Can collagenase effectiveness in Dupuytren's contracture be improved by using ultrasound-guided Injection? A comparative study.

The objective of this study was to compare the effectiveness of ultrasound-guided injection of collagenase Clostridium histolyticum (CCH) in patients with Dupuytren's contracture (DC), with the standard injection. We hypothesised that the ultrasound-guided Injection of CCH is more effective than the standard injection. A prospective cohorts study in patients with DC was done. We treated consecutively 47 fingers with the standard injection and 43 with the ultrasound-guided. Patients in both groups had the same inclusion criteria. The degrees of contracture of the metacarpophalangeal (MCP) and proximal interphalangeal (PIP) joints were measured before treatment and after three months. We compared the effectiveness of each type of injection in respect to obtaining a complete finger extension and to the percentage of improvement in each finger and in each joint. With ultrasound-guided injection, complete finger extension was obtained in 54% of cases and an 81% mean percentage of correction of the finger contracture; with standard injection 49% and 77%, respectively. In the MCP joint, the mean percentage of correction was 92.5 % in the ultrasound-guided Injection group and 84% in the standard injection group. In the PIP joint, it was 75.1% in the ultrasound-guided injection group and 65.3% in the standard injection group. These results showed no statistical significance. Hand surgeons must balance the possible benefits of the ultrasound-guided injection with the complexity and resources needed to perform the technique.

Incidencia de la enfermedad de Lyme en España / Incidence of Lyme disease in Spain

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[Mediterranean Spotted Fever: epidemiological Assessment in Spain during the Period 2009-2012]. / Fiebre botonosa mediterránea: epidemiología en España durante el periodo 2009-2012.

BACKGROUND: The Mediterranean Spotted Fever (MSF) is a zoonosis, produced by Rickettsia conorii whose vector is Rhipicephallus sanguineus. The aim of this study was to describe the epidemiology in Spain and its Autonomous Communities (AA.CC) and the average cost during the period 2009-2012. METHODS: We conducted a retrospective observational study of patients, between 2009-2012, whose diagnostic at hospital discharge was encoded, according to the International Classification of Diseases 9th revision Clinical Modification (ICD-9CM) as 82.1 (MSF). The information was collected through the minimum basic data set. Incidence rates of the disease were calculated in Spain and its Autonomous Communities. The fStats software was used for comparison of rates based on age, sex, annual, seasonal and AA.CC's distribution. The average cost (in euros) was calculated according to the state standard. RESULTS: The incidence rate was 0,36 cases per 100,000 inhabitants and year during 2009-2012, with 667 admissions. The highest incidence was obtained in Ceuta and La Rioja with an incidence of 1,9 and 1,87 cases per 100,000 inhabitants per year. No cases were detected in Cantabria nor Canarias. The relative risk male female was 2:1 (p value<0,05). The predominant age group was over 55 years (327 cases). The months with the most cases were from June to September (466 cases), producing a peak in the number of cases in August (137 cases). The mortality rate was 0,3%. The average cost was 4.647,205 €. CONCLUSION: The incidence of MSF was low, with a heterogeneous geographical distribution and with higher frequency during the month of August. Patients of all ages were detected, predominantly for males over 55 years old. The hospital mortality rate was small.

[Incidence of Bartonella Henselae Infection during the period 2009-2012 in the Valencian Community, Spain]. / Incidencia de la infección por Bartonella henselae en la Comunidad Valenciana durante el período 2009-2012.

BACKGROUND: Bartonella henselae is the causative agent of the disease caused by cat scratches and it has a worldwide distribution. The objective of the study was to investigate its incidence in the Valencian Community during the period 2009-2012. METHODS: A study of the chosen microbiological tests for B. henselae during four years was carried out. Pacients with serology (IgM and IgG), culture, or PCR positive were considered case studies. Data from the Red de Vigilancia Microbiológica Valenciana (RedMIVA) depending on the "General Direction of Public Health" (Dirección General de Salud Pública) was used as the source of information. RESULTS: During the studied period, 14 cases were detected. The incidence rates were: 0,07 per 10(5) inhabitants and year of the Valencian Community, 0,10 per 10(5) inhabitants/year in the province of Alicante, with marked differences in relation to Valencia of 0,06 per 105 inhabitants/year and Castellon (with no cases). The temporal distribution of the cases were: 4 in 2009, 4 in 2010, 3 in 2011, and 3 in 2012. 64% of the cases were women and 36% men. The median age was 21 years (range 1-65 years). Predominant age groups arose between 1-10 years (42%) and 31-40 years (28%). CONCLUSIONS: The incidence of B. henselae in the Valencian Community is low. The data obtained suggest that its distribution varies depending on the geographical area in the Community. There is a predominance of young people.

Fiebre botonosa mediterránea: epidemiología en España durante el periodo 2009-2012 / Mediterranean Spotted Fever: Epidemiological Assessment in Spain during the Period 2009-2012

Fundamento: La Fiebre Botonosa Mediterránea (FBM) es una zoonosis producida por Rickettsia conorii cuyo vector es Rhipicephallus sanguineus. El objetivo de este trabajo fue describir la epidemiología y el coste medio de la fiebre botonosa en España y sus comunidades autónomas durante el período 2009-2012). Métodos: Se realizó un estudio observacional del período 2009-2012 utilizando como fuente de información el Conjunto Mínimo de Datos (CMBD), identificando las altas hospitalaria cuyo diagnóstico, de acuerdo a la Clasificación Internacional de Enfermedades 9ª revisión Modificación Clínica (CIE-9MC) fue 82.1 (fiebre botonosa mediterránea). Se calcularon las tasas de incidencia de dicha enfermedad en España y cada una de las comunidades autónomas. El coste medio (en euros) se calculó de acuerdo a la norma estatal para grupos diagnósticos relacionados. Se utilizó el software fStats para la comparación de tasas según la edad, sexo, distribución anual, estacional y por CCAA. Resultados: Durante el período de estudio se identificaron 667 ingresos con diagnóstico al alta de fiebre botonosa mediterránea, siendo la tasa de incidencia fue de 0,36 casos por 100.000 habitantes. La mayor incidencia se dio en Ceuta y La Rioja con una incidencia de 1,9 y 1,87 casos por 100.000 habitantes y año. No se detectaron casos en Cantabria ni en Canarias. El riesgo relativo hombre/mujer fue 2:1 (valor de p<0,05). El grupo etario predominante fue el de los mayores de 55 años (327 casos). Los meses con más casos fueron de junio-septiembre (466 casos), produciéndose un pico de casos en agosto (137 casos). La tasa de mortalidad fue 0,3%. El coste medio fue de 4.647,205€. Conclusión: La incidencia de la fiebre botonosa mediterránea durante el período estudiado fue menor que en períodos anteriores, con una distribución por comunidades autónomas heterogénea y con mayor frecuencia durante el mes de agosto. Se detectaron pacientes de todas las edades, predominando los varones mayores de 55 años. La tasa de mortalidad intrahospitalaria fue pequeña (AU)

Background: The Mediterranean Spotted Fever (MSF) is a zoonosis, produced by Rickettsia conorii whose vector is Rhipicephallus sanguineus. The aim of this study was to describe the epidemiology in Spain and its Autonomous Communities (AA.CC) and the average cost during the period 2009-2012. Methods: We conducted a retrospective observational study of patients, between 2009-2012, whose diagnostic at hospital discharge was encoded, according to the International Classification of Diseases 9th revision Clinical Modification (ICD-9CM) as 82.1 (MSF). The information was collected through the minimum basic data set. Incidence rates of the disease were calculated in Spain and its Autonomous Communities. The fStats software was used for comparison of rates based on age, sex, annual, seasonal and AA.CC´s distribution. The average cost (in euros) was calculated according to the state standard. Results: The incidence rate was 0,36 cases per 100,000 inhabitants and year during 2009-2012, with 667 admissions. The highest incidence was obtained in Ceuta and La Rioja with an incidence of 1,9 and 1,87 cases per 100,000 inhabitants per year. No cases were detected in Cantabria nor Canarias. The relative risk male female was 2:1 (p value<0,05). The predominant age group was over 55 years (327 cases). The months with the most cases were from June to September (466 cases), producing a peak in the number of cases in August (137 cases). The mortality rate was 0,3%. The average cost was 4.647,205€. Conclusion: The incidence of MSF was low, with a heterogeneous geographical distribution and with higher frequency during the month of August. Patients of all ages were detected, predominantly for males over 55 years old. The hospital mortality rate was small (AU)

Incidencia de la infección por bartonella henselae en la comunidad valenciana durante el período 2009-2012 / Incidence of Bartonella Henselae Infection during the period 2009-2012 in the Valencian Community, Spain

Fundamentos: Bartonella henselae es el agente causal de la enfermedad por arañazo de gato y su distribución es mundial. El objetivo del trabajo fue conocer la incidencia de esta infección en la Comunidad Valenciana durante el periodo 2009-2012. Métodos: Se realizó el estudio sobre las pruebas microbiológicas solicitadas para B. henselae durante cuatro años. Se consideró 'caso' al paciente con serología (IgM e IgG), cultivo o PCR positivos. Como fuente de información se utilizaron los datos procedentes de la Red de Vigilancia Microbiológica Valenciana (RedMIVA) dependiente de la Dirección General de Salud Pública. Resultados: Durante el periodo estudiado se detectaron 14 casos. Las tasas de incidencia fueron: 0,07 por 105 habitantes y año en la Comunidad Valenciana, 0,10 por 105 habitantes/año en la provincia de Alicante, 0,06 por 105 habitantes/año en Valencia y ningún caso en la provincia de Castellón. La distribución temporal de los casos fue: 4 en 2009, 4 en 2010, 3 en 2011 y 3 en 2012. El 64% fueron mujeres y el 36% hombres. La mediana de edad fue de 21 años (rango de 1-65 años). Los grupos etarios predominantes se presentaron entre 1-10 años (42%) y 31-40 años (28%). Conclusiones: La incidencia de infección por B. henselae en la Comunidad Valencia es baja. Los datos obtenidos sugieren que varía su distribución según el área geográfica dentro de la Comunidad. Se observa un predominio de casos entre la población infantil (AU)

Background: Bartonella henselae is the causative agent of the disease caused by cat scratches and it has a worldwide distribution. The objective of the study was to investigate its incidence in the Valencian Community during the period 2009-2012. Methods: A study of the chosen microbiological tests for B. henselae during four years was carried out. Pacients with serology (IgM and IgG), culture, or PCR positive were considered case studies. Data from the Red de Vigilancia Microbiológica Valenciana (RedMIVA) depending on the 'General Direction of Public Health' (Dirección General de Salud Pública) was used as the source of information. Results: During the studied period, 14 cases were detected. The incidence rates were: 0,07 per 105 inhabitants and year of the Valencian Community, 0,10 per 105 inhabitants/year in the province of Alicante, with marked differences in relation to Valencia of 0,06 per 105 inhabitants/year and Castellon (with no cases). The temporal distribution of the cases were: 4 in 2009, 4 in 2010, 3 in 2011, and 3 in 2012. 64% of the cases were women and 36% men. The median age was 21 years (range 1-65 years). Predominant age groups arose between 1-10 years (42%) and 31-40 years (28%). Conclusions: The incidence of B. henselae in the Valencian Community is low. The data obtained suggest that its distribution varies depending on the geographical area in the Community. There is a predominance of young people (AU)

[Computed tomography-guided radiofrequency ablation of malignant lung lesions: early experience]. / Ablación mediante radiofrecuencia guiada por tomografía computarizada de las lesiones pulmonares malignas: experiencia inicial.

OBJECTIVE: To present our early experience in the treatment of primary malignant and metastatic lung lesions by radiofrequency ablation. PATIENTS AND METHODS: From August 2004 through January 2007 we treated 19 patients (in 26 procedures) with curative or palliative intent. None of the lesions was amenable to surgery and some had been treated previously. The procedure was performed in the radiology room under conscious sedation-analgesia administered by an anesthesiologist. Fourteen patients were treated for pulmonary lesions and 5 for metastatic lung disease in a context of controlled primary disease. Treatment was with curative intent in 15 cases and palliative in 4. RESULTS: The radiofrequency technique was applicable in 26 procedures and the mean follow-up was 8.68 months. The principal complications of radiofrequency treatment were pneumothorax in 4 patients, requiring drainage in only 2 cases; pneumonitis in 4; self-limiting pulmonary hemorrhage in 1; and pleural effusion in 5. There were no procedure-related deaths. Six patients died during the follow-up period. CONCLUSIONS: In our experience, radiofrequency offers a safe and minimally invasive option for the treatment of malignant lung lesions in appropriately selected, nonsurgical patients. Morbidity is low, and in combination with other treatments this technique opens up a wide range of possibilities still to be explored.

Ablación mediante radiofrecuencia guiada por tomografía computarizada de las lesiones pulmonares malignas: experiencia inicial / Computed Tomography-Guided Radiofrequency Ablation of Malignant Lung Lesions: Early Experience

OBJETIVO: Presentar la experiencia inicial en el tratamiento de las lesiones pulmonares malignas (primarias y metastásicas) mediante la ablación por radiofrecuencia (RF). PACIENTES Y MÉTODOS: De agosto de 2004 a enero de 2007 tratamos a 19 pacientes (mediante 26 procedimientos) con intención curativa o paliativa. Todos los casos correspondían a lesiones no quirúrgicas, tratadas o no previamente. La técnica se practicó en la sala de radiología, con sedoanalgesia consciente llevada a cabo por el anestesiólogo. Se trató a 14 pacientes con lesión pulmonar y a 5 con enfermedad metastásica pulmonar, con la enfermedad primaria controlada. En 15 casos el tratamiento se realizó con intención curativa y en 4 era paliativo. RESULTADOS: La técnica de RF pudo realizarse en los 26 procedimientos. La media de seguimiento fue de 8,68 meses. Las principales complicaciones derivadas del tratamiento de RF fueron: neumotórax en 4 pacientes, de los que sólo 2 requirieron drenaje; neumonitis en 4; hemorragia pulmonar autolimitada en 1, y derrame pleural en 5. No hubo mortalidad en relación con el procedimiento. Durante el período de seguimiento fallecieron 6 pacientes. CONCLUSIONES: Según nuestra experiencia, la RF puede ser una opción segura y mínimamente invasiva para el tratamiento de las lesiones pulmonares malignas en pacientes no quirúrgicos adecuadamente seleccionados, con una baja morbilidad. La combinación con otros tratamientos ofrece un amplio abanico de posibilidades pendientes de discernir

OBJECTIVE: To present our early experience in the treatment of primary malignant and metastatic lung lesions by radiofrequency ablation. PATIENTS AND METHODS: From August 2004 through January 2007 we treated 19 patients (in 26 procedures) with curative or palliative intent. None of the lesions was amenable to surgery and some had been treated previously. The procedure was performed in the radiology room under conscious sedation-analgesia administered by an anesthesiologist. Fourteen patients were treated for pulmonary lesions and 5 for metastatic lung disease in a context of controlled primary disease. Treatment was with curative intent in 15 cases and palliative in 4. RESULTS: The radiofrequency technique was applicable in 26 procedures and the mean follow-up was 8.68 months. The principal complications of radiofrequency treatment were pneumothorax in 4 patients, requiring drainage in only 2 cases; pneumonitis in 4; self-limiting pulmonary hemorrhage in 1; and pleural effusion in 5. There were no procedure-related deaths. Six patients died during the follow-up period. CONCLUSIONS: In our experience, radiofrequency offers a safe and minimally invasive option for the treatment of malignant lung lesions in appropriately selected, nonsurgical patients. Morbidity is low, and in combination with other treatments this technique opens up a wide range of possibilities still to be explored

[Thoracic sympathectomy in primary hyperhidrosis: patient satisfaction]. / Simpatectomía torácica en la hiperhidrosis primaria: grado de satisfacción de los pacientes.

OBJECTIVE: To evaluate satisfaction among patients who underwent thoracic sympathectomy for primary hyperhidrosis and the possible complications after a minimum of 14 months after surgery. MATERIAL AND METHODS: We performed a retrospective study in 108 patients who underwent thoracic sympathectomy and who responded to all the questions asked in a telephone interview. The sample was composed of 21 men and 87 women, with a mean age of 29.73 years. In all patients, surgery was performed with general anesthesia in a single intervention. Special emphasis was placed on the degree of satisfaction (whether patients would recommend this type of surgery) and the possible negative effects or complications experienced by patients or attributed by them to the procedure. RESULTS: Patients were contacted a minimum of 14 months after the intervention. The most frequent complication was compensatory sweating (81.5%). Pain at the site of trocar insertion was reported by 6.5%. There were few immediate and long-term complications. The degree of satisfaction reached 90.7%. CONCLUSION: Video-assisted thoracic sympathectomy is safe and effective. Despite compensatory sweating, overall satisfaction was very high. However, satisfaction gradually decreased in the months after the intervention. Patients with hyperhidrosis with significant or principal axillary involvement could benefit from botulinic toxin administration as the first-line therapy.

Simpatectomía torácica en la hiperhidrosis primaria: grado de satisfacción de los pacientes / Thoracic sympathectomy in primary hyperhidrosis: patient satisfaction

Objetivo. Evaluar el grado de satisfacción de los pacientes a los que se practicó simpatectomía torácica por hiperhidrosis primaria y las posibles complicaciones, transcurridos un mínimo de 14 meses desde el acto quirúrgico. Material y métodos. Estudio retrospectivo sobre 108 pacientes tratados mediante simpatectomía torácica que respondieron a la totalidad de las preguntas realizadas mediante entrevista telefónica. La muestra está compuesta por 21 varones y 87 mujeres, con una edad media de 29,73 años. A todos se les intervino bajo anestesia general, en un solo acto quirúrgico. Se realizó especial hincapié en el grado de satisfacción (aconsejarían o no esta cirugía) y los posibles efectos negativos o complicaciones que los pacientes han sufrido o que ellos atribuyen al procedimiento. Resultados. Pasados un mínimo de 14 meses desde la cirugía se contactó con los pacientes. El sudor compensatorio (81,5%) es la complicación más frecuente. El 6,5% de los pacientes refirieron dolor en las zonas de inserción de los trocares. Las complicaciones inmediatas o a largo plazo fueron escasas. El grado de satisfacción alcanzó el 90,7%. Conclusión. La simpatectomía torácica por vídeo cirugía es un método seguro y efectivo. A pesar de la sudación compensatoria la satisfacción global es muy alta, aunque sufre un descenso paulatino según nos alejamos del momento de la cirugía. Las hiperhidrosis con importante o principal componente axilar podrían beneficiarse de la administración de toxina botulínica, como primera opción terapéutica (AU)

Objective. To evaluate satisfaction among patients who underwent thoracic sympathectomy for primary hyperhidrosis and the possible complications after a minimum of 14 months after surgery. Material and methods. We performed a retrospective study in 108 patients who underwent thoracic sympathectomy and who responded to all the questions asked in a telephone interview. The sample was composed of 21 men and 87 women, with a mean age of 29.73 years. In all patients, surgery was performed with general anesthesia in a single intervention. Special emphasis was placed on the degree of satisfaction (whether patients would recommend this type of surgery) and the possible negative effects or complications experienced by patients or attributed by them to the procedure. Results. Patients were contacted a minimum of 14 months after the intervention. The most frequent complication was compensatory sweating (81.5%). Pain at the site of trocar insertion was reported by 6.5%. There were few immediate and long-term complications. The degree of satisfaction reached 90.7%. Conclusion. Video-assisted thoracic sympathectomy is safe and effective. Despite compensatory sweating, overall satisfaction was very high. However, satisfaction gradually decreased in the months after the intervention. Patients with hyperhidrosis with significant or principal axillary involvement could benefit from botulinic toxin administration as the first-line therapy (AU)