Comorbidity and prognostic factors on admission in a COVID-19 cohort of a general hospital.

ANTECEDENTS AND OBJECTIVE: To describe clinical features, comorbidity, and prognostic factors associated with in-hospital mortality in a cohort of COVID-19 admitted to a general hospital. MATERIAL AND METHODS: Retrospective cohort study of patients with COVID-19 admitted from 26th February 2020, who had been discharged or died up to 29th April 2020. A descriptive study and an analysis of factors associated with intrahospital mortality were performed. RESULTS: Out of the 101 patients, 96 were analysed. Of these, 79 (82%) recovered and were discharged, and 17 (18%) died in the hospital. Diagnosis of COVID-19 was confirmed by polymerase chain reaction to SARS-CoV2 in 92 (92.5%). The mean age was 63 years, and 66% were male. The most frequent comorbidities were hypertension (40%), diabetes mellitus (16%) y cardiopathy (14%). Patients who died were older (mean 77 vs 60 years), had higher prevalence of hypertension (71% vs 33%), and cardiopathy (47% vs 6%), and higher levels of lactate dehydrogenase (LDH) and reactive C protein (mean 662 vs 335 UI/L, and 193 vs 121mg/L respectively) on admission. In a multivariant analysis the variables significantly associated to mortality were the presence of cardiopathy (CI 95% OR 2,58-67,07), levels of LDH≥345 IU/L (CI 95% OR 1,52-46,00), and age≥65 years (CI 95% OR 1,23-44,62). CONCLUSIONS: The presence of cardiopathy, levels of LDH≥345 IU/L and age≥65 years, are associated with a higher risk of death during hospital stay for COVID-19. This model should be validated in prospective cohorts.

Comorbilidad y factores pronósticos al ingreso en una cohorte COVID-19 de un hospital general / Comorbidity and prognostic factors on admission in a COVID-19 cohort of a general hospital

Antecedentes y objetivo Describir el perfil clínico, la comorbilidad y los factores pronósticos de mortalidad intrahospitalaria en una cohorte COVID-19 de un hospital general. Material y métodos Estudio de cohortes retrospectivo de pacientes con COVID-19 ingresados desde el 26 de febrero, y dados de alta o fallecidos hasta el 29 de abril de 2020; estudio descriptivo y análisis de factores asociados a la mortalidad intrahospitalaria. Resultados De los pacientes ingresados (N=101), se analizaron 96: 79 (82%) dados de alta por curación y 17 (18%) fallecidos. En 92 casos (92,5%) se confirmó COVID-19 por reacción en cadena de la polimerasa a SARS-CoV-2. La edad media fue de 63 años, y el 66% eran varones. La comorbilidad previa más frecuente fue hipertensión arterial (40%), diabetes mellitus (16%) y cardiopatía (14%). Los pacientes que fallecieron tenían significativamente más edad (media 77 vs. 60 años), hipertensión arterial (71% vs. 33%), cardiopatía previa (47% vs. 6%), y niveles más elevados de lactato deshidrogenasa (LDH) (662 vs. 335UI/L) y proteína C reactiva (PCR) (193 vs. 121mg/L) al ingreso. En el análisis multivariante, se asociaron significativamente a mayor riesgo de muerte la presencia de cardiopatía (IC 95% OR 2,58-67,07), los niveles de LDH≥345UI/L (IC 95% OR 1,52-46,00), y la edad≥65 años (IC 95% OR 1,23-44,62). Conclusiones El antecedente de cardiopatía, los niveles de LDH≥345UI/L al ingreso y una edad≥65 años se asocian a una mayor mortalidad durante el ingreso por COVID-19. Hay que validar este modelo pronóstico en cohortes prospectivas (AU)

Antecedents and objective To describe clinical features, comorbidity, and prognostic factors associated with in-hospital mortality in a cohort of COVID-19 admitted to a general hospital. Material and methods Retrospective cohort study of patients with COVID-19 admitted from 26th February, who had been discharged or died, up to 29th April, 2020. A descriptive study and an analysis of factors associated with intrahospital mortality were performed. Results Out of the 101 patients, 96 were analysed. Of these, 79 (82%) recovered and were discharged, and 17 (18%) died in the hospital. Diagnosis of COVID-19 was confirmed by polymerase chain reaction to SARS-CoV-2 in 92 (92.5%). The mean age was 63 years, and 66% were male. The most frequent comorbidities were hypertension (40%), diabetes mellitus (16%) and cardiopathy (14%). Patients who died were older (mean 77 vs 60 years), had higher prevalence of hypertension (71% vs 33%), and cardiopathy (47% vs 6%), and higher levels of lactate dehydrogenase (LDH) and reactive C protein (mean 662 vs 335UI/L, and 193 vs 121mg/L respectively) on admission. In a multivariant analysis the variables significantly associated to mortality were the presence of cardiopathy (CI 95% OR 2,58-67,07), levels of LDH≥345IU/L (CI 95% OR 1,52-46,00), and age≥65 years (CI 95% OR 1,23-44,62). Conclusions The presence of cardiopathy, levels of LDH≥345IU/L and age ≥65 years are associated with a higher risk of death during hospital stay for COVID-19. This model should be validated in prospective cohorts (AU)

Comorbidity and prognostic factors on admission in a COVID-19 cohort of a general hospital. / Comorbilidad y factores pronósticos al ingreso en una cohorte COVID-19 de un hospital general.

ANTECEDENTS AND OBJECTIVE: To describe clinical features, comorbidity, and prognostic factors associated with in-hospital mortality in a cohort of COVID-19 admitted to a general hospital. MATERIAL AND METHODS: Retrospective cohort study of patients with COVID-19 admitted from 26th February, who had been discharged or died, up to 29th April, 2020. A descriptive study and an analysis of factors associated with intrahospital mortality were performed. RESULTS: Out of the 101 patients, 96 were analysed. Of these, 79 (82%) recovered and were discharged, and 17 (18%) died in the hospital. Diagnosis of COVID-19 was confirmed by polymerase chain reaction to SARS-CoV-2 in 92 (92.5%). The mean age was 63 years, and 66% were male. The most frequent comorbidities were hypertension (40%), diabetes mellitus (16%) and cardiopathy (14%). Patients who died were older (mean 77 vs 60 years), had higher prevalence of hypertension (71% vs 33%), and cardiopathy (47% vs 6%), and higher levels of lactate dehydrogenase (LDH) and reactive C protein (mean 662 vs 335UI/L, and 193 vs 121mg/L respectively) on admission. In a multivariant analysis the variables significantly associated to mortality were the presence of cardiopathy (CI 95% OR 2,58-67,07), levels of LDH≥345IU/L (CI 95% OR 1,52-46,00), and age≥65 years (CI 95% OR 1,23-44,62). CONCLUSIONS: The presence of cardiopathy, levels of LDH≥345IU/L and age ≥65 years are associated with a higher risk of death during hospital stay for COVID-19. This model should be validated in prospective cohorts.

Comorbilidad y factores pronósticos al ingreso en una cohorte COVID-19 de un hospital general / Comorbidity and prognostic factors on admission in a COVID-19 cohort of a general hospital

ANTECEDENTES Y OBJETIVO: Describir el perfil clínico, la comorbilidad y los factores pronósticos de mortalidad intrahospitalaria en una cohorte COVID-19 de un hospital general. MATERIAL Y MÉTODOS: Estudio de cohortes retrospectivo de pacientes con COVID-19 ingresados desde el 26 de febrero, y dados de alta o fallecidos hasta el 29 de abril de 2020; estudio descriptivo y análisis de factores asociados a la mortalidad intrahospitalaria. RESULTADOS: De los pacientes ingresados (N=101), se analizaron 96: 79 (82%) dados de alta por curación y 17 (18%) fallecidos. En 92 casos (92,5%) se confirmó COVID-19 por reacción en cadena de la polimerasa a SARS-CoV-2. La edad media fue de 63 años, y el 66% eran varones. La comorbilidad previa más frecuente fue hipertensión arterial (40%), diabetes mellitus (16%) y cardiopatía (14%). Los pacientes que fallecieron tenían significativamente más edad (media 77 vs. 60 años), hipertensión arterial (71% vs. 33%), cardiopatía previa (47% vs. 6%), y niveles más elevados de lactato deshidrogenasa (LDH) (662 vs. 335UI/L) y proteína C reactiva (PCR) (193 vs. 121mg/L) al ingreso. En el análisis multivariante, se asociaron significativamente a mayor riesgo de muerte la presencia de cardiopatía (IC 95% OR 2,58-67,07), los niveles de LDH≥345UI/L (IC 95% OR 1,52-46,00), y la edad≥65 años (IC 95% OR 1,23-44,62). CONCLUSIONES: El antecedente de cardiopatía, los niveles de LDH≥345UI/L al ingreso y una edad≥65 años se asocian a una mayor mortalidad durante el ingreso por COVID-19. Hay que validar este modelo pronóstico en cohortes prospectivas

ANTECEDENTS AND OBJECTIVE: To describe clinical features, comorbidity, and prognostic factors associated with in-hospital mortality in a cohort of COVID-19 admitted to a general hospital. MATERIAL AND METHODS: Retrospective cohort study of patients with COVID-19 admitted from 26th February, who had been discharged or died, up to 29th April, 2020. A descriptive study and an analysis of factors associated with intrahospital mortality were performed. RESULTS: Out of the 101 patients, 96 were analysed. Of these, 79 (82%) recovered and were discharged, and 17 (18%) died in the hospital. Diagnosis of COVID-19 was confirmed by polymerase chain reaction to SARS-CoV-2 in 92 (92.5%). The mean age was 63 years, and 66% were male. The most frequent comorbidities were hypertension (40%), diabetes mellitus (16%) and cardiopathy (14%). Patients who died were older (mean 77 vs 60 years), had higher prevalence of hypertension (71% vs 33%), and cardiopathy (47% vs 6%), and higher levels of lactate dehydrogenase (LDH) and reactive C protein (mean 662 vs 335UI/L, and 193 vs 121mg/L respectively) on admission. In a multivariant analysis the variables significantly associated to mortality were the presence of cardiopathy (CI 95% OR 2,58-67,07), levels of LDH≥345IU/L (CI 95% OR 1,52-46,00), and age≥65 years (CI 95% OR 1,23-44,62). CONCLUSIONS: The presence of cardiopathy, levels of LDH≥345IU/L and age ≥65 years are associated with a higher risk of death during hospital stay for COVID-19. This model should be validated in prospective cohorts

Soil enzyme dynamics in chlorpyrifos-treated soils under the influence of earthworms.

Earthworms contribute, directly and indirectly, to contaminant biodegradation. However, most of bioremediation studies using these annelids focus on pollutant dissipation, thus disregarding the health status of the organism implied in bioremediation as well as the recovery of indicators of soil quality. A microcosm study was performed using Lumbricus terrestris to determine whether earthworm density (2 or 4individuals/kg wet soil) and the time of exposure (1, 2, 6, 12, and 18wk) could affect chlorpyrifos persistence in soil initially treated with 20mg active ingredientkg-1 wet soil. Additionally, selected earthworm biomarkers and soil enzyme activities were measured as indicators of earthworm health and soil quality, respectively. After an 18-wk incubation period, no earthworm was killed by the pesticide, but clear signs of severe intoxication were detected, i.e., 90% inhibition in muscle acetylcholinesterase and carboxylesterase (CbE) activities. Unexpectedly, the earthworm density had no significant impact on chlorpyrifos dissipation rate, for which the measured half-life ranged between 30.3d (control soils) and 44.5d (low earthworm density) or 36.7d (high earthworm density). The dynamic response of several soil enzymes to chlorpyrifos exposure was examined calculating the geometric mean and the treated-soil quality index, which are common enzyme-based indexes of microbial functional diversity. Both indexes showed a significant and linear increase of the global enzyme response after 6wk of chlorpyrifos treatment in the presence of earthworms. Examination of individual enzymes revealed that soil CbE activity could decrease chlorpyrifos-oxon impact upon the rest of enzyme activities. Although L. terrestris was found not to accelerate chlorpyrifos dissipation, a significant increase in the activity of soil enzyme activities was achieved compared with earthworm-free, chlorpyrifos-treated soils. Therefore, the inoculation of organophosphorus-contaminated soils with L. terrestris arises as a complementary bioremediation strategy in terms of recovery of soil biochemical performance and quality.

Elements for optimizing a one-step enzymatic bio-refinery process of shrimp cuticles: Focus on enzymatic proteolysis screening.

This article complements an earlier work published in 2015 Baron et al. (2015) that showed the interest of a shrimp shells bio-refining process. We compare here the effect of eleven commercial proteases at pH 3.5 or 4.0 on a residual amount of shrimp shells proteins after 6 h at 50 °C. The two pH are obtained when respectively 40 and 25 mmol of formic acid are added to 5 g of mild dried shell. Deproteinisation yield above 95% are obtained. Residual amino acids profile in the solid phase was identical for the eleven proteases except for pepsin which was similar to the raw material profile. A significant relative increase in the proportion of Glycine is observed for the ten other cases. Likewise, shapes of size exclusion chromatograms of the dissolved phase are similar except with pepsin.

Earthworm-induced carboxylesterase activity in soil: Assessing the potential for detoxification and monitoring organophosphorus pesticides.

Soil enzyme activities are attracting widespread interest due to its potential use in contaminant breakdown, and as indicators of soil deterioration. However, given the multiple environmental and methodological factors affecting their activity levels, assessment of soil pollution using these biochemical endpoints is still complex. Taking advantage of the well-known stimulatory effect of earthworms on soil microbes, and their associated enzyme activities, we explored some toxicological features of carboxylesterases (CbEs) in soils inoculated with Lumbricus terrestris. A microplate-scale spectrophotometric assay using soil-water suspensions was first optimized, in which kinetic assay parameters (Km, Vmax, dilution of soil homogenate, and duration of soil homogenization) were established for further CbE determinations. Optimal conditions included a soil-to-water ratio of 1:50 (w/v), 30-min of shaking, and 2.5mM of substrate concentration. As expected, CbE activity increased significantly in soils treated with L. terrestris. This bioturbed soil was used for exploring the role of CbE activity as a bioscavenger for organophosphorus (OP) pesticides. Soil treated with two formulations of chlorpyrifos revealed that CbE activity was a significant molecular sink for this pesticide, reducing its impact on soil microbial activity as shown by the unchanged dehydrogenase activity. Dose-dependent curves were adjusted to an exponential kinetic model, and the median ecological dose (ED50) for both pesticide formulations was calculated. ED50 values decreased as the time of pesticide exposure increased (14 d-ED50s=20.4-26.7 mg kg(-1), and 28 d-ED50s=1.8-2.3 mg kg(-1)), which suggested that chlorpyrifos was progressively transformed into its highly toxic metabolite chlorpyrifos-oxon, but simultaneously was inactivated by CbEs. These results were confirmed by in vitro assays that showed chlorpyrifos-oxon was a more potent CbE inhibitor (IC50=35.5-4.67 nM) than chlorpyrifos (0.41-0.84 µM). The results showed that earthworm-induced CbE activity is an efficient bioscavengers for OP pesticides, acting as a soil safeguarding system. Moreover, the simple dose-response curves against OP exposure suggest that this enzyme--combined with other enzyme activities (e.g., dehydrogenase)--may be a suitable biomarker of pesticide exposure.

Parálisis del nervio mediano secundaria a lipofibrohamartoma en el túnel carpiano / Paralysis of the median nerve due to a lipofibrohamartoma in the carpal tunnel

Introducción. El lipofibrohamartoma es una rara entidad nosológica de etiología desconocida que puede afectar a cualquier nervio periférico, localizándose de forma preeminente en el nervio mediano en el interior del túnel carpiano. El lipofibrohamartoma se asocia con frecuencia a otras alteraciones como la macrodactilia, los síndromes de Proteus y Klippel-Trenaunay-Weber, y la exóstosis múltiple, entre otras. Casos clínicos. Los autores han tratado en 20 años 4 lipofibrohamartomas del nervio mediano, 2 de los cuales tenían parálisis mediana, motivo de este artículo. Estos pacientes se trataron con liberación simple del nervio mediano mediante apertura del ligamento anular del carpo y transposición tendinosa abductora con palmaris longus prolongado con la fascia palmar superficial (técnica de Camitz). En uno de los casos, multioperado previamente, se realizó también un colgajo interóseo posterior para mejorar la calidad de las partes blandas de la cara anterior de la muñeca. Discusión. Se hace una revisión de la literatura sobre el lipofibrohamartoma del nervio mediano desde 1964 hasta 2010. La revisión de la literatura sugiere que el tratamiento más recomendado es la liberación simple del túnel carpiano y se recomienda asociar una transposición tendinosa si hay parálisis del nervio mediano(AU)

Introduction. The lipofibrohamartoma is a rare entity of unknown origin that can affect any peripheral nerves, but mainly being found in the median nerve within the carpal tunnel. The lipofibrohamartoma is frequently associated with other conditions such as macrodactyly, the Proteus and Klippel-Trenaunay-Weber syndromes and multiple exostosis, among others. Clinical cases. Two cases of lipofibrohamartoma in the carpal tunnel with associated median nerve palsy are described in the present article. They were treated by simple decompression of the median nerve by releasing the transverse carpal ligament and a palmaris longus tendon transfer to improve the thumb abduction (Camitz procedure). In one of the cases (a previously multi-operated median nerve entrapment at the carpal tunnel), a posterior interosseous skin flap was employed to improve the quality of the soft tissues on the anterior side of the wrist. Discussion. A review of the literature is also presented on lipofibrohamartoma of the median nerve, covering articles from 1964 to 2010. The literature suggests that the most recommended treatment to manage this condition is simple release of the carpal tunnel, which should be associated with a tendon transfer when a median nerve palsy is noticed(AU)

[Paralysis of the median nerve due to a lipofibrohamartoma in the carpal tunnel]. / Parálisis del nervio mediano secundaria a lipofibrohamartoma en el túnel carpiano.

INTRODUCTION: The lipofibrohamartoma is a rare entity of unknown origin that can affect any peripheral nerves, but mainly being found in the median nerve within the carpal tunnel. The lipofibrohamartoma is frequently associated with other conditions such as macrodactyly, the Proteus and Klippel-Trenaunay-Weber syndromes and multiple exostosis, among others. CLINICAL CASES: Two cases of lipofibrohamartoma in the carpal tunnel with associated median nerve palsy are described in the present article. They were treated by simple decompression of the median nerve by releasing the transverse carpal ligament and a palmaris longus tendon transfer to improve the thumb abduction (Camitz procedure). In one of the cases (a previously multi-operated median nerve entrapment at the carpal tunnel), a posterior interosseous skin flap was employed to improve the quality of the soft tissues on the anterior side of the wrist. DISCUSSION: A review of the literature is also presented on lipofibrohamartoma of the median nerve, covering articles from 1964 to 2010. The literature suggests that the most recommended treatment to manage this condition is simple release of the carpal tunnel, which should be associated with a tendon transfer when a median nerve palsy is noticed.

Effects of exposure to amitraz on noradrenaline, serotonin and dopamine levels in brain regions of 30 and 60 days old male rats.

The effects of amitraz oral exposure (20, 50 and 80mg/kg bw, 5 days) on brain region monoamine levels of male rats at 30 and 60 days of age were examined. The amitraz-treated rats at the oral doses of 20 and 50mg/kg bw had no visible injury, i.e., any clinical signs of dysfunction observed in any of the animals. However, rats treated with amitraz at the highest dose (80mg/kg bw, 5 days) showed a slight motor incoordination after 1-2h of treatment. These signs were reversible approximately at 6h after dose. After the last dose of amitraz, NE, DA and 5-HT and its metabolites levels were determined in the brain regions hypothalamus, midbrain, prefrontal cortex, striatum and hippocampus by HPLC. Amitraz caused changes in the NE, DA and 5-HT and their metabolite levels in a brain regional-, dose- and age-related manner. In the brain regions studied, amitraz induced a statistically significant increase in 5-HT, NE and DA content with age interaction, but the NE increases in prefrontal cortex and hippocampus was without age interaction. Moreover, in the brain regions studied, amitraz induced a statistically significant decrease in the metabolite 5-HIAA, MHPG, DOPAC and HVA levels displaying an age interaction, excepting the 5-HIAA decrease in midbrain and the DOPAC decrease in hypothalamus and striatum which were without age interaction. Furthermore, amitraz evoked a statistically significant decrease in 5-HT, NE and DA turnover in the brain regions studied. The present findings indicate that amitraz significantly altered CNS monoaminergic neurotransmitters in a brain regional-, dose- and age-related manner.

Effects of prenatal and postnatal exposure to amitraz on norepinephrine, serotonin and dopamine levels in brain regions of male and female rats.

The effects of maternal exposure to amitraz on brain region monoamine levels of male and female offspring rats at 60 days of age were observed. Maternal and offspring body weight, physical and general activity development were unaffected by the exposure of dams to amitraz (20mg/kgbw, orally on days 6-21 of pregnancy and 1-10 of lactation). Male and female offspring were sacrificed at 60 days of age and possible alterations in the content and metabolism of NE, DA and 5-HT were determined in brain regions by HPLC. The results showed that all these neurotransmitter systems were altered in a brain regional-related manner. In male and female offspring, amitraz induced a significant decrease in the prefrontal cortex 5-HT and its metabolite 5-HIAA and DA and its metabolites DOPAC and HVA levels with interaction of sex. Nevertheless, we verified that striatum DA and 5-HT and corresponding metabolite contents decreased in male and female offspring without statistical distinction of sex. In contrast, amitraz did not modify 5-HT content, but caused an increase in 5-HIAA content in the medulla oblongata and hippocampus in male and female offspring. Alterations in the hippocampus DA, DOPAC and HVA levels after amitraz exposure were also observed displaying a sex interaction. NE levels also showed a decrease after amitraz treatment in the prefrontal cortex and striatum without statistical sex interaction, but MHPG levels decreased in both regions with a sex interaction. Amitraz evoked increases in 5-HT turnover in the prefrontal cortex as well as in DA turnover in the striatum and hippocampus but decreases in NE turnover in the hypothalamus, prefrontal cortex and striatum. The present findings indicated that maternal exposure to amitraz altered noradrenergic, serotonergic and dopaminergic neurochemistry in their offspring in the prefrontal cortex, striatum and hippocampus, and those variations could be related to several alterations in the functions in which these brain regions are involved.

Feasibility and effectiveness of laparoscopic incisional hernia repair after liver transplantation.

BACKGROUND: Incisional hernia is a frequent problem after liver transplantation. It is related to immunosuppression, use of steroids, obesity, as well as the type of incision. Laparoscopic repair shows a lower rate of complications in terms of infection and recurrence, as well as reduced postoperative pain and faster recovery. METHODS: We reviewed our experience with laparoscopic incisional hernia repair (LIHR) in patients after liver transplantation, using the BARD Composix mesh which is composed of two layers of polypropylene and polytetrafluoroethylene (PTFE) and fixed with metal ProTack. RESULTS: Between March 2002 and April 2010, we performed 20 LIHR in 17 male and three female subjects of overall mean age of 58.3 years, and body mass Index of 31.05 kg/m(2). The mean size of the defects was 215.25 cm(2). All patients had undergone bilateral subcostal incisions with a midline extension, and seven had additional operations after the transplantation for various reasons. There were no differences in immunosuppression. Three patients had needed steroid boluses for acute graft rejection episodes. There was no conversion of therapy. The size of mesh was 18 × 23 cm in seven cases and 20 × 25 in 12 cases. The mean postoperative hospital stay was 2.1 days. Oral feeding was initiated a few hours after surgery, and routine immunosuppression was not discontinued. There were no major early complications. During follow-up, we identified one patient with a mesh infection (5%) and one with a recurrence (5%). CONCLUSION: LIHR is safe and feasible even for major hernias after liver transplantation with few complications.

Hepatocellular carcinoma and liver transplantation: a 12-year experience.

BACKGROUND: Orthotopic liver transplantation (OLT) for patients with cirrhosis and concomitant hepatocellular carcinoma (HCC) in early stages is the treatment of choice, with an acceptable recurrence rate and excellent survival. AIM: We sought to evaluate (1) the accuracy of preoperative imaging; (2) the impact of pre-OLT treatments on survival and recurrence; and (3) the influence of beyond Milan criteria selection on global outcomes. METHODS: We studied a cohort of 65 patients with HCC among 300 consecutive OLTs over a single 12-year experience. We analyzed the overall outcomes of survival and recurrence, the accuracy of preoperative diagnosis and staging the influence of neoadjuvant treatment prior to OLT, and the effect on overall outcomes beyond the Milan criteria in our series. RESULTS: The 65 transplants were performed for HCC, mostly in association with hepatitis C virus and alcoholic cirrhosis with HTP. At a mean follow-up of 40.32 months, the recurrence rate was 5.7% among the 61 HCC confirmed by histopathology. The overall survival was 30.07. Actuarial survivals at 1, 5, and 10 years were 82%, 77%, and 62%, respectively. Six retransplants occurred among the seven graft losses albeit with poor survival after the second graft. Most explants showed low pTNM stages with favorable microscopic features. Preoperative imaging tests failed to achieve an accurate diagnosis in 15.38% of the series. The role of alpha-fetoprotein (AFP) and hepatic biopsy was irrelevant. Unfavorable histopathologic factors predicted a greater recurrence rate, but had no influence on survival. Neither recurrence nor survival were modified by pre-OLT therapy. CONCLUSIONS: In our series, AFP, hepatic biopsy, and pre-OLT treatment had limited roles. Radiological imaging techniques underestimated HCC staging and lead to a misdiagnosis to an expected degree. Despite these findings, this single institution experience with OLT for HCC showed excellent survivals with a low recurrence rate including cases of patients beyond the Milan criteria.

Postmenopausal women with Colles' fracture have bone mineral density values similar to those of controls when measured with calcaneus quantitative ultrasound.

BACKGROUND: It is a matter of controversy whether or not Colles' fracture is an osteoporotic fracture. Indeed, the usefulness of quantitative ultrasound in distinguishing Colles' fracture from normal fractures is also unclear. METHODS: A cross-sectional case-control study was done on 469 postmenopausal Spanish women, 121 with Colles' fracture and 348 controls. Assessment of risk factors for osteoporosis and measurement of calcaneus quantitative ultrasound were carried out using a Sahara, Hologic device. RESULTS: Patients with Colles' fracture had BUA, SOS, and QUI values that were similar to those of controls, and no statistically significant differences were found. We estimated ROC curves for SOS and a score based on a linear combination of height and SOS (SH-Score). The areas under both curves were 0.56 and 0.61, respectively, which was statistically significant. To obtain 5% false-negative and 10% false-positive figures, the T-score cut-off for SOS was -2.45 and -0.045, respectively. Of these, only 9.2% were classified as high risk and 11% as low risk with 79.8% undetermined. CONCLUSIONS: Patients with Colles' fracture had BUA, SOS, and QUI values that were similar to those of controls. Nevertheless, ROC curves calculated by a combination of height and SOS showed that quantitative calcaneus ultrasound may be a useful tool for identifying postmenopausal women with Colles' fracture. These results indicate that measuring bone mineral density with ultrasound only captures limited aspects of the pathophysiology of Colles' fractures.

Influence of clinical and immunological parameters on the health-related quality of life of patients with primary Sjögren's syndrome.

OBJECTIVE: To evaluate health-related quality of life (HR-QoL) in patients with primary SS patients using the SF-36 questionnaire and to analyse the association between the main clinical features and the SF-36 scales. METHODS: We studied 110 patients (105 women and 5 men, mean age of 56 years) with primary SS seen consecutively in the outpatient clinic of our Department. We used the population-based reference values for the Spanish version of the SF-36 health survey as control values for a healthy population. RESULTS: Comparison between patients with primary SS and the control population showed lower scores in all SF-36 scales (p < 0.001). Analysis of the SF-36 scales by gender showed a significant correlation between age and the values for physical functioning (p = 0.013) and bodily pain (p = 0.016) scores. No significant differences in SF-36 scores were found when comparing patients according to the presence or absence of sicca features. Women with vaginal dryness had lower scores for social functioning (61.9 vs. 74.4) and general health (37.2 vs. 44.7) than those without, although the differences were not statistically significant (p > 0.05). Patients with extraglandular involvement had lower scores for the vitality scale (40.8 vs. 54.5 p = 0.007), social functioning (67.0 vs. 79.8, p = 0.010), bodily pain (49.5 vs. 62.5, p = 0.018) and general health (38.6 vs. 49.4 p = 0.001) than those without. CONCLUSION: Patients with primary SS had clearly lower HR-QoL scores than the healthy population; with significantly lower scores in all SF-36 scales and in both summary measures. We identified several epidemiological and clinical SS features related to these lower SF-36 scores. Age at protocol correlated with physical functioning and bodily pain. Vaginal dryness was the sicca feature that most affected the HR-QoL of female SS patients, and a poor HR-QoL was also observed in those patients with a systemic expression of the disease, with pulmonary involvement being the extraglandular manifestation that most contributed to a poor HR-QoL. Our results highlight the importance of earlier diagnostic and therapeutic management of patients with primary SS, which, together with a close follow-up, may contribute to a significant improvement in their HR-QoL.

Fracturas del escafoides carpiano. Comentario / Fractures of the carpal navicular. Comment

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Una nueva técnica de tratamiento de la atrofia cutánea post-infiltración esteroidea en la muñeca / A new technique for the treatment of skin atrophy induced by steroid infiltration about the wrist

Las infiltraciones esteroideas son un procedimiento terapéutico muy extendido en Cirugía Ortopédica y Traumatología. Sin embargo, en la cara dorso-radial de la muñeca la utilización de estas infiltraciones para el tratamiento de patología tendinosa y osteo-articular pueden provocar atrofias cutáneas dolorosas incapacitantes y de difícil tratamiento. Se presenta una técnica no descrita de tratamiento de una atrofia cutánea dolorosa post-infiltración esteroidea por una enfermedad de De Quervain mediante expansión tisular. Se realizó una expansión cutánea progresiva del dorso de la muñeca, trasladándose la piel expandida para cubrir el defecto creado tras la resección de la zona patológica atrófica. Se detallan las indicaciones y la técnica operatoria utilizada. El resultado de la paciente intervenida, tanto funcional como estético, ha sido excelente (AU)

Patterns of diagnosis of Paget's disease in Spain.

To evaluate the incidence of diagnosis of Paget's disease of bone in Spain, a retrospective study was performed from 1991-1997 in four Spanish centers to evaluate the number of diagnosed Paget's disease cases. Information about the age, gender, and year of admission and an estimation of the reference population with the number of discharges at the centers were registered for each calendar year. The relative diagnostic risk of Paget's disease was calculated, using 1991 as the reference by Poisson's regression models. The percentage of males among the diagnosed cases varied from 39% in 1992 to 62% in 1993 without significant difference between the different years (p = 0.31). The great majority of the cases were diagnosed between 50 and 89 years of age, from 89% in 1992 and 94% in 1993. During the first years the main part of the cases corresponded to persons younger than 69 years (57.5% in 1991, 50% in 1992, and 64.7% in 1993), but from 1994 the major percentage was found in individuals over 70 years of age (68.1% in 1994, 53.8% in 1995, 62.3% in 1996, and 58.1% in 1997) (p = 0.045). Once the results were adjusted by the diagnosis center, an increased diagnostic risk of Paget's disease relative to the year of diagnosis was seen. In 1996 the risk was 54% higher than in 1991. This tendency reached statistical significance (p for trend = 0.03). The results of this study demonstrate that there is an increasing diagnostic tendency of Paget's disease along the period of study due to different analyzed variables.

Controversies in the treatment of fingertip amputations. Conservative versus surgical reconstruction.

Fingertip amputations are the most common type of amputation injury in the upper extremity. These injuries are either seen in the emergency room or in an office setting. These lesions are very frequent and require precise wound care for optimal results. The longer finger and the thumb, being the most distal and independent mobile parts of the hand are affected very often by these kind of injuries. Treatment of fingertip injuries is a continuous focus of controversy among hand and orthopaedic surgeons. Different treatment options have been described, depending on the affected segment and finger, type of lesion, gender and age of the patient, location, size, and depth of the defect. The indications, advantages, and disadvantages of several reconstructive procedures for fingertip injuries have been described. The techniques themselves are not described in detail.