bluuebunny/crossref_metadata_2025 huggingface dataset:
Tuberculosis Testicular: Reporte de un Caso
Authors: Barandica Lilian , Cabrera Boris , Cuadrado Bernarda
Published: July 2018

La tuberculosis es una enfermedad infectocontagiosa emergente con alta morbimortalidad a nivel mundial tanto en su forma pulmonar como extrapulmonar. De hecho, las formas extrapulmonares a pesar de manifestarse en menor porcentaje, permiten la diseminación de la infección a numerosos órganos blanco incluyendo, el sistema genitourinario. Se presenta el caso de un paciente masculino de 50 años de edad, que consulta por presentar masa dolorosa en testículo derecho de aproximadamente 1 mes de evolución, con salida de material purulento fétido y persistente en hemiescroto, sin respuesta al tratamiento antimicrobiano ambulatorio, acompañado de disnea e hipoventilación en campo pulmonar izquierdo, y antecedente de pérdida de peso y tos con expectoración color verde a café desde hace 6 meses. Es sometido a orquiectomía radical más escrotatectomía observándose por los estudios patológicos y histoquímicos del tejido, una inflamación crónica granulomatosa con necrosis caseosa central y positiva a la coloración de Ziehl Nielssen. Por los hallazgos de la patología más los clínicos e imagenológicos a nivel pulmonar, se hace diagnóstico de tuberculosis pulmonar con diseminación a testículo y escroto. El paciente es sometido a tratamiento antifímico con mejoría.
Uretroplastia transpúbica como tratamiento de la estenosis de uretra proximal compleja: resultados de una intervención interdisciplinaria
Authors: Gaviria Gil Federico , Benavides Martinez Johana , Toro Bermudez Rodrigo , Valderrama Molina Carlos , Gomez Andres
Published: July 2018

Introducción La uretroplastia transpúbica es una técnica empleada para tratar la estenosis de uretra proximal compleja, permitiendo una mejor visualización del campo quirúrgico y una mayor facilidad al momento de realizar la anastomosis. Existen pocas descripciones en la literatura de los resultados quirúrgicos y funcionales en los pacientes sometidos a ese procedimiento, el propósito de este estudio es describir una serie de casos complejos tratados con ese abordaje, de una manera interdisciplinaria entre Urología y Ortopedia.

Materiales y Métodos Estudio tipo serie de casos en un grupo de pacientes masculinos que ingresaron al hospital entre marzo de 2013 y mayo de 2017, con lesión de la uretra proximal secundaria a procedimientos quirúrgicos o trauma a los cuales se realizó uretroplastia transpúbica.

Resultados 13 pacientes fueron sometidos a uretroplastia transpúbica. El 69% de los pacientes fueron de etiología traumática con edad promedio de 50 años y seguimiento promedio de 27 meses. Un 62% de los pacientes, habían sido sometidos a procedimientos como uretroplastia, uretotomías o dilataciones previamente y un 46% de los pacientes, presentaron estenosis a nivel de la uretra bulbomembranosa. El 61% no presentó complicaciones a corto plazo como infección urinaria, fistula por dehiscencia o no unión. El 30% presentó dolor crónico. Ninguno presentó alteraciones en la marcha y solo 2 pacientes requirieron procedimientos adicionales como resección transuretral de próstata (RTU).

Conclusiones Pacientes con estenosis compleja de uretra posterior pueden requerir resección del pubis para una adecuada exposición y mejorar el resultado de la uretroplastia sin consecuencias o complicaciones derivadas de la pubectomía.
Mecanismo de Frank Starling: una visión aplicada en la erección del pene
Authors: Buitrago Gómez Nathalia , Husbands Johnie Smith , García-Perdomo Herney Andrés
Published: July 2018

El mecanismo de Frank-Starling es un concepto básico de la fisiología cardíaca y su aprendizaje. Constituye la base fundamental para el entendimiento del funcionamiento del corazón y patologías prevalentes y con alta morbimortalidad como lo es la insuficiencia cardíaca. Por lo cual, su relación con un proceso más interactivo como la erección del pene, podría asegurar un aprendizaje perdurable y práctico. La relación se fundamentó en el reemplazo del eje X de la curva por precarga en el caso del corazón y estimulación en el caso del pene, para así lograr una relación incluso con la disfunción eréctil, que sería el equivalente a la insuficiencia cardíaca. De esa manera, se encontró que a mayor estimulación hay mayor erección y a mayor precarga hay mayor eyección ventricular, teniendo ambas curvas una meseta. Asímismo, farmacológicamente, se encontró relación con el uso de estimulación β-adrenérgica y de inhibidores selectivos de la fosfodiesterasa tipo 5 como el sildenafil, los cuales desplazan la curva hacia arriba y a la izquierda.
Mesotelioma de túnica vaginal en paciente con hidrocele rápidamente progresivo
Authors: Serrano Adolfo , Bravo-Balado Alejandra , Cañón Diana , Robledo Daniela , Fonseca Liliana
Published: July 2018

El mesotelioma es una entidad poco común y agresiva que compromete el mesotelio, involucrando así los diferentes órganos cubiertos por membranas serosas. El mesotelioma de túnica vaginal es una neoplasia muy rara, con un cuadro clínico poco específico y de difícil diagnóstico con las técnicas imagenológicas actuales. Presentamos el caso de un paciente con hidrocele rápidamente progresivo que fue llevado a hidrocelectomía. Se realizó un diagnóstico histopatológico de mesotelioma epitelial maligno de túnica vaginal que requirió orquidectomía radical, hemiescrotomectomía y linfadenectomía retroperitoneal. A un año de seguimiento, el paciente no tiene evidencia de la enfermedad.
Curvilinear Relations between Age and Hemostatic Parameters in Chinese
Authors: Yeh Chih-Jung , Pan Wen-Harn , Bai Chyi-Huey , You May-Su , Wang Weih-Cinn , Wang Liang-Yueh , Lee Ti-Kuang
Published: July 2018

The role of hemostatic factors in the pathogenesis of cardiovascular disease has gained much attention recently. Information about hemostatic factors, and their age patterns is sparse for orientals. With the data collected in the Cardiovascular Disease Risk Factor Two-township Study in Taiwan, this study shows that, in general, the older the age, the stronger the tendency toward thrombosis. With advancing age, prothrombin time, activated partial thromboplastin time, and antithrom-bin-III level decreased steadily; but mean values of fibrinogen, factor VIIc, and factor VIIIc increased. Gender differences in the age patterns of the above factors are carefully described. Curvilinear relations between hemostatic factors and'age were demonstrated for adults aged 18 and above for all hemostatic factors studied. This curvilinearity should be taken into consideration when adjusting for the effect of age in data analysis to avoid residual confounding, particularly when the age range of the study subjects is wide.
Properties of Fibrinogen Cleaved by Jararhagin, a Metalloproteinase from the Venom of Bothrops jararaca
Authors: Kamiguti Aura S , Slupsky Joseph R , Zuzel Mirko , Hay Charles R M
Published: July 2018

Haemorrhagic metalloproteinases from Bothrops jararaca and other venoms degrade vessel-wall and plasma proteins involved in platelet plug and fibrin clot formation. These enzymes also cause proteolytic digestion of fibrinogen which has been suggested to cause defective platelet function. Fibrinogen degradation by jararhagin, a metalloproteinase from B. jararaca, and the effect of jararhagin fibrinogenolysis on both platelet aggregation and fibrin clot formation were investigated. Jararhagin was found to cleave human fibrinogen in the C-terminal region of the Aα-chain giving rise to a 285-290 kDa fibrinogen molecule lacking the Aα-chain RGD 572-574 platelet-binding site. Platelet binding and aggregation of ADP-activated platelets is unaffected by this modification. This indicates that the lost site is not essential for platelet aggregation, and that the remaining platelet binding sites located in the N-terminal portion of Aα chains (RGD 95-97) and the C-terminal of γ chains (dodecapeptide 400-411) are unaffected by jararhagin-digestion of fibrinogen. Fibrin clot formation with thrombin of this remnant fibrinogen molecule was defective, with poor polymerization of fibrin monomers but normal release of FPA. The abnormal polymerization could be explained by the loss of one of the two complementary polymerization sites required for side-by-side association of fibrin protofibrils. Jararhagin-induced inhibition of platelet function, an important cause of haemorrhage in envenomed patients, is not caused by proteolysis of fibrinogen, as had been thought, and the mechanism remains to be elucidated.
Pharmacological Properties of CY 216 and of Its ACLM and BCLM Components in the Rabbit
Authors: Peyrou V , Lormeau J C , Caranobe C , Gabaig A M , Crepon B , Salvin S , Houin G , Sié P , Boneu B
Published: July 2018

This study compares some in vivo pharmacological properties of CY 216 and of its ACLM and BCLM components having a molecular weight above and below 5.4 kDa respectively. The anti-factor Xa/anti-thrombin ratio of these compounds determined in a rabbit plasma system were 2.5 and 1.2 for CY 216 and ACLM respectively while BCLM was devoid of anti-thrombin effect. After bolus intravenous injection, continuous infusion and subcutaneous administration, the clearances of anti-factor Xa activity generated by ACLM were, on the average, 2 and 1.5 times higher than those generated by BCLM and CY 216 respectively. The clearances of the anti-thrombin activity were comparable for CY 216 and ACLM, and higher than those of the antifactor Xa activity. The duration of the antithrombotic effect was investigated in the Wessler model after a single subcutaneous injection of 1000 anti-factor Xa units of one of the compounds. Using thromboplastin as thrombogenic stimulus, the most efficient agent was ACLM and the antithrombotic activity was essentially correlated to the circulating anti-thrombin activity. Using human serum as thrombogenic stimulus, ACLM and BCLM were more efficient than CY 216 and the antithrombotic activity was mainly correlated to the anti-factor Xa activity. The ability of the 3 compounds to inhibit venous thrombosis growth was compared: they were found equipotent and the antithrombotic effect was independent of the anti-thrombin activity. The pro-haemorrhagic properties were compared in the rabbit ear model. The activity of the 3 compounds were comparable and significantly less prohaemorrhagic than unfractionated heparin. These results suggest that the haemorrhagic potential of unfractionated heparin and of LMWH is independent of the anti-thrombin and anticoagulant activity, but related to the molecular weight. These observations indicate that factor Xa inhibition is a valuable target to prevent and to treat venous thrombosis and that the anti-factor Xa activity of a low molecular weight heparin (LMWH) largely contributes to its antithrombotic effect.
Association of Increased Fibrin Turnover and Defective Fibrinolytic Capacity with Leg Atherosclerosis
Authors: Cortellaro M , Cofrancesco E , Boschetti C , Mussoni L , Donati M B , Catalano M , Gabrielli L , Lambardi B , Specchia G , Tavazzi L , Tremoli E , Turri M ,   PLAT Group
Published: July 2018

Patients with peripheral arterial disease have a high risk of death from cardiovascular events. As defective fibrinolysis associated with leg atherosclerosis has been suggested as a predisposing factor, we sought a relation among decreased fibrinolysis, the presence of leg atherosclerosis and the incidence of thrombotic events in a case control study nested in the PLAT.

Fifty-eight patients with coronary and/or cerebral atherothrombotic disease, free of leg atherosclerosis at Doppler examination, were compared with 50 atherosclerotic patients with leg involvement. High D-dimer (153.0 vs 81.3 ng/ml, p <0.001) and tPA antigen before venous stasis (14.4 vs 11.8 ng/ml, p <0.03), and low tPA antigen (6.7 vs 15.6 ng/ml, p <0.01) and fibrinolytic activity released after venous stasis (fibrinolytic capacity: 113.2 vs 281.4 mm2, p <0.001) were found in patients with leg atherosclerosis. D-dimer and fibrinolytic capacity, in addition to age, were selected by stepwise discriminant analysis as characterizing patients with leg atherosclerosis. Moreover, higher D-dimer and tPA inhibitor characterized patients with leg atherosclerosis who subsequently experienced thrombotic events.

These findings constitute evidence of high fibrin turnover and impaired fibrinolytic potential in patients with leg atherosclerosis. Thus impaired fibrinolysis may contribute to the prothrombotic state in these patients.
The Effects of Some Synthetic Compounds on In Vitro Fibrinolytic Activity Measured by Different Methods and the Relevance to Activity In Vivo
Authors: Baillie A.J , Sim A. K
Published: July 2018

The activity of several synthetic compounds, rated from good to poor (or inactive) fibrinolytic activators, has been assessed by two different commonly-used in vitro methods. Compounds shown to be active over a narrow concentration range in the hanging clot test were shown to be inhibitors of plasmin and trypsin in the casein-olytic test. The inhibitory activity of these compounds was shown to increase with increasing substrate concentration and apparent activity in the hanging clot test. Possible explanations and relevance of these observations are discussed.
Influence of Factor VII on the Assay of Factor VIII by the One Stage Method Using Wettable Surface
Authors: Altman Raúl , Rouvier Jorge , Reussi Carlos ,   with the technical assistance of Silvia M. Taboada
Published: July 2018

The influence of factor VII activated by Contact Product (i. e. the product of the reaction between factor XII and XI) on the factor VIII determination by the partial thromboplastin time with kaolin is described. There is an important decrease in clotting time when, with a constant amount of factor VIII, the concentration of factor VII is increased. This difference is unimportant from a practical point of view; but this does not distract from the possibility that the minute amount of thrombin generated by the XII-VII pathway may be of great practical interest, because it may be capable of activation factors V and VIII as well as influencing platelet metabolism and thus induce hemostasis, especially when the intrinsic pathway is blocked.
Effect of Lidoflazine (R 7904) on Human Platelet Function in Vitro
Authors: De Clerck F
Published: July 2018

The effect of lidoflazine and of cinnarizine on human platelet function in vitro was compared to that of dipyridamole.

Pre-incubation for 30 min at 37° C of platelet rich plasma with lidoflazine or with dipyridamole 5 ×10–4 M resulted in an appreciable inhibition of collagen aggregation in particular and to a lesser extent of ADP aggregation; cinnarizine was marginally active only.

Clot retraction was inhibited by lidoflazine and by dipyridamole. Experiments on biphasic ADP aggregation and C14-serotonin release during aggregation show that lidoflazine reduces the platelet release reaction.

The possible mode of action of the compound is discussed.

Plasma coagulation and PF – 3 availability were not affected.
Systemic Effects of ADP-induced Platelet Aggregation and Their Modification by Aspirin and by Pyridinolcarbamate
Authors: Kobayashi Itsuro , Didisheim Paul
Published: July 2018

ADP, AMP, or ATP was injected rapidly intravenously in rats. ADP injection resulted in the f olio wing transient changes: a drop in platelet count, a rise in central venous pressure, a fall in carotid arterial PO2, bradycardia, arrhythmia, flutter-fibrillation, and arterial hypotension. AMP and ATP produced some of these same effects; but except for hypotension, their frequency and severity Avere much less than those following ADP.

Prior intravenous administration of acetylsalicylic acid or pyridinolcarbamate, two inhibitors of the second wave of ADP-induced platelet aggregation in vitro, significantly reduced the frequency and severity of all the above ADP-induced changes except hypotension. These observations suggest that many of the changes (except hypotension) observed to follow ADP injection are produced by platelet aggregates which lodge transiently in various microcirculatory beds then rapidly disaggregate and recirculate.
Changes Associated with Platelet Aging
Authors: Ginsburg D. A , Aster R. H
Published: July 2018

Cohorts of “young” and “old” platelets were prepared and compared with each other, and with total platelet populations. It was found that approximately 22% of the platelet mass, including phospholipid, cholesterol and protein was lost as the platelets aged in the circulation. No one phospholipid fraction was specifically altered. With aging there was significant reduction in the ability of platelets to respond to aggregating stimuli and to release Pf3. Pf4 activity seemed to be fully preserved and there was no detectable change in specific gravity. Ultrastructural changes seemed to be limited to a decrease in the number of glycogen granules.

It is recognised that the observed changes may be a passive consequence of platelet aging. However, it is speculated that loss of platelet substance may in someway be related to a functional role of platelets - perhaps the maintenance of endothelial integrity.

It is also postulated, on the basis of the reported findings, that radioisotopic labels such as DFP which give an exponential platelet survival curve bind to a platelet constituent which is lost during the aging process.
The Effect of Adrenaline Infusions and of Muscular Exercise upon the Blood Level of Factor VIII (Antihaemophilic A Factor) in the Rat
Authors: Iversen J. G , Waaler B. A
Published: July 2018

The activity of factor VIII (antihaemophilic A factor) in rat blood does not increase upon adrenaline infusions or short term muscular exercise. A possible increase in the factor VIII activity in blood of rats was observed during a postoperative period, however. Short-lasting Nembutal anaesthesia had no influence on the factor VIII blood level in rats.
On Intraocular Fibrinolysis
Authors: Pandolfi M , Nilsson Inga Marie , Niléhn J. E
Published: July 2018

1. Intraocular fibrinolysis can be induced in rabbits by intravenous administration of streptokinase and plasminogen. Enhancement of intraocular fibrinolysis, however, requires a substantial increase in the fibrinolytic activity of the blood. Hence any attempt to induce therapeutic intraocular fibrinolysis by injection of fibrinolytic enzymes without checking the degree of fibrinolysis in the blood is meaningless.

2. The blood-aqueous barrier did not show any significant change during fibrinolytic activation.

3. Fibrinolytic split products could not be demonstrated in primary and plasmoid aqueous humour, but they were found in plasmoid aqueous after treatment of the animals with streptokinase and plasminogen.

4. Intraocular fibrinolysis can be inhibited in primary and plasmoid aqueous by parenteral administration of ε-ACA.
The Kidneys and the Liver as the Organs Regulating the Fibrinolytic System of the Circulating Blood
Authors: Januszko T , Furman M , Buluk K
Published: July 2018

In experiments on rabbits it was shown by means of interruption and reestablishment of hepatic and renal circulation that these organs play an essential role in the regulation of the fibrinolytic system of the circulating blood. The kidneys are the source of the plasminogen activator secreted in the blood whereas the liver is responsible for the inactivation of the fibrinolytic system.
Human Leukocyte Elastase and Cathepsin G Inactivate Factor VII by Limited Proteolysis
Authors: Anderssen Trude , Halvorsen Hanne , Bajaj S Paul , Østerud Bjarne
Published: July 2018

The effect of supernatant from phorbol myristate acetate (PMA) stimulated human polymorphonuclear granulocytes (PMN) on human factor VII was studied in vitro. The supernatant caused a rapid loss in factor VII coagulant activity by the action of human leukocyte elastase (HLE) and cathepsin G in the supernatant, as demonstrated by the use of specific inhibitors of the two serine proteases, respectively. Preincubation of the supernatant with the elastase inhibitor and the cathepsin G inhibitor preserved 80% and 25% of the clotting activity, respectively. Calcium protected factor VII completely from the supernatant mediated inactivation. Cathepsin G and HLE purified from PMN each destroyed the coagulant activity of factor VII when added to a non-plasma system. There were, however, no effect on factor VII activity when cathepsin G was added to plasma. Polyacrylamide gel electrophoresis in the presence of SDS indicated that HLE and cathepsin G cleaved the zymogen in the same manner, producing (a) peptide(s) of low molecular mass and a single large product of 48 kDa. Preincubation of factor VII with calcium ions inhibited the proteolytic action of HLE and cathepsin G. It is suggested that HLE and cathepsin G from activated granulocytes may be partly responsible for the loss in factor VII activity that is observed during sepsis.
Isolation and Properties of Human Vascular Plasminogen Activator
Authors: Allen R A , Pepper D S
Published: July 2018

Improved methods for the isolation of human cadaveric endothelial vascular plasminogen activator have been developed. The enzyme was isolated as the native complex with soluble fibrin by a combination of polyethylene glycol precipitation and hydroxyapatite chromatography. The purified complex was then finally dissociated by affinity chromatography on lysine agarose. The dissociated enzyme was relatively unstable when bioassayed on fibrin plates, however its activity against low molecular weight chromogenic substrates was more stable. The enzymic activity was totally inhibited by DFP, PMSF or DTT and was totally resistant to iodoacetamide or Trasylol, indicating that it was a serine protease but differing in certain respects from urokinase. The specific activity of the native enzyme is ≥ 50,000 CTA units/mg protein, it has a molecular weight of 56,600 and will reform biologically active complexes with soluble fibrin polymers prepared in vitro. Both SFP and various poly-lysine preparations were shown to stimulate the activation of plasminogen by VPA in a spectrophotometric assay based on the rate of plasmin generation assayed against the chromogenic substrate S-2251. Considerable loss of material from purified preparations occurs by adsorption, thus with the limited amount of material available from cadavers, a radioisotopic labelling method was sought using iodination or 3H-DFP labelling, however neither approach was satisfactory. Comparison of VPA activity in cadaveric eluates and in venous occlusion plasma or following infusion of vasopressin analogues showed that all three activities behaved identically in the above purification steps. The affinity of VPA for insoluble fibrin was much higher than that of urokinase, or a human melanoma activator from tissue culture.
Lack of Correlation between Anticoagulant Activity and Phospholipid Hydrolysis by Snake Venom Phospholipases A2
Authors: Condrea Eleonora , Yang Chen-Chung , Rosenberg Philip
Published: July 2018

The anticoagulant effects and the simultaneous plasma phospholipid hydrolysis induced by three purified phospholipases obtained from snake venoms, i.e., the basic, relatively toxic N. nigricollis, the neutral, relatively nontoxic H. haemachatus, and the acidic, relatively nontoxic N. n. atra, have been compared. The N. nigricollis phospholipase has a very strong anticoagulant effect at concentrations which induce relatively low levels of phospholipid hydrolysis in plasma. The H. haemachatus and N. n. atra phospholipases become anticoagulant only at high concentrations, and the associated phospholipid hydrolysis is also very high. It is concluded that, while all phospholipases are likely to inhibit coagulation if used in amounts sufficiently large to deplete plasma of phospholipids, strongly active phospholipases, such as N. nigricollis, interfere nonenzymatically with the clotting process before any appreciable phospholipid hydrolysis is reached.
Investigations into the Clinical Utility of Latex D-Dimer in the Diagnosis of Deep Venous Thrombosis
Authors: Carter Cedric J , Doyle D Lynn , Dawson Nigel , Fowler Shauna , Devine Dana V
Published: July 2018

The serial use of non-invasive tests has been shown to be a safe method of managing outpatients who are suspected of having lower limb deep venous thrombosis (DVT). Objective testing has shown that the majority of these outpatients do not have venous thrombosis. A rapid test to exclude DVT in these patients, without the need for expensive and inconvenient serial non-invasive vascular testing, would have practical and economic advantages.

Studies measuring the fibrin degradation product D-dimer using enzyme-linked immunoassays (EIA) in patients with veno-graphically proven DVT suggest that it should be possible to exclude this condition by the use of one of the rapid latex bead D-dimer tests.

We have examined 190 patients with suspected DVT using both a latex and an EIA D-dimer assay. The latex D-dimer test used in this study was negative in 7 of the 36 proven cases of DVT. This sensitivity of only 80% is not sufficient to allow this type of assay, in its current form, to be used as an exclusion test for DVT. The same plasma samples were tested with an EIA assay. This information was used to mathematically model the effects of selecting a range of D-dimer discriminant cut off points for the diagnosis of DVT. These results indicate that 62% of suspected clinically significant DVT could have this diagnosis excluded, with a 98% sensitivity, if the rapid latex or equivalent D-dimer test could be reformulated to measure less than 185 ng/ml of D-dimer.
Evaluación de la eficacia de fosfomicina trometamol y gentamicina en la profilaxis de la cistoscopia flexible tras el estudio de los patógenos de nuestro entorno
Authors: Planelles Gómez Jorge , Gras Colomer Elena , Pérez Martínez María Ángeles , Bonastre Torró Cristina , Sánchez Sanchís Manuel , Vidal Moreno Juan Francisco
Published: July 2018

Objetivo Optimizar el uso de antibióticos en la profilaxis de la cistoscopia flexible estudiando los patógenos más frecuentes de nuestro entorno y eligiendo el antibiótico según sus antibiogramas.

Métodos Desde Enero del 2015 hasta Noviembre del 2015, se analizaron los urinocultivos de nuestra área, se eligió el antibiótico en función a su sensibilidad frente a los patógenos más frecuentes y se comparó con un antibiótico de amplio espectro. Desde Enero del 2016 hasta Diciembre del 2016, se realizaron las cistoscopias agrupando a los pacientes en: Grupo 1: Pacientes sin profilaxis; Grupo 2: Profilaxis con Gentamicina 240 mg; Grupo 3: Profilaxis con antibiótico seleccionado. Como variables principales se definieron la presencia de bacteriuria asintomática e ITU tras la realización de la cistoscopia flexible.

Resultados Se analizaron 8.530 urinocultivos y se eligió la Fosfomicina Trometamol 3 gr como profilaxis. Se realizaron 244 cistoscopias distribuidas: Grupo 1: 86 (35%); Grupo 2: 72 (30%); Grupo 3: 86 (35%). Se detectó bacteriuria asintomática postcistoscopia en 6 pacientes (2,5%) en el Grupo 1, 7 pacientes (2,9%) en el grupo 2 y 5 pacientes (2%) en el grupo 3 no presentando diferencias significativas (p 0.120). Desarrollaron ITUs postcistoscopia 1 paciente (0,4%) en el Grupo 1, 5 pacientes (2%) en el Grupo 2 y 2 pacientes (0,8%) en el Grupo 3 sin diferencias significativas (p 0.105).

Conclusión La Fosfomicina es tan efectiva como la Gentamicina en la profilaxis de la cistoscopia. Para un uso correcto de los antibióticos, se recomienda el estudio de los patógenos de nuestro entorno.
Relación entre ratio digital (2D:4D) y severidad preoperatoria del cáncer de próstata
Authors: Sánchez-Rodríguez Carlos , Oñate-Celdrán Julián , García-Escudero Damián , Samper-Mateo Paula , Vilchez-Costas Ana , Torres-Roca Marcos , Maldonado-Cárceles Ana , López-Espín José , Martínez-Díaz Francisco , Mendiola-Olivares Jaime , Torres-Cantero Alberto
Published: July 2018

Objetivo La ratio digital del segundo y cuarto dedo de la mano (2D:4D) es un marcador de la exposición a andrógenos prenatal que presenta un dimorfismo sexual en mamíferos, siendo menor en hombres que en mujeres. El objetivo de nuestro estudio fue analizar la asociación entre la ratio 2D:4D (como marcador indirecto del ambiente hormonal intrauterino) y la severidad preoperatoria del cáncer de próstata (CaP).

Material y métodos Se trata de un estudio transversal que incluyó 118 pacientes intervenidos de CaP y con confirmación histológica por biopsia desde abril de 2007 hasta julio de 2015. A cada paciente se le realizó una exploración física y se midió desde la base de la falange proximal hasta el extremo de la falange distal tanto en el cuarto como en el segundo dedo de la mano derecha. La asociación entre la ratio 2D:4D y los indicadores de severidad prequirúrgicos de CaP se realizaron mediante test de medias, correlación de Spearman y regresión lineal simple.

Resultados La ratio 2D:4D se asoció significativamente con el PSA prequirúrgico (p = 0,023) y con el porcentaje de cilindros afectados en la biopsia (p = 0,05)

Conclusión Nuestros resultados sugieren que una mayor exposición androgénica prenatal, reflejado en una ratio 2D:4D disminuida, estaría asociada con una mayor severidad prequirúrgica del CaP.
Profilaxis antibiótica en el manejo conservador de los pacientes con trauma renal: ¿Aún existe controversia?
Authors: García-Perdomo Herney Andrés , Gómez-Puerto Diego Andrés , Zapata-Copete James Alejandro , Manzano-Núñez Ramiro
Published: July 2018

Objetivo Describir la evidencia que existe en la actualidad acerca del uso del antibiótico profiláctico en el manejo conservador del trauma renal.

Material y métodos Decidimos realizar una revisión de la literatura para intentar resolver la controversia existente acerca de la efectividad del uso de antibiótico profiláctico en pacientes con trauma renal para prevenir complicaciones infecciosas.

Resultados El trauma renal es un problema importante en los servicios de urgencias en el mundo. La mayoría corresponden a traumatismos cerrados y principalmente a accidentes de tránsito, aunque pueden ser secundarios a un trauma penetrante. Los abscesos perirrenales son poco frecuentes, se estima que ocurren en menos del 1% de todos los casos de trauma renal y en aproximadamente 5% de los casos de trauma renal penetrante. Dada la baja incidencia de abscesos perirrenales y las diferentes corrientes existe controversia para el tratamiento antibiótico. El manejo es conservador en la mayoría de los casos, y depende del grado de la lesión, el compromiso vascular y el estado hemodinámico del paciente.

Conclusión Aún no existe claridad acerca de la utilización de antibiótico profiláctico en el manejo conservador del paciente con un traumatismo renal, relacionado con el tipo de trauma y el grado de la lesión. Sugerimos el uso de antibiótico profiláctico en pacientes con trauma penetrante grado IV dada la mezcla de ambiente externo, cuerpo extraño y orina, sin embargo, no hay evidencia de alta calidad al respecto.
Prostatectomía paliativa en cáncer de próstata localmente avanzado y metastásico con uropatía obstructiva
Authors: Chavarriaga Soto Julián , Álvarez Villarraga David , Silva Herrera José , Fakih Garcia Nayib , Álvarez Jaramillo Juliana , Quiñones Andrés , Ocampo María , Iregui Juan
Published: July 2018

Introducción Los pacientes con cáncer de próstata localmente avanzado frecuentemente consultan por síntomas urinarios obstructivos bajos secundarios a la obstrucción del tracto de salida de la vejiga por el efecto obstructivo del adenocarcinoma prostático. El objetivo de este estudio es evaluar la prostatectomía transuretral paliativa en esos pacientes y comparar las características preoperatorias, calidad de vida e IPSS antes de la cirugía y en el postoperatorio.

Métodos y Materiales Estudio retrospectivo multicentrico que mediante el cuestionario WHOQOL-Bref evalúa calidad de vida y compara el IPSS pre y post-quirúrgico en una cohorte de 26 pacientes llevados a Resección transuretral de la próstata paliativa (pRTUP) por Cáncer de próstata localmente avanzado.

Resultados La media de la edad poblacional fue de 73 años, todos fueron llevados a pRTUP entre el 2011 y el 2017, solo un paciente fue dado de alta el mismo día de la cirugía, la media de hospitalización de 2,1 días. Cinco pacientes (26%), tenía antecedente de pRTUP y requirieron una nueva intervención. La media del IPSS inicial fue 23.2 ± 5.4. El Qmax antes de la intervención quirúrgica tuvo una media de 8.3 ± 1, más del 50% de los pacientes eran de alto riesgo dado por el Gleason. Con respecto a la QoL encontramos que en los dominios de salud física y psicológica fue moderada, mientras que en los otros dominios fue adecuada, el IPSS postquirúrgico mejoro considerablemente con una media de 16.5 ± 3.4.

Conclusiones La pRTUP es una buena opción de tratamiento para la desobstrucción al tracto de salida de la vejiga secundaria al adenocarcinoma de próstata localmente avanzado, con mejoría considerable de los síntomas urinarios obstructivos bajos, el IPSS y con buena calidad de vida después de la intervención. Sin evidencia de progresión oncológica de la enfermedad secundaria a la intervención quirúrgica desobstructiva.
Efecto in vitro de los suplementos vitamínicos que se venden como afrodisíacos sobre la movilidad espermática
Authors: Quintero Quinchia Yulieth Catherine , Cardona Maya Walter D.
Published: July 2018

Objetivo El objetivo de este trabajo es determinar el efecto in vitro de los suplementos vitamínicos que se venden como afrodisíacos sobre la movilidad espermática.

Materiales y métodos Comprimidos de venta libre obtenidos en diferentes centros de venta de productos naturales y sexuales de la ciudad de Medellín fueron evaluados (Sex Bull, Ses-Max, Vigorday, Up12, Furumbao, Canguro, MAGYMas) y diluidos en solución salina. Posteriormente, fueron mezclados en proporciones iguales con las muestras de semen de 22 voluntarios aparentemente sanos y se determinó el efecto sobre la movilidad en función del tiempo (0, 60, 120 y 180 minutos).

Resultados El análisis del efecto de los tratamientos con extractos acuosos de los suplementos vitamínicos sobre los espermatozoides, fueron divididos según la presencia de L-arginina en su composición. No se observaron cambios positivos sobre la movilidad espermática.

Conclusión Los suplementos vitamínicos que se venden en las tiendas naturistas y sexuales de la ciudad, no ejercen ningún efecto sobre la calidad seminal in vitro, seguramente basados en su composición solo sirven como suplementos energéticos.
Normal Platelet Function In Scurvy And Experimental Human Vitamin C Deficiency
Authors: Johnson G J , Holloway D , Hutton S , Duane W
Published: July 2018

Mucocutaneous hemorrhage is a prominent feature of human scurvy. Platelet dysfunction has been observed in scorbutic guinea pigs and some humans with scurvy, but others have found normal platelet function in human scurvy. Since it is uncertain whether platelet dysfunction contributes to the hemorrhagic diathesis of scurvy, we studied platelet function in one patient with typical perifollicular hemorrhagic manifestations of scurvy and in five healthy human ascorbic acid (AA) deficient volunteers. Volunteers were hospitalized on a metabolic ward, and fed a diet providing 3-4mg AA per day. Platelet function studies were performed at the end of a) a 30 day control period of AA supplementation; b) a 60 day period of AA deficiency; and c) a 40 day period of AA supplementation. The patient with scurvy was studied before and 10 days after AA supplementation. The following platelet studies were performed: venous count, bleeding time (Ivy method), in vitro adhesiveness (Bowie method), in vivo adhesiveness (Johnson method), aggregation in response to ADP, collagen, epinephrine, sodium arachidonate and ristocetin, and 14C-serotonin release. Plasma and leukocyte AA were found to be normal in both periods of supplementation and markedly decreased (plasma mean 0.12 ± 0.02mg/dl; WBC mean 8.9 ± 1.8μg/108 cells) following the deficient diet. Plasma AA was 0.07mg/dl and WBC AA was 4.92μg/108 cells in the scurvy patient. Platelet count and all platelet function studies were within the normal range in the patient with scurvy and all volunteers during AA supplementation. In vivo platelet adhesiveness decreased in 4 of the 5 volunteers during AA deficiency, but it remained in the normal range in all but one. All other studies were normal in both AA deficient volunteers and the patient with scurvy. We conclude that significant platelet dysfunction does not accompany subclinical AA deficiency, and that platelet dysfunction is not primarily responsible for the hemorrhagic diathesis of scurvv.
Syndrome Of Acquired Prothrombin Deficiency And The “Lupus Anticoagulant”: Demonstration Of A Prothrombin Antibody That Does Not Neutralize Prothrombin Clotting Activity In Vitro
Authors: Bajaj S P , Herbst K D , Schwartz D B , Fierer D , Rapa-port S I
Published: July 2018

A child was seen after an acute illness with bruising, the “lupus anticoagulant”, and the virtual absence of plasma prothrombin clotting activity. Screening test results were: patient’s plasma, PTT 117", prothrombin time 36"; 1/1 mixture of patient’s and normal plasma, PTT 162" (cofactor phenomenon), prothrombin time 18". F. XII, XI, IX, and VIII assays were typical for the “lupus anticoagulant”, yielding higher values with increasing dilution of the patient’s plasma. The patient’s plasma contained 0.05 U/ml of prothrombin activiy in a one-stage assay and no demonstrable prothrombin antigen by double immunodiffusion or electroimmunoassay with a goat anti-prothrombin anitserum. Prothrombin clotting activity was not inhibited when the patient’s plasma was incubated with varying concentrations of normal plasma or purified human prothrombin. Nevertheless, when the patient’s plasma was used as a source of antibody in agar immunodiffusion plates precipitin lines of identity were observed against normal plasma and purified prothrombin. Presence of an antibody against human prothrombin was further demonstrated by incubating varying concentrations of 125I-prothrombin with the patient’s plasma followed by ammonium sulfate precipitation of the antigen-antibody complex (estimated affinity, 2.5 × 109). Over a 3-week period prothrombin activity and antigen increased, prothrombin antibody decreased, and the bruising subsided. This study demonstrates: (1) that the acquired deficiency of prothrombin clotting activity in this rare syndrome stems from the disappearance of the prothrombin molecule from the plasma, and (2) that a prothrombin antibody is present in the plasma despite its inability to neutralize prothrombin in vitro. Rapid clearance of prothrombin antigen-antibody complexes could be a mechanism for the acquired hypoprothrombinemia of this unusual syndrome.
Fibrinopeptide A And Beta-Thromboglobulin Levels In Pre-Eclampsia And Hypertensive Pregnancy
Authors: Douglas Jessie T , Shah M , Lowe G D O , Prentice C R M
Published: July 2018

To evaluate thrombin generation and platelet activation in pre-eclampsia we have measured fibrinopeptide A (FPA) and beta-thromboglobulin (BTG) by radioimnunoassay in patients with this disorder and have compared them to patients with essential hypertension of pregnancy and normal controls. In 10 patients with pre-eclampsia significantly elevated levels were found of FPA (8.3 ± 4.3 ng/ul; mean normal 1.6 ± 0.8ng/μl, p<0.01) and of BTG (51.9 ± 16 ng/μl; mean normal 31 ± 16 ng/μl, p<0.01). In 5 patients with pregnancy and essential hypertension the levels of FPA (5.65 ± 2.2 ng/μl, p<0.01) were lower than in pre-eclampsia but were still significantly elevated. BTG (37 ± 2.5 ng/μl) was not significantly increased in these patients. These results are consistent with increased thrombin generation and platelet release in preeclampsia. In pre-eclampsia there is evidence of intravascular coagulation which occurs to a greater degree than in pregnant patients with comparable raised blood pressure due to essential hypertension. Serial FPA measurements may prove useful in monitoring the development and treatment of pre-eclampsia.
The Kallikrein-Kinin System During Bacterial Shock
Authors: Kalter E S , Bouma B N
Published: July 2018

The liberation of vascactive substances, kinins, from plasma kininogen (HMWK) by plasma kallikrein is implicated in the pathogenesis of bacterial shock. This proces is initiated by the reciprocal activation of Hageman Factor (FXII) and prekallikrein (PK) which may occur during sepsis by the actions of bacterial cell fragments. Of 9 patients with bacterial shock clinical and laboratory data were collected simultaneously at intervals of at least 4 hours, and averaged per patient. Bacteria were recovered from the site of infection of all patients and on culture of blood from 8 patients and involved both Gram-negative (n=7) as- well as Gram-positive (n=2) organisms. Circulatory shock was documented by clinical signs, oliguria, hypotension and blood lactate elevations above 2 mM/L. Mean Arterial Pressure was 79 + l9(SD)mmHg and Lactate 7.0±3.7 mM/l. FXII, FXI, PK and HMWK were measured functionally by clotting assay (c) and/or quantitatively by rocket immuno-electro- phoresis (ag) and expressed as percentage of a normal plasma pool of 40 donors (mean ± SD): These data support the theory of the extensive involvement of this system in the pathogenesis of bacterial shock, since the very low values measured indicate excessive consumption of these factors. Moreover, the 3 patients who died during shock had significantly lower values for FXII- antigen than the 6 patients who recovered from shock (36±13 vs 52±4, p<0.001), in concert with the hypothesis that a more serious invasion with bacteria causes a greater activation of FXII and thus a more severe clinical picture. To this extent these results are at variance with previous reports.
Hereditary Hemorrhagic Telangiectasia And Disseminated Intravascular Coagulation: A New Clinical Syndrome
Authors: Bick R L
Published: July 2018

Hereditary hemorrhagic telangiectasia (HHT) is the most common of the hereditary vascular defects which is associated with hemorrhagic diathesis. Many patients with HHT may have other defects in hemostasis which remain unrecognized. Over the last two years 47 patients with HHT and associated bleeding problems have been evaluated. This report summarizes these 47 patients. All patients underwent a complete clinical evaluation, template bleeding time, PT, PTT, and platelet adhesion. If indicated, platelet aggregation,platelet survival, thrombin time, reptilase time, fibrinogen level, FDP titer, AT-III level, and PSO4 were also performed Especially noteworthy was finding an association of hereditary hemorrhagic telangiectasia and disseminated intravascular coagulation (DIC). Twenty-four of the 47 patients (51%) evaluated had clinical and laboratory evidence of DIC. Of these, 19 had numerous episodes of acute DIC with significant hemorrhage. In all instances of DIC associated with HHT patients responded to mini-dose heparin therapy or antiplatelet therapy (ASA/Dipyridamole). In addition, 6 of the patients with HHT and DIC presented with diffuse recurrent deep venous thromboses and 3 suffered pulmonary emboli. It is suggested that this syndrome of HHT and DIC is similar to the association of DIC and giant cavernous hemangiomata or the so-called Kasabach-Merritt syndrome. It should be appreciated that patients with HHT and bleeding are candidates for the development of DIC and thus a “mini-Kasabach-Merritt syndrome”; when patients with HHT present with undue bleeding or unexplained thrombosis this syndrome should be appreciated, searched for from the clinical and laboratory standpoint, and when found, mini-heparin or antiplatelet therapy should be considered.
Purification Of A New High Mw Single Chain Form Of Urokinase (UK) From Urine
Authors: Husain S S , Gurewich V , Lipinski B
Published: July 2018

Purified UK exists in 2 forms, a high MW (55,000 daltons) and a low MW (33,000 daltons) enzyme. The former is composed of 2 chains held together by disulfide bonds and is believed to be a precursor of the latter. Little affinity for fibrin has been ascribed to either form. We have purified a third form of UK using affinity chromatography on fibrin-celite, a method which we developed to purify the major plasminogen activator from blood. When freshly voided urine was exposed to fibrin-celite, approximately 20% of the UK present was tightly bound to the fibrin. This high affinity UK (HAUK) was eluted in a sharp peak with arginine (0.2 M). Purification was achieved by gel filtration (Sephadex G-200) of the activator peak. SDS gel electrophoresis showed a single band (56,000 daltons) which remained intact after exposure to reducing agents, indicating that HAUK has a single chain structure and may be the native form of UK. The specific activity of HAUK is relatively low (40,000-50,000 CTA u/mg) suggesting that it may be a proactivator. Freshly voided urine and a rapid isolation procedure are necessary if degradation of HAUK is to be avoided. The unique high fibrin affinity of HAUK, which is not shared by the other 2 forms of UK, may make it a more specific and efficient fibrinolytic agent by confining and concentrating the enzymatic activity to the fibrin surface. The attachment of a suitable radiolabel to HAUK may also provide a useful tool for the detection of intravascular fibrin thrombi.
On The Stimulating Effect Of Bothroxobin Induced Fibrin (Fibrin I) On Tissue Activator Induced Fibrinolysis
Authors: Rånby M , Wallén P , Bergsdorf N
Published: July 2018

Thrombin induced fibrin is in contrast to fibrinogen a powerful stimulator for the tissue plasminogen activator (TPA) catalysed conversion of plasminogen to plasmin. The aim of the study was to compare fibrin I, obtained from fibrinogen by the release of the fibrinopeptides A with bothroxobin (reptilase), and fibrin II, obtained by release of both fibrinopeptides A and B with thrombin, as for stimulating effect on the plasminogen activation by TPA.

The rate of plasmin generation was continuously determined by measuring the absorbancy at 405 nm in reaction mixtures containing a plasmin specific chromogenic substrate. In a solution of 0.1 μM fibrinogen, 0.1 μM Glu-plasminogen in 0.1 M sodium phosphate buffer pH 7.3 containing 0.3 mM D-Val-Leu-Lys-pNA plasmin is generated by one-chain TPA at a turn-over rate of 0.5·10-3 s-1. When thrombin (1 NIH- unit/ml) is added to the solution the turn-over rate is within minutes raised to 40·10-3 s-1. If bothroxobin (0.2 BU/ml) is added the turn-over rate is raised to 200·10-3 s-1. The stimulation noted is 80 and 400 fold for fibrin II and fibrin I respectively.

Thus fibrin I seems to be at least as efficient as fibrin II in stimulating the activation of plasminogen. This may be of great physiological importance for removal of soluble fibrin consisting of fibrin I complexes. Nossel et al. have demonstrated that fibrin I may be elevated in prethrombotic states (e.g. in patients after surgery) and have suggested that plasmin digestion of fibrin I may be of importance for the prevention of thrombosis.