy and amplification with 5.8S-ITS2-28S . Species identification was achieved through the amplification of the gene cytochrome oxidase I ( COX1 )., Results: Microscopic detection of microfilariae was possible in 4.81% (13/270) of the dogs. In addition, by PCR of COX1 and Sanger sequencing of ITS2 , Acanthocheilonema reconditum was identified as the circulating microfilarial species in 12 dogs, coinfecting with the species L. infantum ( Leishmania donovani complex)., Conclusion: To the best of our knowledge, this is the first report on A. reconditum and L. infantum mixed infection in dogs in Colombia, particularly in the Valle del Cauca., Competing Interests: The authors declare that they have no competing interests., (Copyright: © Pérez-Ramírez, et al.)

Leishmaniasis is a widespread disease caused by species of the genus Leishmania. In Colombia, this zoonosis is endemic in rural areas with a high prevalence in the departments of Antioquia, Santander, Meta, Tolima and Nariño. Dogs are the most important domestic reservoirs of the pathogen, given the epidemiological importance of dogs in the control of leishmaniasis is needed to determine the prevalence of Leishmania spp. in canine population of the rural area of Ibagué and to identify potential risk factors related to the presence of this parasite. A cross-sectional study was carried out in 173 dogs from the rural area of Ibagué. Leishmania spp. was detected by amplifying the Internal Transcribed Spacer (ITS-1) and two regions of the hsp70 gene through PCR. Factor associations were calculated through the Chisquare and odds ratio. Prevalence of Leishmania spp. infection in dogs was of 91.33% (158/173), where 36.71% (58/158) of the Leishmania spp. positive dogs showed one or more clinical signs of canine leishmaniasis and 63.29% (100/158) of the dogs were asymptomatic. Factors associated with the presence of the parasite did not show significance. In addition, hsp70D-PCR was proved to be highly efficient for the detection of Leishmania spp.

Aquaporins ( AQPs ) are proteins with various functions related to proper cell function and early development in mammals. The aim of this study was to evaluate the presence of AQPs and determine their mRNA levels in the cumulus oocyte complex (COC) of four bovine breeds and in blastocysts of five bovine crosses. Grade I, II and III COCs were collected by ovum pick up from non-lactating heifers of the Brahaman, Holstein, Gir and Romosinuano breeds. Embryos were produced in vitro up to the blastocyst stage of the bovine ♀Gir × ♂Holstein, ♀Holstein × ♂Gir, ♀Brahman × ♂Holstein, ♀Holstein × ♂Brahman, and ♀Romosinuano × ♂Holstein crosses. mRNA expression of AQP1 - AQP12b was estimated in COC and embryos by real-time-PCR. The presence of the twelve AQPs in the COCs and bovine embryos was established. Additionally, significant differences were determined in the expression of AQP6 and AQP12b in COCs, as well as in transcripts levels of AQP4 , AQP8 and AQP9 from bovine embryos. Gene expression of AQPs in COCs and bovine embryos is consistent with the previously described biological functions. This is the first report of AQPs in COC of Gir, Brahman, Holstein and Romosinuano and embryos of five crossbreeds between Bos indicus and B. taurus .

Extracellular vesicles (EVs) are biological nanoparticles of great interest as novel sources of biomarkers and as drug delivery systems for personalized therapies. The research in the field and clinical applications require rapid quantification. In this study, we have developed a novel lateral flow immunoassay (LFIA) system based on Fe 3 O 4 nanozymes for extracellular vesicle (EV) detection. Iron oxide superparamagnetic nanoparticles (Fe 3 O 4 MNPs) have been reported as peroxidase-like mimetic systems and competent colorimetric labels. The peroxidase-like capabilities of MNPs coated with fatty acids of different chain lengths (oleic acid, myristic acid, and lauric acid) were evaluated in solution with H 2 O 2 and 3,3,5,5-tetramethylbenzidine (TMB) as well as on strips by biotin-neutravidin affinity assay. As a result, MNPs coated with oleic acid were applied as colorimetric labels and applied to detect plasma-derived EVs in LFIAs via their nanozyme effects. The visual signals of test lines were significantly enhanced, and the limit of detection (LOD) was reduced from 5.73 × 10 7 EVs/μL to 2.49 × 10 7 EVs/μL. Our work demonstrated the potential of these MNPs as reporter labels and as nanozyme probes for the development of a simple tool to detect EVs, which have proven to be useful biomarkers in a wide variety of diseases.

Hepcidins are cysteine-rich peptides, which participate in iron metabolism regulation, the inflammatory and antimicrobial response. This study characterizes the hepcidin-1 (HAMP1) gene, its transcript expression in different tissues, as well as its regulation in a model of brain injury in Piaractus brachypomus. Bioinformatic analysis was carried out to determine conserved domains, glycosylation sites and protein structure of HAMP1, and probability that HAMP1 corresponds to an antimicrobial peptide (AMP). Relative gene expression of the P. brachypomus HAMP1 gene was determined by qPCR from cDNA of several tissues, a brain injury model, an organophosphate sublethal toxicity model and anesthetic experiment using the 2 -ΔΔCt method. HAMP1 ORF encodes for a 91 aa pre-prohepcidin conformed for a prodomain with 42 aa and mature peptide of 25 aa. Mature domain was determined as an AMP. HAMP1 transcript is expressed in all the tissues, being higher in the spleen and liver. HAMP1 mRNA level was upregulated in the brain injury group, as well as in the olfactory bulb, optic chiasm and telencephalon of red-bellied pacu brain exposed to an organophosphate. In anesthetic experiment, HAMP1 mRNA level was upregulated in the liver and gills. HAMP1 gene of P. brachypomus may be involved in the inflammatory, antimicrobial, hypoxia and stress oxidative response., (Copyright © 2022 Elsevier Ltd. All rights reserved.)

(1) Aims: To assess the incidence of inflammatory bowel disease (IBD) in Spain, to describe the main epidemiological and clinical characteristics at diagnosis and the evolution of the disease, and to explore the use of drug treatments. (2) Methods: Prospective, population-based nationwide registry. Adult patients diagnosed with IBD-Crohn's disease (CD), ulcerative colitis (UC) or IBD unclassified (IBD-U)-during 2017 in Spain were included and were followed-up for 1 year. (3) Results: We identified 3611 incident cases of IBD diagnosed during 2017 in 108 hospitals covering over 22 million inhabitants. The overall incidence (cases/100,000 person-years) was 16 for IBD, 7.5 for CD, 8 for UC, and 0.5 for IBD-U; 53% of patients were male and median age was 43 years (interquartile range = 31-56 years). During a median 12-month follow-up, 34% of patients were treated with systemic steroids, 25% with immunomodulators, 15% with biologics and 5.6% underwent surgery. The percentage of patients under these treatments was significantly higher in CD than UC and IBD-U. Use of systemic steroids and biologics was significantly higher in hospitals with high resources. In total, 28% of patients were hospitalized (35% CD and 22% UC patients, p < 0.01). (4) Conclusion: The incidence of IBD in Spain is rather high and similar to that reported in Northern Europe. IBD patients require substantial therapeutic resources, which are greater in CD and in hospitals with high resources, and much higher than previously reported. One third of patients are hospitalized in the first year after diagnosis and a relevant proportion undergo surgery.

Colorectal cancer (CRC) is the third leading cause of cancer death and the fourth most common cancer in the world. Colonoscopy is the most sensitive test used for detection of CRC; however, their procedure is invasive and expensive for population mass screening. Currently, the fecal occult blood test has been widely used as a screening tool for CRC but displays low specificity. The lack of rapid and simple methods for mass screening makes the early diagnosis and therapy monitoring difficult. Extracellular vesicles (EVs) have emerged as a novel source of biomarkers due to their contents in proteins and miRNAs. Their detection would not require invasive techniques and could be considered as a liquid biopsy. Specifically, it has been demonstrated that the amount of CD147 expressed in circulating EVs is significant higher for CRC cell lines than for normal colon fibroblast cell lines. Moreover, CD147-containing EVs have been used as a biomarker to monitor response to therapy in patients with CRC. Therefore, this antigen could be used as a non-invasive biomarker for the detection and monitoring of CRC in combination with a Point-of-Care platform as, for example, Lateral Flow Immunoassays (LFIAs). Here, we propose the development of a quantitative lateral flow immunoassay test based on the use of magnetic nanoparticles as labels coupled to inductive sensor for the non-invasive detection of CRC by CD147-positive EVs. The results obtained for quantification of CD147 antigen embedded in EVs isolated from plasma sample have demonstrated that this device could be used as a Point-of-Care tool for CRC screening or therapy monitoring thanks to its rapid response and easy operation.

Objective: Helicobacter pylori resistance to antimicrobial agents is on the rise and it is thus imperative to be aware of local resistance rates. The main objective of the present study was to describe the evolution of primary antimicrobial resistance in H. pylori, analysing its antibiotic susceptibility over a 13-year period in a region of northern Spain, as well as host-related factors., Patients and Methods: Between 2004 and 2016 a total of 3426 patients who met the H. pylori eradication criteria underwent gastroscopy. The gastric biopsies were processed and those testing positive for H. pylori were identified and tested for clarithromycin, metronidazole and levofloxacin susceptibility using E-test., Results: H. pylori was isolated in 1604 (47%) patients, ranging from 63% (133/212) in 2004 to 39% (137/347) in 2016. Primary resistances to clarithromycin, metronidazole and levofloxacin were on average 19% (278/1116), 40% (572/865) and 17% (137/669), respectively. Clarithromycin resistance was 24% (167/686) in females and 15% (11/753) in males (p=0.0002); metronidazole resistance was 29% (72/246) in patients over 70 years compared to 42% (499/1190) in younger patients (p=0.0396); levofloxacin resistance increased with age, being 13% (57/439) in patients ≤55 years, 19% (46/236) for those between 56 and 70, and 26% (34/130) in patients >70 years (p=0.0087)., Discussion: A decline in the prevalence of H. pylori infection was observed over the years, along with relatively high rates of primary resistance to clarithromycin, metronidazole and levofloxacin. Variations in resistance rates were found with sex and age., (Copyright © 2019 Elsevier España, S.L.U. All rights reserved.)

Aims: To determine risk factors for active tuberculosis in patients with inflammatory bowel diseases., Methods: Retrospective, case-control study at 4 referral hospitals in Spain. Cases developed tuberculosis after a diagnosis of inflammatory bowel disease. Controls were inflammatory bowel disease patients who did not develop tuberculosis. For each case, we randomly selected 3 controls matched for sex, age (within 5 years) and time of inflammatory bowel disease diagnosis (within 3 years). Inflammatory bowel disease characteristics, candidate risk factors for tuberculosis and information about the tuberculosis episode were recorded. Multivariate analysis and a Chi-squared automatic interaction detector were used., Results: Thirty-four cases and 102 controls were included. Nine of the 34 cases developed active tuberculosis between 1989 and 1999, and 25 became ill between 2000 and 2012. Multivariate regression showed an association between active tuberculosis and anti-TNF (tumor necrosis factor) therapy in the previous 12 months (OR 7.45; 95% CI, 2.39-23.12; p = .001); hospitalization in the previous 6 months (OR 4.38; 95% CI, 1.18-16.20; p = .027); and albumin levels (OR 0.88; 95% CI, 0.81-0.95; p = .001). The median time between the start of biologic therapy and the onset of active tuberculosis was 13 (interquartile range, 1-58) months. Tuberculosis developed after a year of anti-TNF therapy in 53%, and late reactivation occurred in at least 3 of 8 patients., Conclusions: The main risks factors for developing tuberculosis were anti-TNF therapy and hospitalization. Over half the cases related to anti-TNF treatment occurred after a year.

Introduction . Labyrinthine concussion is a term used to describe a rare cause of sensorineural hearing loss with or without vestibular symptoms occurring after head trauma. Isolated damage to the inner ear without involving the vestibular organ would be designated as a cochlear labyrinthine concussion. Hearing loss is not a rare finding in head trauma that involves petrous bone fractures. Nevertheless it generally occurs ipsilateral to the side of the head injury and extraordinarily in the contralateral side and moreover without the presence of a fracture. Case Report . The present case describes a 37-year-old patient with sensorineural hearing loss and tinnitus in his right ear after a blunt head trauma of the left-sided temporal bone (contralateral). Otoscopy and radiological images showed no fractures or any abnormalities. A severe sensorineural hearing loss was found in his right ear with a normal hearing of the left side. Conclusion . The temporal bone trauma requires a complete diagnostic battery which includes a neurotologic examination and a high resolution computed tomography scan in the first place. Hearing loss after a head injury extraordinarily occurs in the contralateral side of the trauma as what happened in our case. In addition, the absence of fractures makes this phenomenon even more unusual., Competing Interests: The authors declare that there are no competing interests.

Aims: To analyse the outcome of the proactive management of patients with diabetes, critical limb ischaemia and foot ulcers using percutaneous transluminal angioplasty as the only vascular procedure and adjuvant conservative surgery when indicated., Methods: A retrospective study of patients with diabetes included in our database who sought a second opinion in our unit and met the following criteria: foot ulcer and critical limb ischaemia in patients for whom any proactive vascular treatment had not previously been considered by other teams., Results: Twenty patients underwent endovascular procedures. Success was achieved in 19 cases (95%). No post-operative mortality (within 30 days after the procedure) was found. Additional surgery was required in eight cases (40%): one calcaneal ostectomy and seven minor amputations. The need for surgery was associated with infection (P < 0.01). Limb salvage was sustained during a mean period of follow-up of 642 days (SD 488) in 19 cases (95%). Healing was achieved in 14 cases (70%), four are still healing (20%), one underwent major amputation (5%) and the last one died before being healed (5%). Three patients died during follow-up (15%)., Conclusions: Management of patients with diabetes, foot ulcers and critical limb ischaemia by means of a proactive approach including endovascular procedures in specialized settings provides a high rate of limb salvage. This may result in lowering the number of lower limb amputations in our community., (© 2011 The Authors. Diabetic Medicine © 2011 Diabetes UK.)

Purpose: Previous publications have linked Herbalife® products to hepatotoxicity. The identification of earlier cases in which the culprit agent could not be established raised the hypothesis of a possible contamination of some specific batches of Herbalife products., Methods: We searched the Spanish Pharmacovigilance Centres' database of adverse reactions for reports of liver injury associated with the use of Herbalife products from 2003, when the first case was submitted, through September 2010., Results: The search resulted in 20 reports of liver damage (mean age, 49 years; 16 women), with 12 patients (60%) requiring hospitalization. Hepatocellular damage predominated, and nine (53%) of the hepatocellular cases with bilirubin values were jaundiced, fulfilling the Hy's law criteria, which increases the risk for serious outcomes. Two patients experienced a positive rechallenge. One patient developed cirrhosis, whereas all the others recovered. Causality assessment by the Karch and Lasagna modified algorithm showed a category of definite in 1 case, probable in 14, and possible in 5. Analysis of the different Herbalife products that each patient had taken did not enable us to identify any commonly known hepatotoxic ingredient., Conclusions: Our results support the relationship between the consumption of Herbalife products and hepatotoxicity, underscore the concern regarding the liver-related safety of this dietary supplement, and emphasize the need to establish further regulatory measures., (Copyright © 2011 John Wiley & Sons, Ltd.)

Background: Colorectal tumors caused by failure of the DNA mismatch repair system commonly show microsatellite instability. Our goals were to compare the performance of two panels of markers (a panel previously recommended by the National Cancer Institute [NCI] and a pentaplex of mononucleotide repeats) and to devise the simplest diagnostic strategy for identification of patients with colorectal cancer characterized by defects in mismatch repair., Methods: We recruited 1058 patients who were newly diagnosed with colorectal cancer. DNA from fresh-frozen and paraffin-embedded tumors was tested for microsatellite instability, using the NCI-recommended panel of microsatellite markers and the pentaplex panel of mononucleotide repeats, respectively, as templates for polymerase chain reactions (PCRs). Microsatellite instability in fresh-frozen tumors was also assessed using the pentaplex panel of mononucleotides in a crossover analysis. The expression of mismatch repair proteins (MLH1, MSH2, MSH6, and PMS2) in the tumors was determined immunohistochemically. The sensitivity and specificity with which the marker panels identified tumors with deficiencies in the expression of mismatch repair proteins were calculated. All statistical tests were two-sided., Results: The sensitivity and positive predictive value of the NCI panel were 76.5% (95% confidence interval [CI] = 61% to 92%) and 65.0% (95% CI = 49% to 81%), respectively; corresponding values for the mononucleotide pentaplex panel were 95.8% (95% CI = 89% to 103%) and 88.5% (95% CI = 79% to 98%), respectively. A panel consisting of the mononucleotide repeat markers BAT26 and NR24 alone had the same predictive value as the pentaplex panel of mononucleotide repeats., Conclusions: The pentaplex panel of mononucleotide repeats performs better than the NCI panel for the detection of mismatch repair-deficient tumors. Simultaneous assessment of the instability of BAT26 and NR24 is as effective as use of the pentaplex panel for diagnosing mismatch repair deficiency.

We report our experience with the use of a self-expanding stent in the treatment of a severe innominate artery stenosis resulting in right upper limb ischemia. A 45-year-old woman was admitted for right upper limb ischemia, asymmetry of the carotid pulse and the lack of pulse in the right upper extremity. The patient had a history of chain smoking, hypertension, hypercholesterolemia, and acute myocardial infarction one year ago. She was diagnosed of the innominate artery stenosis by angiography one year ago at another hospital. At the time of admission her blood pressure was normal in the left arm and absent in the right upper limb. Arteriography showed a severe stenosis subocclusion of the innominate artery with an inverse flow of the ipsilateral vertebral artery. As the patient was not considered to be a surgical candidate due to instable angina, stent placement was indicated. After placement through an axillary approach an angiogram showed a patent right subclavian artery without residual stenosis. Angiographic follow-up showed a patent innominate arterial lumen two years after the procedure. The patient continued to be asymptomatic during six years follow-up. Blood pressure remained normal in both upper extremities, without any ischemic signs. Our experience indicates that placement of an endovascular stent is an effective therapeutic option in selected patients with symptomatic stenosis in the innominate artery when a surgical treatment is contraindicated.

Background: For colorectal cancer screening, the predictive value of distal findings in the ascertainment of proximal lesions is not fully established. The aims of this study were to assess distal findings as predictors of advanced proximal neoplasia and to compare the predictive value of endoscopy alone vs. combined endoscopic and histopathologic data., Methods: Primary colonoscopy screening was performed in 2210 consecutive, average-risk adults. Age, gender, endoscopic (size, number of polyps), and histopathologic distal findings were used as potential predictors of advanced proximal neoplasms (i.e., any adenoma > or =1 cm in size, and/or with villous histology, and/or with severe dysplasia or invasive cancer). Polyps were defined as distal if located in the descending colon, the sigmoid colon, or the rectum. Those in other locations were designated proximal., Results: Neoplastic lesions, including 11 invasive cancers, were found in 617 (27.9%) patients. Advanced proximal neoplasms without any distal adenoma were present in 1.3% of patients. Of the advanced proximal lesions, 39% were not associated with any distal polyp. Older age, male gender, and distal adenoma were independent predictors of advanced proximal neoplasms. The predictive ability of a model with endoscopic data alone did not improve after inclusion of histopathologic data. In multivariate logistic regression analysis, the predictive ability of models that use age, gender, and any combination of distal findings was relatively low. The proportion of advanced proximal neoplasms identified if any distal polyp was an indication for colonoscopy was only 62%., Conclusions: A strategy in which colonoscopy is performed solely in patients with distal colonic findings is not effective screening for the detection of advanced proximal neoplasms in an average-risk population.

Objective: The use of colonoscopy as a primary screening test for colorectal cancer (CRC) in average risk adults is a subject of controversy. Our primary objective was to build a predictive model based on a few simple variables that could be used as a guide for identifying average risk adults more suitable for examination with colonoscopy as a primary screening test., Methods: The prevalence of advanced adenomas was assessed by primary screening colonoscopy in 2210 consecutive adults at least 40 yr old, without known risk factors for CRC. Age, gender, and clinical and biochemical data were compared among people without adenomas, those with non-advanced adenomas, and those with any advanced neoplasm. A combined score to assess the risk of advanced adenomas was built with the variables selected by multiple logistic regression analysis., Results: Neoplastic lesions were found in 617 subjects (27.9%), including 259 with at least one neoplasm that was 10 mm or larger, villous, or with moderate-to-severe dysplasia, and 11 with invasive cancers. Advanced lesions were more frequent among men, older people, and those with a higher body mass index (BMI). These three variables were independent predictors of advanced adenomas in multivariate analysis. A score combining age, sex, and BMI was developed as a guide for identifying individuals more suitable for screening colonoscopy., Conclusions: Age, gender, and BMI can be used to build a simple score to select those average risk adults who might be candidates for primary screening colonoscopy.

Objective: collagenous colitis (CC) and lymphocytic colitis (LC) are two entities of unknown cause, characterized by chronic watery diarrhea, grossly normal-appearing colonic mucosa and abnormal histopathological findings in colonic biopsies. The clinical features of the disease are based mainly on case reports or small uncontrolled series. Although normal colonoscopic findings are, as a rule, part of the diagnosis of CC, several cases of macroscopic colitis associated with CC have been reported, and the spectrum of endoscopic mucosal changes has not been described in large series., Methods: we present a retrospective study of all patients who underwent total colonoscopy and mucosal biopsy in our Endoscopy Unit between 1991 and 1997. Clinical and endoscopic findings in patients diagnosed as having CC or LC were recorded., Results: of 676 patients studied, 398 suffered from chronic diarrhea. Collagenous colitis was diagnosed in 22 patients and LC in 10. Eleven per cent of the patients with CC and 20% of those with LC did not have diarrhea. Macroscopic colitis was observed in 6 out of 22 patients with CC (27%) and in 4 out of 10 with LC (40%). Macroscopic lesions included edema, erythema, abnormal vascular pattern, superficial erosions or ulcerations and hemorrhagic lacerations. In this series 7.03% of the patients with chronic diarrhea were diagnosed as having CC or LC., Conclusions: collagenous colitis and LC are two entities that should be considered in the differential diagnosis of chronic diarrhea. Total colonoscopy with multiple biopsies that include the right colon are mandatory. The presence of macroscopic lesions on endoscopy does not rule out a diagnosis of either entity. We identified patients who fulfilled the histopathological criteria for CC or LC but who did not have diarrhea.

We report the case of a 12-year-old boy, diagnosed of Klippel Trenaunay Weber syndrome, with hemangiomas and venous varicosities in the right leg, who complaint about incidental hematochezia. In the colonoscopy some violet and plain angiodysplastic lesions like in the skin, were observed in rectum and distal sigmoid colon. We think this case is interesting, because of the unusual affectation of the gut in this disease and the importance of considering the endoscopic procedures in the evaluation of these patients.

Objective: to report our experience in the diagnosis and treatment of gastrointestinal hemorrhage., Method: from April 1987 to April 1997, 196 patients with gastrointestinal hemorrhage (134 men and 62 women) were studied. 165 (84%) were diagnosed as presenting upper gastrointestinal hemorrhage, and 31 (16%) presented lower gastrointestinal hemorrhage. The patients were studied with endoscopy and arteriography, and embolization was prescribed in 131 (67%). Patients with bleeding from esophageal varices were excluded from this study., Results: a bleeding point was identified angiographically in 33% (n = 65) patients. 131 (67%) patients were treated with therapeutic embolization, which was successful in 89% (n = 116) patients. The bleeding was resolved in 80% (n = 93) of the patients. Complications included arterial spasm (n = 12), pain (n = 24), coil migration (n = 8), allergic reaction (n = 2) and celiac trunk dissection (n = 2). During follow-up 16 patients presented rebleeding that stopped after reembolization in 9 cases, whereas in 7 cases surgery was needed., Conclusions: in our experience, diagnostic angiography and percutaneous therapeutic embolization are effective, less aggressive methods that lead to few complications. Both methods have become indispensable tools in managing patients with gastrointestinal hemorrhage that does not respond to conservative therapy. Even in patients with no evidence of angiographic bleeding, embolization in selected patients is successful.

Percutaneous retrieval of intravascular foreign bodies has emerged as a standard method of treatment, which audits major surgery. This procedure was performed in a patient with a fragment of a broken introducer sheath located in the right ventricle with risk of arrhythmias. Extraction was difficult because the sheath was trapped in the tendinous cords. The foreign body was embolized to the pulmonary artery and extraction was performed. No clinically significant complications occurred.

Objective: Vascular malformations are uncommon pathologic entities in which surgery is usually not possible or is inefficient. Our experience with the percutaneous treatment of peripheral vascular malformations, by means of transarterial embolization or direct puncture is here reported., Material and Methods: During the 1993-1997 period a total of 35 patient, 20 females (57%) and 15 males (43%) aged 11 to 75 years, were treated at our Unit. Sixteen vascular malformations were hemodynamically active (45.7%) and 19 hemodynamically inactive (54.3%). A total of 126 embolizations (mean 3.6) were performed. Malformations were studied by means of doppler-echography, magnetic resonance, arteriography and direct puncture angiography. Considering location, size and hemodynamic characteristics a specific approach and therapy was performed in each case. In two cases (5.7%) a surgical exeresis after embolization was performed., Results: A technical success, defined as the possibility of embolizing the malformation, was achieved in 100% of cases. No technical complications during the procedure occurred. The mean follow-up time was 23 months (6-69). All patients but one improved both objectively and subjectively and all but one have recovered their daily activities in the following days. The exception was one patient who developed a severe complication--cutaneous necrosis--a few days after the procedure which required repairing surgery. All patient had edema, pain and increased functional impairment after the embolization which subsided with medical treatment., Conclusions: Percutaneous embolization of vascular malformations is an effective method associated with a low complication rate. Our results are encouraging although more extensive investigation are required to draw definite conclusions.

Barrett's esophagus (BE), a complication of gastroesophageal reflux disease, is the replacement of squamous tissue with specialized intestinal metaplasia. Other noxious factor, as biliary acids, may contribute to the induction of BE. It is a premalignant condition, and adenocarcinoma arises in some cases. An endoscopic surveillance with multiple biopsies is mandatory to detect different grades of dysplasia or intramucosal cancer and allow effective therapy. Since its prevalence is high, current surveillance protocols become expensive and patient's compliance is difficult. The main medical goals are: 1) To stratify individuals without dysplasia as either lower or higher risk, to screen less often those at lower risk. 2) To obtain complete remission or eliminate the risk of cancer and the need for surveillance. Current treatments have not demonstrate complete regression of metaplasia. Recently, new endoscopic approaches to therapy have been developed. Although they remain experimental and larger series are required, initial results are encouraging.

Our purpose was to study the effectiveness of thrombolytic therapy in treating acute, subacute, and chronic arterial occlusions in a multicenter retrospective study. Intraarterial urokinase infusion was performed in 235 patients for occluded native arteries. There were 70 (30%) with acute and 26 (5%) with subacute occlusions, and 141 (59%) with chronic symptoms for longer than 3 mo. Complete thrombolysis was achieved in 60 (86%) of the acute, 20 (77%) of the subacute, and 106 (75%) of the chronic occlusions. Adjunctive interventional procedures were performed as needed. Long-term follow-up revealed a primary patency of 87%, 85%, and 76% for the acute, subacute, and chronic occlusion groups, respectively. We conclude that the rate of complete thrombolysis of chronic occlusions proved slightly more efficient for acute and virtually the same for subacute occlusions. Long-term follow-up demonstrated a higher failure rate with chronic than with acute occlusions, probably due to worsened peripheral vascular runoff.

Objective: To obtain an initial assessment of the implantation technique of bifurcated vascular endoprothesis in the treatment of abdominal aorta aneurysms (AAA)., Methods: Eleven Vanguard type endoprostheses were implanted in eleven patients with infra-renal aortic aneurysm. The technique was performed with surgical approach in one femoral artery, and percutaneously in the other. The procedure was performed with epidural anesthesia., Results: A technical success--i.e., the exclusion of the aneurysm--was obtained in all cases. No technical complications occurred during the procedure. Three patients had low degree contrast leak in the angiographic control immediately after the procedure. Eight patients had low grade fever in the immediate follow-up which resolved with medical therapy, two patients had hematomas in the approach sites, one renal infarction, one ileus for two days, another one for five days, and three patients had lymphatic effusion. During follow-up the patients with leak had to undergo co-axial endoprosthesis implantation., Conclusions: It is our view that bifurcated vascular endoprostheses offer a valid alternative in the treatment of AAA. The procedure can be performed with epidural anesthesia and sedation, with a low rate of complications. The long term follow-up and the perfecting of the approach and resection systems will ultimately dictate their usefulness in this and other vascular conditions.

The aim of this study was to evaluate our results in treatment and management of symptomatic hepatic venous malformations using transcatheter embolization therapy. From 1991 to 1997 five venous malformations were embolized in one man and four women ranging in age from 31 to 50 years. All patients presented nonspecific abdominal pain and were assessed in the general surgery unit. Percutaneous embolization was recommended. In all cases polyvinyl alcohol was used to embolize the afferent arterioles. Clinical and echographic control follow-up was carried out on an outpatient basis in our Vascular and Interventional Radiology Unit. Embolization was possible in all cases. No complications developed during the procedure, except in one case where the subject suffered a spasm of the hepatic artery. Mean follow-up time was 42 months (6-73 months). Four patients remained asymptomatic during the entire follow-up period, whereas one patient required reembolization. In our experience, transcatheter embolization of hepatic venous malformations is a noninvasive technique which requires few admissions and presents few complications. With further use, it could become the treatment of choice in symptomatic hepatic venous malformations as an alternative to surgery.

Purpose: To present our experience in the treatment of nasolacrimal occlusion by means of polyurethane stents., Methods: Forty polyurethane stents were placed under fluoroscopic guidance in 35 consecutive patients with epiphora due to total or partial obstruction of the nasolacrimal system. The set designed by Song was used in all patients. The procedure was performed by introducing a guidewire through the superior punctum into the canaliculus and advancing it across the obstruction into the inferior meatus of the nasal cavity. After pulling out the guidewire, the stent was advanced in retrograde fashion and released into the sac and the nasolacrimal duct., Results: The technical success rate was 100%. The average time for the procedure was 25 min (range 10-60 min). Immediate complications were: mild pain (n = 5), severe pain (n = 1), minimal epistaxis (n = 7), and moderate epistaxis (n = 1). No major complications occurred. The last clinical control revealed complete resolution of epiphora in 35 eyes and partial resolution in four; one patient did not improve., Conclusion: This technique for treatment of obstruction of the nasolacrimal system is simple and safe, and may obviate the use of more invasive procedures.

Objective: To report our experience with long term external catheters and implantable ports in the last 8 years., Material and Methods: From December 1987 to August 1995 a total of 617 central venous catheters were implanted in 541 patients in our Interventionist Vascular Radiology Unit, 265 men (49%) and 276 women (51%), with a mean age of 46 years. A total of 335 (54%) were partially implantable external catheters and 241 (39%) implantable ports in chest and 41 (7%) in the forearm., Results: A technical success--defined as the possibility of implanting the catheter--was achieved in 98% of cases. Immediate complications included 5 pneumothorax (0.8%), 11 accidental carotid artery puncture (2%) with no clinical relevance, 18 catheter misplacement (3%), and 8 vein spasm (1%). Fifty-two catheters (8%) were removed on account of infectious complications. Currently, 71 catheters are still in use (12%), 433 (70%) have been removed or the catheter was patent until patients's death., Conclusions: Partially implantable central venous catheters and totally implantable ports are a safe alternative in patients requiring a central venous access for prolonged treatments. The low number of immediate complications renders the Interventionist Vascular Radiology Unit the proper place where to perform these procedures.

Purpose: The objective of this study was to present our experience with metallic stents (Wallstent) for palliation of dysphagia due to malignant esophageal obstruction and esophagotracheal fistula., Patients and Methods: From August 1994 to July 1996 20 uncovered and 6 covered stents were inserted in 16 consecutive patients with dysphagia grade 3 (n = 4) or grade 4 (n = 12) caused by incurable malignant obstructions. The obstruction was in the proximal (n = 4), in the middle (n = 3) and the distal (n = 9) third of the esophagus. Five patients presented with esophagotracheal fistula. The stent insertion was performed under fluoroscopic control., Results: Exact positioning of the stent with reduction of the dysphagia was obtained in all patients. There were no complications related with the procedure. Esophagotracheal fistula was solved in those patients treated with covered stents. Six patients had recurrent dysphagia due to tumor ingrowth or overgrowth. In these patients an additional overlapping stent was placed. In latest evaluation 2 patients presented dysphagia grade I, 5 grade III, and 4 grade IV., Conclusion: Implantation of stents proved to be an effective and safe method of palliating dysphagia and occluding esofagotracheal fistula. Placement of stents was feasible without major procedure-related complications.

Background: The purpose of this study was to evaluate the clinical results analyzing the cure, improvement and failure rates of percutaneous transluminal angioplasty (PTA) in patients with the diagnosis of renovascular hypertension with special reference to those with atherosclerotic vascular disease, according to their age, and their effect on blood pressure control and renal function., Patients and Methods: In 93 hypertensive patients with a mean age of 43.4 years 123 renal artery PTA were performed: Twenty-six patients older than 50 years and eleven with 50 years or less had atherosclerosis, 27 fibromuscular dysplasia and a mixed disease was found in one patient. Twenty-eight patients with renal transplant were diagnosed as having arterial graft stenosis., Results: After renal PTA, there was a significant decrease in blood pressure in all cases. Patients with atherosclerotic renal vascular disease showed a decrease in systolic pressure (SP) from 168 +/- 19 before PTA to 154 +/- 8 mmHg at 96 months (p < 0.001) and diastolic (DP) from 113 +/- 10 before PTA to 90 +/- 4 mmHg at 96 months (p < 0.001) respectively after the procedure. Significant differences were also observed in patients with fibromuscular dysplasia. Most patients with renal transplant arterial stenosis had less than five years of follow-up and SP and DP decreased from 162 +/- 18 and 109 +/- 8 mmHg before PTA, to 147 +/- 10 (p < 0.001) and 91 +/- 7 mmHg (p < 0.001) at 12 months after dilation respectively. Clinical improvement was achieved in 91% of patients with atherosclerosis at 96 months and fifty percent of the patients with fibromuscular dysplasia were cured after the same period from the time of PTA. Twelve months after the renal transplant artery dilation was achieved a clinical improvement in 81% and a cure rate in 6% of the patients. Ostial lesions comprised the majority of blood pressure benefit failures. There was no significant improvement in renal function immediately after renal artery dilation except in those patients with fibromuscular dysplasia. Residual stenosis greater than 75% was present in 15 patients after the first PTA. Complications were seen in 4.8% and were related to renal failure and vessel dissection., Conclusion: Angioplasty is effective in the long-term management of high arterial blood pressure and may preserve renal function according to renal artery disease.

Seventy-seven transjugular liver biopsies were performed with a coaxial, spring-loaded, 18-gauge cutting needle, the Biopty gun (Bard Biopsy System, Covington, GA, USA) on consecutive patients between July 1993 and February 1995. Fifty men and 27 women were included in the study; the mean age was 45 years (range 15-69 years). The average number of punctures per patient was 5.2, with a range of 2-9, yielding an average of 4.8 samples per patient (range 1-7). The length of the samples varied from 10 to 22 mm with a constant diameter of 1 mm. The mean time required to complete the procedure was 48 min (43-52 min). Histological diagnoses were obtained in 74 of 77 patients (96%), with non-diagnostic specimens attributed to excessive fragmentation (3 cases). Complications occurred in 10 patients (puncture site hematoma, carotid artery puncture, abdominal pain, vasovagal reaction, hepatic capsule perforation, and hemobilia). The latter two complications were self-limited. In our experience this transjugular hepatic biopsy method is promising for performing biopsies in patients with chronic liver disease, due to its high success rate and low morbidity rate.

Intractable and recurrent ureteral stricture presents a continuous challenge to the urologist. We report on 5 patients with severe ureteral stricture who were successfully treated with self-expanding metallic stents. Ureteral stricture occurred at ureteroileal anastomotic sites after neoplasm resection in 2 cases, multiple upper ureteral strictures were related to multiple surgical procedures for correction of bladder exstrophy in 1 and a ureteral kink developed in 1. Treatment with transluminal balloon dilation provided poor results but self-expanding metallic stents were used successfully with no major complications. In the last patient the stent and the overlying ureter were removed due to recurrent reflux; the gross and histological ureteral changes are discussed in detail. The technical approach is described, alternative therapeutic options are considered and pertinent literature is reviewed.

Purpose: The clinical results of percutaneous transluminal angioplasty (PTA) were evaluated in patients with renovascular hypertension, and the effect of PTA on blood pressure and renal function was determined., Patients and Methods: Between February 1982 and December 1990, 93 hypertensive patients underwent 123 renal artery PTA procedures. Mean patient age was 43.4 years (range, 12-78 years). Average baseline blood pressure was 162/111 mm Hg (range, 140-230/95-150 mm Hg). The cause of renovascular hypertension, as determined with angiography, was atherosclerosis in 37 patients, fibromuscular dysplasia in 27, and mixed disease in one; 28 patients had renal transplant arterial stenosis., Results: In patients with atherosclerotic renal vascular disease or fibromuscular renal artery stenosis, systolic and diastolic blood pressure decreased significantly (P < .001) at 96 months after PTA. In patients with renal transplant arterial stenosis, blood pressure also decreased significantly (P < .001) at 12 months after PTA. Technical success was achieved in 78% of patients with atherosclerosis, 92% of patients with fibromuscular dysplasia, and 76% of patients with renal transplants. Complications were seen in 4.8% and were related to renal failure and vessel dissection., Conclusion: PTA is the therapy of choice in patients with renovascular hypertension due to fibromuscular dysplasia. Patients with atherosclerotic renal artery stenosis or stenosis of a renal artery in a transplanted kidney should be selected according to the anatomy of the lesion and clinical patient characteristics.

Objective: The purpose of this study was to determine the feasibility of using a flexible trocar/catheter system to create a transjugular intrahepatic portosystemic shunt (TIPS)., Subjects and Methods: A flexible needle/trocar was used to connect the hepatic vein to the portal vein in 23 patients with portal hypertension and a history of bleeding gastroesophageal varices. Five patients had signs and symptoms of encephalopathy before shunting; in four, the disease was classified as Child's class C and in one, as Child's class B. Nine-millimeter self-expandable metallic stents were used in all patients., Results: The procedure was technically successful in all patients. The mean portosystemic pressure gradient decreased from 26 to 16 mm Hg (range, 7-23 mm Hg). Eight patients have died. One patient in a hepatic coma with hepatorenal failure survived percutaneous portosystemic shunting, but died 2 days after the TIPS procedure was done. After creation of the shunt, three other patients died of unrelated disease without recurrence of bleeding from gastroesophageal varices. Two patients died of massive bleeding from esophageal varices, one 24 hr after shunting and one of disseminated intravascular coagulation after a second attempt to establish a shunt. One patient died of sepsis associated with infected ascitic fluid 2 months after the TIPS procedure was done, and one died of unknown causes 4 months after the procedure was done. The mean follow-up time in the surviving 15 patients was 12 months. Seven patients had recurrence of gastrointestinal bleeding; the recurrence was due to a thrombosed shunt in two, to hepatic vein stenosis in four, and to a high portosystemic pressure gradient (22 mm Hg) after creation of the shunt in one. Hepatic vein stenosis was noted on portal venograms in another three otherwise asymptomatic patients. In four of five patients, encephalopathy was adequately controlled after shunting. The fifth patient with encephalopathy (Child's class C) and an additional patient in whom encephalopathy (Child's class C) developed after the TIPS procedure have had two additional hospital admissions because of difficulty in controlling the encephalopathy. The amount of ascitic fluid decreased or totally disappeared after treatment in all cases. No severe complications associated with creation of a TIPS were observed., Conclusion: Use of a flexible trocar/catheter system to create a TIPS is a simple, safe, and moderately reliable means of decompressing the portal vein in patients with portal hypertension.

The authors describe a technique for administration of anesthetic to the area of the transparenchymal tract during transjugular percutaneous transhepatic portosystemic shunting. Seven of the eight patients in whom the technique was used did not experience pain during balloon dilation of the tract, and one patient experienced only minimal pain. The technique allows good pain control in patients with severe liver failure and resultant inability of the liver to metabolize pharmaceuticals.

Percutaneous transluminal angioplasty is limited by a high percentage of restenosis in the medium and long runs. Other arterial recanalization systems to be combined with or to be used in alternative to angioplasty are under investigation. Atherectomy with Simpson's catheter (Atherocath) allows mechanical removal of the atheromatous plaque, leaving a smooth lumen, and vessel dilatation with the same effects as those of angioplasty and coaxial Dotter catheters. A Hundred and ten atherectomies with Atherocath were performed by the authors in 103 patients for the treatment of 77 stenoses and 33 total occlusions. All patients had 36 months' follow-up. Immediate and medium patency rates are encouraging in femoropopliteal arteries; the actual role of the method in iliac arteries is still to be demonstrated. Atherectomy with Aterocath can be useful not only in the treatment of arterial stenoses, but also in complete obstructions, in combination with angioplasty. Other relevant indications are the removal of partially or totally obstructive intimal flaps complicating angioplasty, and treatment of such ulcerated lesions as the blue-digit syndrome.

The Simpson atherectomy catheter has been used successfully to recanalise eleven complete occlusions of the iliac and femoropopliteal arteries. Atherectomy and angioplasty were used in combination in 8 cases. Following atherectomy, all patients showed clinical improvement. Distal pulses returned in 7; rest pain and/or claudication disappeared in the other 4. Ischaemic ulcers healed in the 2 affected patients. Overall, ankle-arm indices (AAI) improved by an average of 0.43, with the improvement being greatest (0.55) in patients in whom the lumen was recanalised to within 91-100% of the native luminal diameter. Seven patients have remained with stable AAI values and without change in their clinical status at 18 months follow-up.

Gianturco self-expandable stents were used successfully in the management of 5 patients with tracheobronchial pathology. Placement was performed under endoscopic and fluoroscopic guidance. None of the patients has experienced complications secondary to the stent placement, and in all of them the clinical problems resolved satisfactorily. Longer follow-up is required to determine the place of tracheobronchial stenting in patients with respiratory compromise.