Diagnostic validity of ultrasound including extra-cranial arteries in giant cell arteritis.

OBJECTIVES: Color Doppler ultrasound (CDUS) of the temporal arteries (TA) is becoming the first test to be performed for suspected giant cell arteritis (GCA). Our aim was to assess the added value of including CDUS of large vessels (LV) in the diagnosis of GCA. METHODS: We performed an observational and retrospective study of consecutive patients with suspected GCA. Baseline CDUS of the TA and LV (axillary, subclavian, and carotid) were conducted. We defined the CDUS finding as positive if the halo sign was present. RESULTS: Of 198 patients with suspected GCA, 87 were eventually diagnosed with GCA: 45 (51.7%) had a cranial pattern exclusively, 31 (35.6%) had both a cranial and an LV pattern, and 11 (12.6%) had an isolated LV pattern. CDUS of the TA had a sensitivity of 83.9%, specificity of 97.3%, and positive and negative predictive values (PPV, NPV) of 96.1% and 88.5%, respectively. When LV was added, sensitivity increased to 96.6% and NPV to 98.2%. Specificity was 97.3% and PPV was 96.6%. As for LVs, the axillary, subclavian, and carotid arteries were involved in 87.8%, 77.4%, and 34.4%, respectively. Isolated axillary examination resulted in a loss of 12.2% of patients with LV involvement; however, inclusion of the axillary and subclavian arteries retained 100% of patients with LV involvement. CONCLUSIONS: Detection of GCA by ultrasound should routinely include examinations of the TA and LV (at least the axillary and subclavian arteries) to improve diagnostic accuracy. More than 12% of patients in our cohort had isolated LV involvement. Key Points • Extracranial involvement in GCA is very common: half of patients have extracranial vasculitis and more than 12% isolated LV involvement that can be demonstrated with CDUS. • Adding a CDUS examination of LV to TA increased sensitivity (from 83.9 to 96.6%) and the negative predictive value (from 88.5 to 98.2%) for diagnosis of GCA. • In our cohort, if we only examined the axillary arteries, 12.2% of the CGA with LV involvement would not have been diagnosed. • We propose a CDUS protocol that includes examination of the TA and LV (at least the axillary and subclavian arteries) routinely in cases of suspected GCA.

Alendronate after denosumab discontinuation in women previously exposed to bisphosphonates was not effective in preventing the risk of spontaneous multiple vertebral fractures: two case reports.

At denosumab discontinuation, an antiresorptive agent is indicated to reduce the high bone turnover, the rapid bone loss, and the risk of spontaneous vertebral fractures. We report two cases of postmenopausal women, previously exposed to bisphosphonates, treated with alendronate at denosumab discontinuation. Alendronate was ineffective to avoid spontaneous clinical vertebral fractures. They presented three and nine spontaneous vertebral fractures 8 and 12 months after denosumab discontinuation, respectively. Ineffectiveness of alendronate was attributed to insufficient control of the rebound as assessed by B-crosslaps measures in the first case, and partially to the high risk of fractures in the later. In both situations, the increased fracture risk may have favoured these new fractures. It is urgent to define effective therapeutic strategies to avoid spontaneous vertebral fractures after denosumab discontinuation.

First clinical isolation report of Shewanella algae from the stools of a patient with acute enteritis in Spain.

We report a case of acute enteritis caused by Shewanella algae in a cirrhotic patient. Biochemical identification systems revealed to be insufficient to identify the Shewanella isolate at the species level, thus requiring 16S rRNA and gyrB partial gene sequencing. Even if co-infection by Clostridium difficile could not be ruled out, this is, to our knowledge, the first report of acute enteritis caused by Shewanella algae in Europe.

Ultrasonic monitoring of malolactic fermentation in red wines.

The progress of malolactic fermentation in red wines has been monitored by using ultrasonic techniques. The evolution of ultrasonic velocity of a tone burst 1MHz longitudinal wave was measured, analyzed and compared to those parameters of oenological interest obtained simultaneously by analytical methods. Semi-industrial tanks were used during measurements pretending to be in real industrial conditions. Results showed that the ultrasonic velocity mainly changes as a result of the conversion by lactic acid bacteria of malic acid into lactic acid and CO2. Overall, the present study has demonstrated the potential of the ultrasonic technique in monitoring the malolactic fermentation process.

Antioxidant properties of sparkling wines produced with ß-glucanases and commercial yeast preparations.

UNLABELLED: The aim of this study was to evaluate the in vitro antioxidant potential of sparkling wines produced with ß-glucanases, autolysated yeasts, yeast cell walls, and purified mannoproteins. Total antioxidant capacity (measured by 2,2-diphenyl-1-picrylhydrazyl [DPPH] radical-scavenging method and ferric reducing antioxidant power [FRAP] assay), and hydroxyl radical-scavenging activity (HRSA) were higher in the wine samples with coadjuvants (in relation to the control wine). The highest values of antioxidant activity were achieved with purified mannoproteins and, in lesser extent, with ß-glucanases. Neutral polysaccharides and total proteins were highly and positively correlated with DPPH, FRAP, and HRSA assays. However, correlations between the levels of each different phenolic family and antioxidant and radical-scavenging activities were not found. ß-Glucanase and commercial yeast preparations can be excellent coadjuvants to increase the antioxidant properties of sparkling wines. PRACTICAL APPLICATION: ß-Glucanase and commercial yeast preparations can be excellent coadjuvants to increase the antioxidant properties of sparkling wines. The suggested improvement has significant implication for the production of high added value sparkling wines.

[Silodosin therapy for lower urinary tract symptoms in men with suspected benign prostatic hyperplasia: results of an international, randomized, double-blind, placebo- and active-controlled clinical trial performed in Europe].

BACKGROUND: Silodosin is a new selective therapy with a high pharmacologic selectivity for the a (1A)-adrenoreceptor. OBJECTIVE: Our aim was to test silodosin's superiority to placebo and noninferiority to tamsulosin and discuss the findings in the context of a comprehensive literature review of the new compound silodosin. DESIGN, SETTING, AND PARTICIPANTS: We conducted a multicenter double-blind, placebo-and active-controlled parallel group study. A total of 1228 men > or = 50 yr of age with an International Prostate Symptom Score (IPSS) < or = 13 and a urine maximum flow rate (Q(max))> 4 and < or = 15 ml/s were selected at 72 sites in 11 European countries. The patients were entered into a 2-wk wash-out and a 4-wk placebo run-in period. A total of 955 patients were randomized (2:2:1) to silodosin 8 mg (n = 381), tamsulosin 0.4 mg (n = 384), or placebo (n = 190) once daily for 12 wk. MEASUREMENTS: We calculated the change from baseline in IPSS total score (primary), storage and voiding subscores, quality of life (QoL) due to urinary symptoms, and Q(max). Responders were defined on the basis of IPSS and Q(max) by a decrease of > or = 25% and an increase of > or = 30% from baseline, respectively. RESULTS AND LIMITATIONS: The change from baseline in the IPSS total score with silodosin and tamsulosin was significantly superior to that with placebo (p < 0.001): difference active placebo of -2.3 (95% confidence interval [CI], -3.2, -1.4) with silodosin and -2.0 (95% CI, -2.9, -1.1) with tamsulosin. Responder rates according to total IPSS were significantly higher (p < 0.001) with silodosin (66.8%) and tamsulosin (65.4%) than with placebo (50.8%). Active treatments were also superior to placebo in the IPSS storage and voiding subscore analyses, as well as in QoL due to urinary symptoms. Of note, only silodosin significantly reduced nocturia versus placebo (the change from baseline was -0.9, -0.8, and -0.7 for silodosin, tamsulosin, and placebo, respectively; p = 0.013 for silodosin vs placebo). An increase in Q(max) was observed in all groups. The adjusted mean change from baseline to end point was 3.77 ml/s for silodosin, 3.53 ml/s for tamsulosin, and 2.93 ml/s for placebo, but the change for silodosin and tamsulosin was not statistically significant versus placebo because of a particularly high placebo response (silodosin vs placebo: p = 0.089; tamsulosin vs placebo: p = 0.221). At end point, the percentage of responders by Q(max) was 46.6%, 46.5%, and 40.5% in the silodosin, tamsulosin, and placebo treatment groups, respectively. This difference was not statistically significant (p = 0.155 silodosin vs placebo and p = 0.141 tamsulosin vs placebo). Active treatments were well tolerated, and discontinuation rates due to adverse events were low in all groups (2.1%, 1.0%, and 1.6% with silodosin, tamsulosin, and placebo, respectively). The most frequent adverse event with silodosin was a reduced or absent ejaculation during orgasm (14%), a reversible effect as a consequence of the potent and selective a(1A)-adrenoreceptor antagonism of the drug. The incidence was higher than that observed with tamsulosin (2%); however, only 1.3% of silodosin-treated patients discontinued treatment due to this adverse event. CONCLUSIONS: Silodosin is an effective and well-tolerated treatment for the relief of both voiding and storage symptoms in patients with lower urinary tract symptoms suggestive of bladder outlet obstruction thought to be associated with benign prostatic hyperplasia. Its overall efficacy is not inferior to tamsulosin. Only silodosin showed a significant effect on nocturia over placebo.

Distribución temporal de las urgencias pediátricas hospitalarias durante los últimos diez años / Time distribution of hospital pediatric emergencies during the last 10 years

Objetivo. Establecer el patrón temporal de consumo de recursos en un servicio de urgencias pediátricas y buscar posibles cambios en los últimos 10 años. Material y métodos: Estudio ecológico de todas las urgencias pediátricas atendidas entre 1-1-1999 y 31-12-2008 de Asturias). Descripción general y comparación temporal. Resultados. Se atendieron 175.657 pacientes. Su edad media fue de 3,8 años (IC 95% 3,8-3,9), con mediana de 2,7 años. El 54,8% fueron varones y el 45,2% mujeres. El 31% de los casos fue atendido por las mañanas, el 46% por la tarde y el 23% durante la noche. La media diaria de consultas varió mensualmente entre 65 en diciembre y 34 en agosto. La media diaria de pacientes atendidos en días laborables fue de 42 frente a 61 en días no laborables (p<0,001). La media diaria de visitas en periodo lectivo fue de 51, en vacaciones de navidad 66, en vacaciones de semana santa 53 y en vacaciones de verano 34 (p<0,001). En el primer quinquenio (1998-2003) acudieron menos pacientes (diferencia media diaria 6,8: IC95% de la diferencia 5,7-7,9; p<0,001), su edad media era más alta (diferencia media 0,29 años; IC 95% de la diferencia 0,26-0,33; p<0,001), y hubo un mayor porcentaje de ingresos (9,7% frente a 7,1%) que en el segundo quinquenio (2003—2008). Conclusiones. Existen un perfil temporal específico de visita a los servicios de urgencia pediátricos. En los últimos años se están produciendo cambios en el consumo de este recurso (AU)

Aim. To establish the temporal pattern of resource consumption in a pediatric emergency service and explore possible changes in the last 10 years. Material and methods. Ecological study of all pediatric emergency assisted between 1.1.1999 and 31.12.2008 in Cabueñes Hospital (Health Area V Asturias). Overview and temporal comparison. Results. 175,657 children were treated. Their average age was 3.8 years (95% CI 3.8-3.9), with a median of 2.7 year. 54.8% were male and 45.2% women. 31% of the cases were treated in the mornings, 46$ in the afternoon and 23% at night. The average daily number of children ranged montly form 65 December and 34 in August. The average daily number of children in care was 42 working days versus 61 on not working days (p<0,001). The average daily number of children seen in school period was 51, on Christmas vacation 66 in Easter holidays 53 and summer 34 (p<0,001). In the first five years (1998-2003) attended fewer children (mean difference 6.8 daily, 95% of the difference 5.7-6.9, p<0,001), their average age was higher (mean difference 0,29 years, 95% of the difference 0.26 – 0.33 years, p<0,0001) and a higher percentage of hospital admission (9,7% versus 7.1%) than in the second half (2003-2008) (AU)

Development of an environmental friendly method for the analysis of organochlorine pesticides in sediments.

This work proposes a pressurized hot water extraction (PHWE) followed by solid phase microextraction (SPME) and determination by gas chromatography-mass spectrometry method for the analysis of organochlorine pesticides in sediment samples. For SPME, extraction temperature and time, desorption temperature and desorption time, and effect of an organic modifier were studied. For PHWE, parameters such as organic modifier, percentage of organic modifier, temperature, and static extraction time were studied. When these parameters were selected, the figures of merit were calculated in order to assess the performance of the proposed method. Quantitative recoveries (80-115%) and satisfactory precisions were obtained. The detection and quantification limits were between 0.11 and 16 microg kg(-1) and between 0.24 and 22 microg kg(-1), respectively with good linearity between LOQs and 500 microg kg(-1) for most of the studied pesticides. The method was validated by the analysis of a reference marine sediment material (SRM 1944). The obtained results are in excellent agreement with the certificate material. Another sediment reference material (SRM 1941b), with a very low concentration of pesticides was also analyzed with good results. In addition, this method was successfully applied to the analysis of three marine sediment samples. The developed method seems to be a nearly full automated, environmental friendly, sensitive, simple and less-time consuming method. Moreover this method, look for the implementation of the principles of green analytical chemistry and has demonstrated to be suitable for the analysis of organochlorine pesticides at trace levels in environmental matrices as sediment samples.

[Usefulness of urine cytology for bladder carcinoma diagnosis: comparative study with biopsy]. / Utilidad de la citología de orina para el diagnóstico del carcinoma vesical: estudio comparativo con biopsia.

OBJECTIVES: Traditionally, urine cytology has been considered as the gold standard for bladder cancer screening. However, new methods are playing new roles in these cases. In order to assess the value of cytology of voided urine we performed one comparative study between cytology and biopsy. METHODS: We retrospectively analyzed the results of urine cytology and biopsy follow-up in 109 patients. All cytologies were from voided urine. They were cytocentrifuged and stained with Papanicolaou stain. RESULTS: We found 70 true positive cases and 24 true negative cases. Sensitivity was calculated to be 97% and specifity 96-100%. 12 cases had the first cystoscopy test and biopsy negative, as the cancer was diagnosed in the second biopsy. CONCLUSIONS: Patients with clearly positive urine cytology, which was not confirmed in a first cystoscopic study, should be carefully followed up to identify a possible bladder or upper urinary tract cancer. The urine cytology still has a significant role as the gold standard for bladder cancer screening.

Características epidemiológicas del lactante con primer episodio sibilante ¿podemos identificar al niño con riesgo de episodio grave y/o de recidiva? / Epidemiological characteristics of first wheezy episodes: can we identify children at risk of serious episode and/or relapse?

Introducción: los episodios sibilantes bronquiales son una de las patologías más frecuentes en la época del lactante. Pacientes y métodos: se diseñó un estudio prospectivo observacional con el objetivo de determinar los factores de riesgo de mala evolución y de reingreso de los episodios sibilantes en los lactantes. Se incluyeron, durante 12 meses, a todos los niños menores de 2 años ingresados en nuestro Hospital por un primer episodio sibilante. En los pacientes en que se realizó analítica sanguínea se determinaron los valores de troponina I. Se realizó una comparación por grupos, virus sincitial respiratorio (VSR) positivo frente a VSR negativo y mayores de 6 meses frente a menores y se estableció un período de observación de reingreso. Resultados: los pacientes pertenecientes al grupo VSR positivo presentaron una puntuación en la escala de Wood-Downes modificada por Ferres en el peor momento de evolución superior a la de los VSR negativos (7,2 vs 5,9; p<0,01). Los pacientes con troponina I elevada (≥0,1 ng/ml) presentaron también mayor media en esta escala, aunque estos hallazgos no adquirieron significación estadística. En el grupo de pacientes que reingresaron encontramos mayor porcentaje de niñas, padres fumadores y una estancia hospitalaria prolongada en el primer ingreso, adquiriendo todos estos resultados significación estadística. Conclusiones: la infección por VSR y la troponina I elevada pueden jugar un papel como factores predictivos de gravedad. Se relacionan con el reingreso el sexo femenino, padres fumadores y primer episodio con estancia hospitalaria prolongada (AU)

Introduction: wheezing is a common problem in infancy. Patients and methods: a prospective observational study was designed to determine risk factors for a poor outcome and readmission among infants admitted for a wheezing episode. Infants younger than 2 years admitted in a 12 month period for a first wheezing episode were included. Troponine I values were measured in some infants who had a blood sample. A comparison among groups, Respiratory Syncytial Virus (RSV)- positive versus RSV- negative, and younger than six months of age versus 6 months or older() were performed and an observation period was established. Results: scores in the Wood-Downes scale modified by Ferres were higher among the RSV + children (7,2 vs 5,9; p<0,01). Patients with elevated troponine I values (≥0,1 ng/ml) showed higher average scores but this finding did not reach statistical significance. In the group of patients who were readmission there was more female, parental smoking, and a longer length- of stay in their first admission, this results reach statistical significance. Conclusions: RSV positive and high troponine I levels may play be related to more severe disease. Female gender, parental smoking and a long length of stay in their first episode are related to a higher risk of readmission (AU)

Divergencias en el tratamiento del cáncer de próstata localizado / Management of localized prostate cancer

No disponible

Comparación temporal y bacteriológica de la infección urinaria neonatal / Temporal and bacteriological comparison of neonatal urinary infections

Objetivo: Conocer los cambios epidemiológicos y de abordaje diagnóstico y terapéutico de la infección urinaria neonatal en los últimos años. Pacientes y métodos: Estudio descriptivo retrospectivo de las infecciones del tracto urinario (ITU) en pacientes ingresados durante11 años en nuestra unidad neonatal. Se realiza una comparación temporal, por grupo de microorganismos y por resultados en cistouretrografía miccional seriada (CUMS). Resultados: Se estudiaron 106 casos (5 casos por cada 1.000 recién nacidos vivos [RNV]). Los microorganismos más frecuentemente aislados fueron Escherichia coli (81,1 %), Enterococcusfaecalis (6,6 %) y Enterobacter cloacae (4,7 %). La gentamicina tuvo una sensibilidad global del 93,2%, seguida de la cefotaxima con el 91,3 % y de la amoxicilina-ácido clavulánico con el 89,5 %. No encontramos diferencias temporales por microorganismos ni por sensibilidades. Hemos encontrado diferencias en la proteína Creactiva (PCR), en la nitrituria y en la leucocituria en las ITU causadas por E. coli frente a no causadas por este microorganismo, así como en los patrones de sensibilidad antibiótica, ya que las infecciones por microorganismos que no eran E. coli eran más resistentes. No se encontraron diferencias por microorganismos en pacientes con CUMS normal y patológica. Encontramos alteraciones en la ecografía y en la CUMS en el 35,2 y en el 21,4 % de la serie, respectivamente. Conclusiones: La ITU es un problema frecuente en nuestro medio. E. coli es el microorganismo más frecuentemente aislado. En las ITU no causadas por E. coli se produce una mayor resistencia a los tratamientos habituales, aunque en ellas no se detectan más datos patológicos en las pruebas de imagen. No encontramos aumento alguno de resistencias antibióticas a lo largo del estudio (AU)

Objective: To find out the epidemiological and management changes of urinary tract infection over the last years. Patients and methods: Descriptive retrospective review of patients with urinary tract infections (UTIs) admitted to our neonatal unitover an 11 year period. A temporal, microorganism group and voiding cystourethrography (VCUG) group comparison. Results: We studied 106 cases (5 cases/1,000 alive newborns).The most commonly isolated microorganisms were Escherichiacoli (81.1%), Enterococcus faecalis (6.6 %) and Enterobacter cloacae (4.7 %). Gentamicin had an overall sensitivity of 93.2 %, followed by cefotaxime 91.3 % and amoxicillin-clavulanic acid 89.5 %. We did not found temporal differences in microorganisms or sensitivities. We found differences in C reactive protein, nitrate and leucocyte values in E. coli versus non-E. coli UTIs, as well as patterns of antibiotic sensitivity with more resistances by non-E. coli microorganisms. No differences were found in patients with normal and pathological VCUG. We found ultrasound and VCGU disturbances in 35.2% and 21.4%, respectively. Conclusions: UTI is a common problem in our area. The most frequently isolated microorganism is E. coli. Non-E. coli UTI shave more resistances to usual therapies, although these did not show any increase in disease in the imaging tests. We found no increase in resistances throughout the study (AU)

Utilidad de la citología de orina para el diagnóstico del carcinoma vesical: estudio comparativo con biopsia / Usefulness of urine cytology for bladder carcinoma diagnosis: comparative study with biopsy

Objetivo: La citología de orina se ha considerado la técnica de elección para el cribado de carcinoma vesical. La existencia de otros métodos diagnósticos adicionales, han puesto en duda su utilidad. Aportamos un estudio comparativo cito-histológico para comprobar su valor. Método: Hemos realizado un estudio retrospectivo de 109 biopsias vesicales en relación con los diagnósticos citológicos previos. Todas las citologías eran de micción espontánea, procesadas por citocentrifugación y teñidas con Papanicolaou. Resultados: Encontramos 70 casos verdaderos positivos, y 24 casos verdaderos negativos, consiguiendo una sensibilidad del 97% y una especificidad del 96-100%. Destacando que 12 casos positivos tenían la primera cistoscopia y biopsia negativa, diagnosticándose la neoplasia en la segunda biopsia. Conclusiones: Los pacientes con citologías de orina claramente positivas, que no se confirman en una primer estudio citoscópico, deben ser seguidos, para identificar una posible neoplasia vesical o de vías urinarias altas. La citología de orina puede seguir considerándose como una técnica de elección para el cribado y control de neoplasia vesical (AU)

Objectives: Traditionally, urine cytology has been considered as the gold standard for bladder cancer screening. However, new methods are playing new roles in these cases. In order to assess the value of cytology of voided urine we performed one comparative study between cytology and biopsy. Methods: We retrospectively analyzed the results of urine cytology and biopsy follow-up in 109 patients. All cytologies were from voided urine. They were cytocentrifuged and stained with Papanicolaou stain. Results: We found 70 true positive cases and 24 true negative cases. Sensitivity was calculated to be 97% and specifity 96-100%. 12 cases had the first cystoscopy test and biopsy negative, as the cancer was diagnosed in the second biopsy. Conclusions: Patients with clearly positive urine cytology, which was not confirmed in a first cystoscopic study, should be carefully followed up to identify a possible bladder or upper urinary tract cancer. The urine cytology still has a significant role as the gold standard for bladder cancer screening (AU)

Tratamiento ambulatorio con insulina intravenosa a través de un catéter central en una paciente con síndrome de resistencia a la insulina subcutánea / Ambulatory intravenous insulin therapy by a venous central catheter access in a patient with subcutaneous insulin resistance syndrome

El síndrome de resistencia a la insulina subcutánea es una causa poco frecuente de diabetes inestable, caracterizada por un mal control glucémico pese al empleo de altas dosis de insulina subcutánea y que mejora, junto con la disminución de los requerimientos de insulina, cuando ésta se administra por vía intravenosa. Su etiología es desconocida y su manejo clínico resulta muy difícil, dada la necesidad de emplear una vía alternativa a la subcutánea para el tratamiento ambulatorio. Presentamos el caso de una paciente con este síndrome en la que se decidió colocar un acceso venoso central con bomba de infusión adaptada como solución provisional hasta contar con un dispositivo de administración de insulina intraperitoneal, que es el tratamiento más comúnmente aceptado en la actualidad (AU)

The subcutaneous insulin resistance syndrome is a rare cause of brittle diabetes, defined as diabetes mellitus poorly controlled with high doses of subcutaneous insulin, which ameliorates, together with a reduction of insulin requirements, when insulin is intravenously infused. Its cause is unknown and its clinical management very difficult, because of the need to use an alternative to the subcutaneous route for ambulatory therapy. We report the case of a patient with this syndrome, in which a venous central access connected to anadapted insulin pump was placed as a temporary solution until having an intraperitoneal insulin infusion device, the currently most accepted treatment for this condition (AU)

[Temporal and bacteriological comparison of neonatal urinary infections]. / Comparación temporal y bacteriológica de la infección urinaria neonatal.

OBJECTIVE: To find out the epidemiological and management changes of urinary tract infection over the last years. PATIENTS AND METHODS: Descriptive retrospective review of patients with urinary tract infections (UTIs) admitted to our neonatal unit over an 11 year period. A temporal, microorganism group and voiding cystourethrography (VCUG) group comparison. RESULTS: We studied 106 cases (5 cases/1,000 alive newborns). The most commonly isolated microorganisms were Escherichia coli (81.1%), Enterococcus faecalis (6.6%) and Enterobacter cloacae (4.7%). Gentamicin had an overall sensitivity of 93.2%, followed by cefotaxime 91.3% and amoxicillin-clavulanic acid 89.5%. We did not found temporal differences in microorganisms or sensitivities. We found differences in C reactive protein, nitrate and leucocyte values in E. coli versus non-E. coli UTIs, as well as patterns of antibiotic sensitivity with more resistances by non-E. coli microorganisms. No differences were found in patients with normal and pathological VCUG. We found ultrasound and VCGU disturbances in 35.2% and 21.4%, respectively. CONCLUSIONS: UTI is a common problem in our area. The most frequently isolated microorganism is E. coli. Non-E. coli UTIs have more resistances to usual therapies, although these did not show any increase in disease in the imaging tests. We found no increase in resistances throughout the study.

[Miliary tuberculosis in a patient treated with BCG intravesical instillation]. / Tuberculosis miliar secundaria a instilación endovesical de BCG.

Intravesical instillation of bacillus Calmette-Guérin is the elective treatment for transitional cell and in situ bladder carcinoma. Severe complications occur very seldom but must be known and promptly recognized. We present a case of miliary tuberculosis reactivation secondary to the mentioned treatment.

Tuberculosis miliar secundaria a instilación endovesical de BCG / Miliary tuberculosis in a patient treated with BCG intravesical instillation

La instilación endovesical con bacilo de Calmette-Guerin es el tratamiento de elección para el carcinoma superficial e in situ de vejiga. En raras ocasiones presenta complicaciones graves que deben ser tenidas en cuenta. A continuación presentamos un caso de reactivación endógena de tuberculosis miliar secundaria a dicho tratamiento

Intravesical instillation of bacillus Calmette-Guérin is the elective treatment for trnasitional cell and in situ bladder carcinoma. Severe complications occur very seldom but must be known and promptly recognized. We present a case of miliary tuberculosis reactivation secondary to the mentioned treatment