Punción accidental de la arteria ilíaca durante retirada de Catéter Doble J por ureteroscopia, una complicación nodescrita / Accidental puncture of the iliac artery when pulling back a double J by ureteroscopy, an undescribed complication

La punción de la arteria iliaca durante ureteroscopia es una complicación rara pocas veces descrita en la literatura pero potencialmente grave. La ureteroscopia es un procedimiento seguro para el diagnóstico y tratamiento de la patología del tracto urinario superior. Presentamos por tanto, un caso clínico no muy frecuente como llamada de atención para todos a no subestimar ningún tipo de acto quirúrgico, y que demuestra la importancia de la comunicación entre todos los profesionales que cuidamos del paciente durante una cirugía. Por último queremos llamar la atención sobre la mascarilla laríngea que permitió una ventilación eficaz de la paciente durante todo el procedimiento (AU)

SUMMARY: the puncture of the iliac artery during an ureteroscopy is a rare complication seldom described in the literature but potentiallyserious. Ureteroscopy is a safe procedure for diagnosis and treatment of the pathology of the higher urinary tract. We present a clinical case as a warning not to underestimate any surgical procedure. This case emphasizes the importance of communication among all medical personnelwho participate in a surgical procedure. Finally we wish to draw attention to the laryngeal mask that allowed the efficient ventilation of the patient during the whole procedure (AU)

Estudio de las características fenotípicas y exposición a radiación ultravioleta en pacientes diagnosticados de melanoma cutáneo / Analysis of Phenotypic Characteristics and Exposure to UV Radiation in a Group of Patients With Cutaneous Melanoma

Introducción: El melanoma es la forma más grave de cáncer cutáneo, y está ocasionado por una combinación de factores de riesgo endógenos y exógenos. En el presente trabajo se describen las características anatomoclínicas, factores de riesgo endógenos y exógenos en 120 pacientes diagnosticados de melanoma cutáneo en el área sanitaria norte de la provincia de Santa Cruz de Tenerife. Pacientes y método: Se realizó un estudio descriptivo transversal sobre los pacientes diagnosticados de melanoma en el área sanitaria que cubre el Hospital Universitario de Canarias, entre enero de 1999 y julio de 2005. Se obtuvieron los datos referentes a las características epidemiológicas, fenotipo, hábitos de exposición solar, fotoprotección y daño actínico. Resultados: Los melanomas se diagnosticaron con más frecuencia en mujeres (62,5%). La localización anatómica más frecuente fue el tronco. El tipo anatomoclínico más frecuente fue el melanoma de extensión superficial (63,3%). El 51,5% de los pacientes presentaban un fototipo II. El 81,8% de los pacientes refirió una exposición solar intermitente y el 50% manifestaron una exposición solar acumulada moderada (50-120 horas/ año). El 3,3% de los pacientes presentaron melanomas múltiples. El tiempo de evolución del melanoma fue elevado (el 43% refiere lesiones de más de 24 meses de evolución). Conclusión: Un gran porcentaje de melanomas se asocia a daño actínico. Se observaron diferencias entre la intensidad de la exposición solar y el tipo anatomoclínico. El motivo de alarma más frecuente fue el crecimiento y el cambio de color, y un porcentaje importante de pacientes consultaron tardíamente tras la aparición de los signos de alarma (AU)

Background: Melanoma is the most serious type of skin cancer and is caused by a combination of endogenous and exogenous risk factors. Here were describe the clinical and anatomical characteristics of melanoma along with the endogenous and exogenous risk factors in 120 patients diagnosed with cutaneous melanoma in a health care area of the province of Santa Cruz de Tenerife in Spain. Patients and methods: A descriptive, cross-sectional study was undertaken in patients diagnosed with melanoma between January 1999 and July 2005 in the health care area served by Hospital Universitario de Canarias. Data were collected on demographic characteristics, phenotype, sun exposure, sun protection, and actinic damage. Results: Melanoma was most commonly diagnosed in women (62.5%) and lesions were most frequently located on the trunk. The most frequent tumor subtype was superficial spreading melanoma (63.3%) and 51.5% of patients were classified as having skin phototype II. Intermittent sun exposure was reported by 81.8% of patients and 50% had a moderate cumulative sun exposure (50-120h/y). Multiple melanomas were present in 3.3% of patients. In 43% of patients, the time to diagnosis of melanoma was more than 24 months. Conclusions: A substantial percentage of melanomas were associated with actinic damage. Differences were observed in the level of sun exposure according to melanoma subtype. The most common causes for concern were growth and color changes in the lesion, and a substantial number of patients waited for some time between observing these changes and consulting a doctor (AU)

[Analysis of phenotypic characteristics and exposure to UV radiation in a group of patients with cutaneous melanoma]. / Estudio de las características fenotípicas y exposición a radiación ultravioleta en pacientes diagnosticados de melanoma cutáneo.

BACKGROUND: Melanoma is the most serious type of skin cancer and is caused by a combination of endogenous and exogenous risk factors. Here were describe the clinical and anatomical characteristics of melanoma along with the endogenous and exogenous risk factors in 120 patients diagnosed with cutaneous melanoma in a health care area of the province of Santa Cruz de Tenerife in Spain. PATIENTS AND METHODS: A descriptive, cross-sectional study was undertaken in patients diagnosed with melanoma between January 1999 and July 2005 in the health care area served by Hospital Universitario de Canarias. Data were collected on demographic characteristics, phenotype, sun exposure, sun protection, and actinic damage. RESULTS: Melanoma was most commonly diagnosed in women (62.5%) and lesions were most frequently located on the trunk. The most frequent tumor subtype was superficial spreading melanoma (63.3%) and 51.5% of patients were classified as having skin phototype II. Intermittent sun exposure was reported by 81.8% of patients and 50% had a moderate cumulative sun exposure (50-120 h/y). Multiple melanomas were present in 3.3% of patients. In 43% of patients, the time to diagnosis of melanoma was more than 24 months. CONCLUSIONS: A substantial percentage of melanomas were associated with actinic damage. Differences were observed in the level of sun exposure according to melanoma subtype. The most common causes for concern were growth and color changes in the lesion, and a substantial number of patients waited for some time between observing these changes and consulting a doctor.

Repigmentation of vitiligo lesions in a child with celiac disease after a gluten-free diet.

There is a well-established association of vitiligo with autoimmune conditions, and circulating autoantibodies to melanocytes have been demonstrated in the serum of patients with vitiligo. We present a case of repigmentation of vitiligo lesions in a girl with celiac disease after initiating a gluten-free diet, which to our knowledge has not been reported.

[Value of positive resection margins in patients with pT2 prostate cancer. Implications for adjuvant treatment]. / Valor de los márgenes quirúrgicos de resección positivos en lospacientes con cáncer de próstata pT2. Implicaciones en eltratamiento adyuvante.

OBJECTIVE: To analyse the impact on the recurrence-free biochemical survival of tumour involvement of surgical resection margins in patients with localized prostate cancer (pT2) in the prostatectomy specimen and its implications for adjuvant treatment. MATERIALS AND METHOD: Retrospective study of 536 patients with stage pT2 prostate cancer, treated with radical prostatectomy between 1996 and 2007. Subsequent to the prostatectomy, the following variables were collected: Gleason score, pathological stage, capsular invasion, surgical margins and perineural invasion. We performed a univariate analysis and subsequently adjusted it by means of a Cox proportional hazard model (enter method). RESULTS: 21.7% presented positive surgical margins and 20.9% developed biochemical recurrence after a mean follow-up of 57 months. 37.9% of the patients with pathological involvement of the resection surgical margins presented biochemical recurrence against 16% that did not have it (p<0.001). In the multivariate analysis, only the surgical margin (p<0.001) and the Gleason score greater or equal to 8 (p<0.001) behaved as independent biochemical recurrence factors. On stratifying the series according to these two variables, we found that the patients with positive surgical margins and a Gleason score of ≤ 7 have a recurrence probability at 5 and 10 years of 35% and 50% against 74% and 87% in the group with positive surgical margins and a Gleason score of ≥ 8 (p=0.002). CONCLUSION: Patients with pT2 prostate cancer, positive surgical margins and a Gleason score of ≥ 8 will benefit from adjuvant radiotherapy. 50% of the patients with positive margins and a Gleason score of ≤ 7 will not recur, which means that the indication of adjuvant radiotherapy continues to be controversial.

Second cadaveric kidney transplantations in the pediatric population.

OBJECTIVE: To evaluate the functional outcomes and complications among a series of second in comparison to first kidney transplantations in pediatric patients. MATERIALS AND METHODS: We reviewed 163 consecutive kidney transplants in pediatric recipients performed from 1978 to present: 120 cases (69.3%) were first transplants (group A) and 43 (24.8%), second transplant (group B). We analyzed the incidences of delayed graft function (DGF), medical and surgical complications, as well as medium- and long-term graft survivals. RESULTS: We observed DGF among 51 group A patients (43%) versus 32.5% of group B. Ten patients suffered vascular complications in group A (8.3%) versus one in group B (2.3%) (P < .05). The 15-year graft survivals were 54.2% for group A and 45% for group B. The 15-year patient survivals were 84.9% in group A versus 93.6% in group B. CONCLUSIONS: Second kidney transplantations for children are a satisfactory option that achieves good functional results as well as acceptable graft and patient survivals.

Safety of long-term treatment with cyclosporin A in resistant chronic plaque psoriasis: a retrospective case series.

BACKGROUND: An intermittent short course of cyclosporin A (CyA) therapy is a good choice in the treatment of severe psoriasis. Nevertheless, some severe or resistant patients might benefit from long-term treatment. Adverse effects of long-term use of CyA are investigated and the results are compared with the literature. PATIENTS AND METHODS: A retrospective study of adverse effects of CyA treatment in a group of 53 patients suffering from psoriasis. The mean treatment time was 31.4 +/- 23.2 months with a minimum of 4 months to a maximum of 95 months, with very few short interruptions of treatment (from 2 to 5 months in five patients). RESULTS: The group consisted of 29 women and 24 men, ranging in age from 18 to 65 years, with an average age of 44.49 years. Arterial hypertension appeared in 45.3% of patients during treatment. Pharmacological treatment was required in 32% of these patients to control the condition. Serum creatinine levels were transiently elevated in 11.3% of the cases, but withdrawal of treatment was required in none of them. DISCUSSION: Long-term CyA treatment might be necessary in some patients and this study shows that it could be sustained with a close follow-up. This involves regular visits depending on each patient, as well as common test protocol and clinical evaluation. In conclusion, this retrospective study seems to confirm the relative safety of long-term CyA treatment when patients are adequately monitored.

Tratamiento del carcinoma basocelular con radiaciones ionizantes / Ionizing radiation treatment of basal cell carcinoma

El conocimiento y correcto empleo de las diferentes técnicas de radioterapia suponen una gran ayuda en el manejo de los pacientes con carcinomas basocelulares. En nuestro Servicio continuamos empleando la técnica de radioterapia de contacto para estas neoplasias en un número elevado de enfermos. Hemos recogido los datos referentes a los tumores tratados durante los años 1997, 1998 y 1999, un total de 279, y hemos analizado los datos epidemiológicos de la muestra, edad, sexo y fototipo, así como tamaño, tipo clínico, localización, cicatrización y recidivas de los tumores. Empleamos una técnica desarrollada por nuestro equipo, consistente en tres sesiones de 10 Gy, hasta un total de 30 Gy, lo cual supone un buen balance entre la comodidad del enfermo y los resultados médicos en tasas de curación y resultado estético de las cicatrices. Los pacientes tratados fueron en su mayoría de pelo oscuro en la edad adulta y ojos claros. Hemos tratado lesiones de 0,5 a 3,5 cm de diámetro con un 5% de recidivas y un 22,3% de cicatrices imperceptibles (AU)

[Applications and goals of molecular biology]. / Aplicaciones y metas de la biología molecular.

Clonal studies define the proteic sequence of several allergens leading to the recombination and the use of them for immunotherapy extracts. It has been possible to clone the receptors for IgE in basophils and mast cells and the regulation mechanisms had been delucidates. In a near future it will be possible to design recombinant molecules for the specific inhibition of synthesis and receptors of IgE and avoid the signal transmissions and the release of mediators. The diagnosis of several diseases is based in molecular techniques, inclusive in uterus. Genes for various diseases had been cloned in immunology, recombinations with gamma interferon had been used for treatment of subjects with atopic dermatitis and chronic granulomatous disease.

[Applications and aims of molecular biology]. / Aplicaciones y metas de la biología molecular.

Clonal studies define the proteic sequence of several allergens leading to the recombination and the use of them for immunotherapy extracts. It has been possible to clone the receptors for IgE in basophils and mast cells and the regulation mechanisms had been delucidated. In a near future it will be possible to design recombinant molecules for the specific inhibition of synthesis and receptors of IgE and avoid the signal transmissions and the release of mediators. The diagnosis of several diseases is based in molecular techniques, inclusive in uterus. Genes for various diseases had been cloned in immunology; recombinations with gamma interferon had been used for treatment of subjects with atopic dermatitis and chronic granulomatous disease.

[The use of methotrexate in cortico-resistant asthma]. / Uso de methotrexate en el asma corticorresistente.

Methotrexate represents a new therapeutic modality in patients with corticoresistant asthma. Its mechanism of action is the competitive inhibition of the folate reducing enzyme, converting folic acid in tetrahydrofolate during the S phase of the cell cycle. It is 50% fixed to albumin and excreted by glomerular filtration and proximal tubule secretion.

[Application of a paste composed of sodium bicarbonate, sodium chloride and hydrogen peroxide in treating of active periodontal pockets]. / Aplicación de una pasta compuesta por bicarbonato de sodio, cloruro de sodio y agua oxigenada en el tratamiento de bolsas parodontales activas.

Close relationship existing between dentobacterial plaque and chronic inflammatory periodontal disease, as well as effectiveness of conservative treatments used to eliminate chronic gingivitis, is wordly known. However, several years ago, chronic destructive periodontal disease was only solved by surgical techniques, most of them bloody and of doubtful solution for some periodontal problems; for such reasons, a study was carried out in order to learn about the role played by a medicament formed with sodium bicarbonate, sodium chloride and hydrogen peroxide, deeply applied as a paste into active periodontal pockets, after an exquisite open radicular planing. Results obtained point out that the use of this procedure effective in the therapy of chronic inflammatory periodontal disease.