The Endoscopic Reference Score shows modest accuracy to predict either clinical or histological activity in adult patients with eosinophilic oesophagitis.

BACKGROUND: Conflicting results have been recently reported for the accuracy of the Endoscopic Reference Score (EREFS), an standardised endoscopic classification, to predict the histological activity of eosinophilic oesophagitis (EoE). AIM: To evaluate the accuracy of the EREFS to predict either histological or clinical activity of EoE. METHODS: Prospective multicentre study conducted in eight Spanish centres evaluating adult EoE patients, either naïve or after treatment. Symptoms were evaluated before upper endoscopy through the Dysphagia Symptom Score, whereas researchers scored the EREFS immediately after the endoscopic procedure, unaware of the histological outcome. RESULTS: One hundred and forty-five EoE patients undergoing 240 consecutive endoscopic procedures were included. Exudates (P = 0.03), furrows (P = 0.03) and a composite score of inflammatory signs (exudates, furrows and oedema) (P < 0.001) accurately predicted histological activity. Exudates were the only endoscopic sign showing a good correlation with histological outcome after therapy. Furrows and oedema persisted in 50% and 70% of patients despite histological remission. No endoscopic feature exceeded 70% accuracy to predict histological activity. Likewise, no endoscopic finding could adequately predict dysphagia severity. Crepe paper mucosa, diffuse exudates and severe rings correlated with higher symptom scores. CONCLUSIONS: Endoscopic findings assessed by the Endoscopic Reference Score did not correlate with histological or clinical disease activity in adult EoE patients. Only exudates correlated with peak eosinophil count and histological outcome, whereas furrows and oedema persisted in over half of patients despite histological remission.

[Cecal tuberculosis: the importance of a high diagnostic suspicion]. / Tuberculosis cecal: la importancia de una alta sospecha diagnóstica.

Intestinal tuberculosis is less common than pulmonary tuberculosis. Its clinical and endoscopic features are nonspe-cific, so diagnostic suspicion must be high in order to make an early diagnosis and prevent iatrogenia. Pharmacotherapy is often effective, with an excellent clinical and endoscopic evolution. Surgical treatment is reserved for complications. We present the case of cecal tuberculosis diagnosed endoscopically; this is the second case diagnosed in a few months in our center. In this case there were no risk factors, such as recent travel, risk of contacts or inmunosupression.

[Lymphoplasmacytic inflammatory pseudotumor of the liver]. / Pseudotumor inflamatorio hepático linfoplasmocítico.

We present the case of a middle-aged woman with antecedents of cholecystectomy and several episodes of resi-dual coledocolitiasis resolved endoscopically. She attended Emergency Services due to a new clinical picture of abdo-minal pain and alteration of hepatic enzymes. Image tests showed lesions that suggested hepatic abscesses without ruling out a malign origin. Given this doubt it was decided to carry out a thick needle biopsy obtaining a diagnosis of an inflammatory pseudotumour of the liver related to IgG4-related disease. This is an infrequent entity but must be taken into consideration because - unlike malign pathology, which is the main differential diagnosis - its behaviour is benign, with a good evolution with medical treatment. That is why a suitable diagnosis is vital to avoid aggressive, diagnostic-therapeutic procedures.

Tuberculosis cecal: la importancia de una alta sospecha diagnóstica / Cecal tuberculosis: the importance of a high diagnostic suspicion

La tuberculosis intestinal es mucho menos frecuente que la pulmonar. Además, tanto su presentación como el aspecto endoscópico son muy variados, de modo que la sospecha diagnóstica debe ser elevada para un diagnóstico precoz y para evitar la posible yatrogenia. Con el tratamiento antituberculoso convencional la evolución, tanto clínica como endoscópica, suele ser excelente, quedando la cirugía relegada como tratamiento para las complicaciones. Presentamos un caso de tuberculosis cecal diagnosticada endoscópicamente, la segunda diagnosticada en unos meses en nuestro centro. En este caso no había factores de riesgo como viajes recientes, contactos con infectados ni toma de fármacos inmunosupresores (AU)

Intestinal tuberculosis is less common than pulmonary tuberculosis. Its clinical and endoscopic features are nonspecific, so diagnostic suspicion must be high in order to make an early diagnosis and prevent iatrogenia. Pharmacotherapy is often effective, with an excellent clinical and endoscopic evolution. Surgical treatment is reserved for complications. We present the case of cecal tuberculosis diagnosed endoscopically; this is the second case diagnosed in a few months in our center. In this case there were no risk factors, such as recent travel, risk of contacts or inmunosupression (AU)

Pseudotumor inflamatorio hepático linfoplasmocítico / Lymphoplasmacytic inflammatory pseudotumor of the liver

Presentamos el caso de una mujer de mediana edad con antecedentes de colecistectomía y varios episodios de coledocolitiasis residual resueltos endoscópicamente. Acude al servicio de Urgencias por un nuevo cuadro de dolor abdominal y alteración de enzimas hepáticas, apreciándose en las pruebas de imagen lesiones sugestivas de abscesos hepáticos sin poder descartarse un origen maligno. Dada esta duda se decide realizar una biopsia con aguja gruesa llegando al diagnóstico de pseudotumor inflamatorio hepático relacionada con la enfermedad por IgG4. Ésta es una entidad infrecuente pero que debe ser tenida en cuenta debido a que, a diferencia de la patología maligna, que es el principal diagnóstico diferencial, su comportamiento es benigno, con buena evolución con tratamiento médico. Por ello es vital un adecuado diagnóstico para evitar procedimientos diagnóstico-terapéuticos agresivos (AU)

We present the case of a middle-aged woman with antecedents of cholecystectomy and several episodes of residual coledocolitiasis resolved endoscopically. She attended Emergency Services due to a new clinical picture of abdominal pain and alteration of hepatic enzymes. Image tests showed lesions that suggested hepatic abscesses without ruling out a malign origin. Given this doubt it was decided to carry out a thick needle biopsy obtaining a diagnosis of an inflammatory pseudotumour of the liver related to IgG4-related disease. This is an infrequent entity but must be taken into consideration because - unlike malign pathology, which is the main differential diagnosis - its behaviour is benign, with a good evolution with medical treatment. That is why a suitable diagnosis is vital to avoid aggressive, diagnostic-therapeutic procedures (AU)

[Autoimmune pancreatitis: a case report]. / Pancreatitis autoinmune: a propósito de un caso.

Autoimmune pancreatitis (AIP) is an infrequent pathology, although there is a growing incidence in Eastern countries, which might be due to a greater rate of detection. It can be associated with other auto immune pathologies and its association with IgG4-related systemic disease has been described.Its clinical presentation is varied and the normal treatment is medical, using corticoids.A diagnosed clinical case is described.

Pancreatitis autoinmune: a propósito de un caso / Autoimmune pancreatitis: a case report

La pancreatitis autoinmune (PAI) es una patología poco frecuente, aunque con una creciente incidencia en países orientales, si bien esto podría deberse a una mayor tasa de detección. Puede asociarse a otras patologías autoinmunes, y se ha descrito su asociación con la enfermedad sistémica por IgG4. La clínica es variada y el tratamiento habitualmente es médico, mediante corticoides. Se describe un caso clínico diagnosticado (AU)

Autoimmune pancreatitis (AIP) is an infrequent pathology, although there is a growing incidence in Eastern countries, which might be due to a greater rate of detection. It can be associated with other autoimmune pathologies and its association with IgG4-related systemic disease has been described. Its clinical presentation is varied and the normal treatment is medical, using corticoids. A diagnosed clinical case is described (AU)

Intoxicación aguda por anestésicos locales / Acute toxicity due to local anesthetics

No disponible

Trace metals in oysters, Crassotrea sps., from UNESCO protected natural reserve of Urdaibai: space-time observations and source identification.

The seasonal and spatial variability of trace metal concentrations of oyster tissues (Crassostea sps.) was studied. The samples were collected between 2002 and 2004 along the Urdaibai estuary (Murueta, Kanala and Arteaga). The seasonal influence on some metal concentrations (higher values in spring-summer season than in autumn-winter season) is more pronounced than the local site-specific influence. Furthermore, within each location a significant time-specific dependence on the trace metal concentration variations can be detected. Substantially higher concentrations of Zn (445.5-2,403.3 mg kg(-1)) and Mn (29.4-169.6 mg kg(-1)) were recorded in oysters inhabiting estuarine locations, possibly indicating a markedly higher natural bioavailability at these locations. Principal component analysis demonstrated that oysters could be separated depending on the inhabiting areas: Sn for Murueta, essential metals for Kanala, and Co and Cd for Arteaga sampling points, respectively.

Distribution and bioaccumulation of PAHs in the UNESCO protected natural reserve of Urdaibai, Bay of Biscay.

Along 10 campaigns, from June 2002 to September 2004, the concentrations of 16 polycyclic aromatic hydrocarbons (PAHs) were measured in sediments and oysters (Crassostrea sp.) taken from four sites in the Unesco protected natural reserve of Urdaibai (Basque Country, Bay of Biscay). Total PAH concentration ranged from 0.7 to 140 microg kg(-1) (dw) in the case of sediments, and from 300 to 1400 microg kg(-1) (dw) in the case of oysters. During this study, the coast of the Bay of Biscay was severely affected by the Prestige oil spill (November 2002). Presumably, as a consequence of this accident, both spatial and temporal variations of the PAHs, as well as the sources of the PAHs were affected by the oil spill, and this effect was observed in the total concentrations and, especially, in several diagnostic ratios and in multivariate data analysis. Finally, both BAF (bioaccumulation factor) and BSAF (biota-sediment accumulation factor) parameters were calculated to conclude that particulate matter seems to be the most favourable uptake pathway of PAHs in oysters from this estuary.

Comparison of solid phase extraction, saponification and gel permeation chromatography for the clean-up of microwave-assisted biological extracts in the analysis of polycyclic aromatic hydrocarbons.

The feasibility of different clean-up procedures was studied for the determination of polycyclic aromatic hydrocarbons (PAHs) in biota samples such as oysters, mussels and fish liver. In this sense, once the samples were extracted--essentially with acetone and in a microwave system--and before they could be analysed by gas chromatography-mass spectrometry (GC-MS), three different approaches were studied for the clean-up step: solid phase extraction (SPE), microwave-assisted saponification (MAS) and gel permeation chromatography (GPC). The main aim of this work was to maximise the recoveries of PAHs and to minimise the presence of interfering compounds in the last extract. In the case of SPE, Florisil cartridges of 1, 2 and 5 g, and silica cartridges of 5 g were studied. In that case, and with oysters and mussels, microwave-assisted extraction and 5 g Florisil cartridges provided good results. In addition, the concentrations obtained for Standard Reference Material (SRM) NIST 2977 (mussel tissue) were in good agreement with the certified values. In the case of microwave-assisted saponification, the extracts were not as clean as those obtained with 5 g Florisil and this fact lead to overestimate the concentration of the heaviest PAHs. Finally, the cleanest extracts were obtained by GPC. The method was successfully applied to mussels, oysters and hake liver, and the results obtained for NIST 2977 (mussel tissue) were within the confidence interval of the certified reference material for most of the certified analytes.

Simultaneous microwave-assisted extraction of polycyclic aromatic hydrocarbons, polychlorinated biphenyls, phthalate esters and nonylphenols in sediments.

A new method was developed for the simultaneous extraction of polycyclic aromatic hydrocarbons (PAHs), polychlorinated biphenyls (PCBs), phthalate esters (PEs), nonylphenols (NPs) and nonylphenol mono- and diethoxylates (NP1EOs and NP2EOs, respectively) in sediment samples by means of a closed microwave system. The extractions were carried out at 21 psi and 80% of microwave power and 15 ml of acetone were used as the common extraction solvent. The filtered extract was further fractionated in two groups using Florisil cartridges: PAHs and PCBs were eluted with n-hexane:toluene (4:1) and the PEs, NPs and ethoxylates were eluted with ethyl acetate. All the compounds were analysed by gas chromatography-mass spectrometry (GC-MS). In case of PAHs and PCBs, the developed method was validated by comparison of the results obtained for the certified reference material NIST 1944 with the certified values. In the absence of a reference material for phthalate esters and nonylphenols, one sediment sample was extracted twice under the optimal conditions in order to check than an exhaustive extraction of the analytes occurred. This method is currently used in the study of the distribution of those organic contaminants in the estuaries of the Bay of Biscay (Spain).

MultiSimplex optimisation of the solid-phase microextraction-gas chromatographic-mass spectrometric determination of polycyclic aromatic hydrocarbons, polychlorinated biphenyls and phthalates from water samples.

Solid-phase microextraction coupled to GC-MS was optimised for the determination of polycyclic aromatic hydrocarbons (PAHs), phthalate esters and polychlorinated biphenyls (PCBs) in water samples. A 30-microm polydimethylsiloxane fiber was immersed in a 30-ml water sample that contained the analytes of interest (PAHs, PCBs and phthalate esters) and the variables studied were extraction time (15-60 min), extraction temperature (30-90 degrees C), desorption time (1-5 min), desorption temperature (220-270 degrees C) and the addition of sodium chloride (0-9 g). The MultiSimplex programme based on the simplex algorithm was used to establish the optimal conditions. MultiSimplex allowed the simultaneous study of the variables mentioned above and considered the answers of all types of compounds studied in this work. Thus, the optimal conditions obtained allowed the simultaneous determination of PAHs, phthalate esters and PCBs. Furthermore, the accuracy and repeatability of the developed method were calculated from water samples spiked at known concentrations of the analytes. Finally, the optimised method was used to analyse water samples from different sampling points of the Urdaibai and Nerbioi-Ibaizabal estuaries (Biscay, Spain).

Automation of a procedure to find the polynomial which best fits (kappa, c1, c2, T) data of electrolyte solutions by non-linear regression analysis using MATHEMATICA software.

A MATHEMATICA package, 'CONDU.M', has been developed to find the polynomial in concentration and temperature which best fits conductimetric data of the type (kappa, c, T) or (kappa, c1, c2, T) of electrolyte solutions (kappa: specific conductivity; ci: concentration of component i; T: temperature). In addition, an interface, 'TKONDU', has been written in the TCL/Tk language to facilitate the use of CONDU.M by an operator not familiarised with MATHEMATICA. All this software is available on line (UPV/EHU, 2001). 'CONDU.M' has been programmed to: (i) select the optimum grade in c1 and/or c2; (ii) compare models with linear or quadratic terms in temperature; (iii) calculate the set of adjustable parameters which best fits data; (iv) simplify the model by elimination of 'a priori' included adjustable parameters which after the regression analysis result in low statistical significance; (v) facilitate the location of outlier data by graphical analysis of the residuals; and (vi) provide quantitative statistical information on the quality of the fit, allowing a critical comparison among different models. Due to the multiple options offered the software allows testing different conductivity models in a short time, even if a large set of conductivity data is being considered simultaneously. Then, the user can choose the best model making use of the graphical and statistical information provided in the output file. Although the program has been initially designed to treat conductimetric data, it can be also applied for processing data with similar structure, e.g. (P, c, T) or (P, c1, c2, T), being P any appropriate transport, physical or thermodynamic property.

[Alterations in neuro-development in the 1st year of life in newborn infants weighing 2000 grams or less at birth]. / Alteraciones del neurodesarrollo en el primer año de vida en neonatos que pesaron 2.000 gramos o menos al nacer.

The infants with low weight at birth have great chance of exhibiting early death or neurodevelopmental sequelae. We prospectively evaluated the neurological and psychological development during the first year of life in 118 infants who weighted less than 2,000 g at birth. All patients were examined with the Amiel Tison and Grenier test (neurologic evaluation), Gesell test (psychological) and Brunette-Lezine test (Psychomotor scale). Mean gestational age was 33 weeks (SD = 3.1) and birth mean weight was 1495 g (SD = 291). Seventy per cent were delivered by cesarean section. Neurological abnormalities were found in 20 infants (alteration of muscular tone in all and motor deficit in 50%). Twenty five per cent had abnormal Gesell test and 17% psychomotor retardation (13% mild and 4% severe).

[Congenital cyst of the common bile duct. Surgical treatment with total excision of the cyst]. / Quiste congénito del colédoco. Tratamiento quirúrgico con excisión total del quiste.

Congenital choledochal cyst (CChC) has a very low frequency in our population; it is more frequent among females and its pattern of inheritance is multifactorial. The frequency of CChC in our population was 1 per 20,000 to 1 per 30,000 hospitalized patients in the pediatrics department of the Hospital Juarez and Hospital Infantil de Tacubaya, respectively. Four new cases of CChC are reported, two school children and two teenagers. Pre-operative diagnosis was accomplished clinically, which is the most precise non-invasive method. The most effective actual diagnostic methods include ultrasonography, CAT scan, and basic laboratory data, which can corroborate the clinical diagnosis of CChC with 100% certainty. The surgical treatment of CChC is controversial, but the surgical procedures of choice are choledochocystojejunostomy with total cyst removal, Roux's Y, and cholecystectomy. One case was treated with latero-terminal choledochocystojejunostomy and 3 cases with total removal of the cyst. The results were excellent.