Prevalence of Pathogenic Yersinia enterocolitica in Finnish Slaughter Pigs.

The prevalence of human pathogenic Yersinia enterocolitica was determined in tonsil and intestinal content samples from 388 healthy fattening pigs at the four biggest Finnish slaughterhouses. These slaughterhouses process 73% of pigs in Finland. Tonsil samples were tested by PCR targeted for yadA, and intestinal samples were cultured. All pathogenic Y. enterocolitica isolates represented bioserotype 4/O:3. The prevalence of Y. enterocolitica in tonsil samples was 60% (95% confidence limit, 55.4 to 65.1%), and its prevalence in intestinal samples was 26% (95% confidence limit, 22.1 to 31.2%). The prevalence of Y. enterocolitica in tonsil and intestinal samples varied between the four slaughterhouses. The tonsil prevalence of Y. enterocolitica was higher in slaughterhouse B, and the prevalence in intestinal content was higher in slaughterhouse C. There were more positive results in both tonsil and intestinal samples in pigs coming from fattening farms than in pigs coming from farrowing-and-fattening farms. A seasonal variation was observed in the prevalence of Y. enterocolitica in intestinal samples, with the highest prevalence during July and August, but no seasonal variation was detected in tonsil samples.

The optimal age for performing surgery on patients with MEN 2B syndrome.

Multiple endocrine neoplasia (MEN) syndromes are characterized by the association of various endocrine neoplasias. Prophylactic thyroidectomy is the treatment of choice for patients with RET gene mutations. The age at which patients undergo prophylactic thyroidectomy may vary depending on the position of the RET gene codon. In cases of MEN 2B, when the mutation is carried in codons 883, 918 or 922, prophylactic thyroidectomy is performed prior to 6 months of age, due to the increased aggressiveness of these heterozygosities, which are capable of determining the onset of medullary cancer during the first months of life. We present two heterozygous twin patients with MEN 2B syndrome who were born 32 weeks premature, and who underwent prophylactic thyroidectomy at 7 months of age. The patients were carriers of the mutation at codon 918. We suggested the early surgery at 7 months as, due to their prematurity, the patients were required to gain weight to improve their condition prior to surgery. The two patients had medullary thyroid carcinoma without lymph node involvement. In conclusion, for a truly prophylactic thyroidectomy, such patients should undergo surgery within the first month of life, particularly if these patients are carriers of the mutation in codons 883, 918 or 922.

Early spondyloarthritis: results from the pilot registry ESPIDEP.

OBJECTIVES: Studies on the incidence of spondyloarthritis (SpA) are scarce. Early SpA clinics should facilitate the detection of new cases as well as to decrease the diagnosis and treatment delay. However, the workload of such clinics has not been estimated. METHODS: ESPIDEP is a pilot registry of patients with early SpA performed in Madrid, Spain. General practitioners (GPs) agreed and were trained to refer all patients under 45 with either inflammatory back pain or asymmetric arthritis of lower limbs with 3 to 24 month duration of symptoms to a specialised unit during 6 consecutive months. Case definition of SpA was based on the ESSG criteria. The success of the program was measured by: the satisfaction of the GPs regarding the referral process, the percentage of patients correctly derived according to the rheumatologist, the expected incidence of AS. RESULTS: From a population of 111,941, the unit attended 52 patients, of whom 43 (83%) had been derived correctly and 35 were diagnosed with SpA (49% women; mean age 33+/-8; mean duration of symptoms 11+/-6 months; 46% HLA-B27 positive). The annual estimated incidence of SpA was 62.5 cases per 100,000 (95% CI: 45-87). Only 20/35 (57%) had radiological sacroiliitis and 4 (11.8%) fulfilled the modified New York criteria for ankylosing spondylitis (annual estimated incidence 7.2 per 100,000 (IC95%: 3.1-14.1)). CONCLUSIONS: Around 60 cases of early SpA are expected annually in an area of 100,000. A referral based upon clinical parameters seems efficient. The planning of early SpA clinics may be based upon these figures.

Patología postquirúrgica del cáncer de mama. Propuesta de subproceso y desarrollo de una unidad de tratamiento rehabilitador en el contexto sanitario andaluz / Post-surgical pathology of breast cancer. Proposal of subprocess and development of the rehabilitation treatment unit in the Andalusian health care context

En los últimos años, la Consejería de Salud de la Junta de Andalucía ha favorecido el desarrollo de procesos asistenciales encaminados a estructurar, mejorar e impulsar la asistencia al usuario/paciente en determinadas patologías que considera prioritarias por su incidencia, repercusiones y costes, tanto sociales como económicos. El papel del médico especialista en Medicina Física y Rehabilitación no siempre está bien definido dentro de los algoritmos asistenciales de estos procesos y puede quedar difuminado entre otros especialistas y fisioterapia. Dentro de estos procesos asistenciales se encuentra el cáncer de mama y como subproceso, el tratamiento del linfedema secundario a la cirugía. En este trabajo proponemos un modelo de desarrollo de subproceso asistencial que incluye tanto el tratamiento del linfedema como de otras lesiones asociadas a la cirugía del cáncer de mama, en el que queremos situar y definir el papel que cumple nuestra especialidad de forma que tomemos un papel activo en la creación de las bases de la futura asistencia sanitaria de calidad, tanto dentro como fuera de nuestra comunidad

In recent years, the Public Health Care Administration of Andalusia has developed health care programs to improve care programs aimed at structuring, improving and encouraging user care/patient care in specific diseases due to their social and economic incidence, repercussions and costs. The role of the specialist in Physical Medicine and Rehabilitation is not always well defined within the care algorithms of these processes and can become blurred among other specialists and physical therapy. Within these care processes are breast cancer and the treatment of secondary lymphedema to surgery as a subprocess. We propose a development model of health subprocess that also included treatment of lymphedema and other breast cancer surgery associated injuries in which we want to define the active role we take in our speciality in the creation of the bases of future health care of quality within and outside of our community

Etanercept: long-term clinical experience in rheumatoid arthritis and other arthritis.

Etanercept is a dimeric fusion protein based on the p75 TNF-alpha receptor. It binds to TNF-alpha and blocks its biologic activity. In randomized, double-blind, placebo-controlled trials, etanercept has therapeutic activity in rheumatoid arthritis, psoriatic arthritis, polyarticular-course juvenile idiopathic arthritis and ankylosing spondylitis. Etanercept improves joint inflammation, physical function and slows/halts structural damage, especially when combined with methotrexate. A sustained response is observed in a substantial percentage of patients. Although some safety issues should be considered before starting etanercept treatment, in general terms, etanercept is a well tolerated drug with an acceptable safety profile. The use of any TNF-alpha antagonist must be in agreement with the National Recommendations for Biologic Therapy, and in difficult clinical situations, a balance between risk/benefit needs to be obtained.

Clinical and ultrasonographic findings related to knee pain in osteoarthritis.

OBJECTIVES: To determine clinical and sonographic factors associated with painful episodes in patients with knee osteoarthritis (OA). METHODS: In this cross-sectional controlled study, patients with primary knee OA (ACR criteria) were prospectively placed into two groups. Group A: 81 patients with knee pain during physical activity >or=30 mm in visual analogue scale (VAS) for pain for at least 48 h prior to inclusion; Group B: 20 patients without knee pain from at least 1 month prior to inclusion. Clinical parameters, knee radiographic and ultrasonographic findings were collected. The sonographic study assessed joint effusion in the suprapatellar pouch, infrapatellar superficial and deep bursitis, meniscal lesions, anserine tendinobursitis, and Baker's cyst. RESULTS: Group A patients tended to be older and heavier women than group B (P<0.05). The most frequent radiographic stage was III (57%) in group A, and I (35%) and II (35%) in group B, showing differences in the distribution of each radiographic stage (P<0.005). The most frequent ultrasonographic finding in group A was suprapatellar effusion (79%), and in group B it was meniscal lesions (40%). Ultrasonographic findings showed in group A a significant increase of suprapatellar effusion (P<0.001) and a tendency towards an increase of Baker's cyst (P=0.06). Suprapatellar effusion, Baker's cyst, and body mass index (BMI) were the factors associated with the appearance of pain after the logistic regression analysis. CONCLUSIONS: Suprapatellar effusion, Baker's cyst, and higher BMI are more frequent and seem to be risk factors of painful flare in OA of the knee.

Valoración de la invasión miometrial en el carcinoma de endometrio mediante resonancia magnética / Evaluation of myometrial invasion in endometrial carcinoma through magnetic resonance imaging

Objetivo: Evaluar la fiabilidad de la resonancia magnética (RM) en la valoración del grado de invasión miometrial en el carcinoma de endometrio en nuestro medio. Material y método: Estudio retrospectivo realizado sobre las RM pélvicas (dinámico, contraste por vía endovenosa con gadolinio), efectuadas de forma sistemática en el estudio preoperatorio de los carcinomas endometriales de nuestro servicio. Se realizaron 123 RM pélvicas en otras tantas pacientes diagnosticadas de carcinoma endometrial entre los años 2000-2004, ambos inclusive. Posteriormente se contrastaron los resultados con los estudios histológicos de la pieza operatoria. Resultados: De las 123 neoplasias estudiadas en 112 había invasión miometrial valorada en el estudio anatomopatológico (AP) (cortes en parafina). La RM presentó concordancia con la histología en 101 casos; el valor predictivo positivo (VPP) fue del 97 por ciento y, aunque el valor predictivo negativo (VPN) fue del 38,8 por ciento , el VPN corregido (VPNc) fue del 87,5 por ciento. Conclusiones: La RM pélvica con contraste por vía intravenosa es una buena técnica para descartar la invasión miometrial profunda en el carcinoma de endometrio (VPNc 87,5 por ciento), pero su valor es menor cuando se pretende valorar la invasión superficial de éste (VPN 38,8 por ciento). Cuando los miomas uterinos están asociados al cáncer de endometrio la especificidad (25 por ciento) y el VPNc (14 por ciento) sufren un importante descenso

Objective: Evaluation of feability of magnetic resonance (MRI) in the assessment of the grade of myometrial invasion in endometrial carcinoma in our service. Material and method: Retrospective study about pelvic MRI (dynamic, intravenous contrast media with gadolinium) sistematically made in the presurgical study of endometrial carcinoma in our service. 123 MRI were made in many other patients diagnosed of endometrial carcinoma between the year 2000-2004, both included. Afterwards, the results were contrasted with the histologic studies of the surgical piece. Results: In 112 of the 123 neoplasms studied there was myometrial invasion valorated in the anatomopathologic study (paraffin sections). The MRI presented concordance with the histology in 101 cases, the positive predictive value (PPV) was 97 percents and although the negative predictive value (NPV) was 38.8 percents, the corrected negative predictive value (cNPV) was 87.5percents. Conclusions: Pelvic magnetic resonance with intravenous contrast media is a good technique to leave out deep myometrial invasion in endometrial carcinoma (cNPV: 87.5 percents), but its value is lower when pretending to asses superficial myometrial invasion (NPV 38,8 percents). When the uterine miomas are associated to endometrial carcinoma the specificity (25 percents) and the cNPV (14 percents) endure a great descent

[Infliximab (anti-TNF-alpha) treatment in patients with adult Still's disease. Experience in 2 cases]. / Tratamiento con infliximab (anti-TNF alfa) en pacientes con enfermedad de Still del adulto. Experiencia de dos casos.

Adult Still's disease is a systemic inflammatory disorder of unknown etiology. First-line treatment for Still's disease includes nonsteroidal anti-inflammatory drugs and corticosteroids. In refractory cases o when the dose of corticosteroid is unacceptably high, other disease modifying antirheumatic drugs have been used. But recent study showed the efficacy anti-TNF therapy in adult Sill's disease refractory to conventional therapy. We report a favourable response to infliximab in two patients who has proved resistant to conventional therapy.

Tratamiento con infliximab (anti-TNF alfa) en pacientes con enfermedad de Still del adulto. Experiencia de dos casos / Infliximab (anti-tnf alfa) in the treatment of adult still's disease. Two cases

La enfermedad de Still del adulto es una enfermedad inflamatoria crónica de etiología desconocida. Los antinflamatorios no esteroideos (AINEs) y los glucocorticoides son la base del tratamiento, pero en casos refractarios o cuando la dosis de esteroides es muy elevada es necesario recurrir al tratamiento con fármacos antireumáticos modificadores de la enfermedad (FAME). Ultimamente se ha comenzado a utilizar tratamientos biológicos como alternativa terapéutica a los casos de enfermedad de Still del adulto refractaria al tratamiento convencional.Presentamos nuestra experiencia satisfactoria del tratamiento con infliximab en dos pacientes con esta enfermedad (AU)

Papulosis bowenoide: a propósito de un caso / Bowenoide papulosis: a case study

La papulosis bowenoide de la vulva es una expresión antigua. En la actualidad debe incluirse dentro de la neoplasia intraepitelial vulvar de grado III (VIN III), ya que en la vulva se considera un carcinoma in situ. Su incidencia ha aumentado en los últimos 25 años, sobre todo en mujeres jóvenes. Las causas no se conocen con exactitud. Se sabe que la infección por el virus del papiloma humano, principalmente el tipo 16, es un factor desencadenante muy importante. El diagnóstico de sospecha es por la clínica. Se manifiesta por presentar lesiones papulosas hiperpigmentadas, que pueden ser asintomáticas o producir prurito o vulvodinia. La confirmación siempre se hará mediante biopsia y estudio histológico de las lesiones. Puede progresar a carcinoma invasor, sobre todo en lesiones extensas, mujeres jóvenes, inmunodeprimidas y fumadoras. Estas lesiones pueden coexistir con un carcinoma invasor oculto, lo que es más frecuente en lesiones extensas y en mujeres de edad avanzada. El tratamiento será la exéresis con márgenes o vulvectomía simple, si las lesiones no son muy extensas, y la vulvectomía cutánea con injerto, si se trata de lesiones muy extensas (AU)

Carcinoma primario de vagina / Primary vaginal carcinoma

El carcinoma primario de vagina es un tumor poco frecuente. Supone el 1-2 por ciento de los tumores malignos ginecológicos. El carcinoma escamoso es el más frecuente (85 por ciento). La localización más habitual es en el tercio superior y pared posterior de la vagina. El diagnóstico se realiza por exploración física y biopsia de la lesión sospechosa. La causa se desconoce, posiblemente influyan los mismos factores que en el carcinoma de cérvix. El pronóstico ha mejorado en los últimos años. La radioterapia es el tratamiento más utilizado, aunque no el único, ya que la cirugía también tiene su lugar sobre todo en estadios iniciales y en mujeres sexualmente activas. Hemos presentado el caso clínico de una paciente de 76 años que acudió a nuestra consulta por un sangrado vaginal de 2 meses de evolución. La paciente fue diagnosticada de un carcinoma escamoso primario de vagina, situado en la pared anterior y tercio inferior de la misma. Fue tratada con radioterapia (58 Gy) (AU)

Cistinosis nefropática infantil / Nephropathic cystinosis in children

La cistinosis nefropática, rara afección recesiva, se produce por defecto en el transporte lisosomal de cistina, y depósitos de cristales intracelulares en riñón, córnea, y otros tejidos. Constituye la primera causa congénita de síndrome de Fanconi, y evoluciona en la primera década de la vida a insuficiencia renal crónica. El diagnóstico se confirma por una detección de cistina en leucocitos y linfoblastos circulantes. Su tratamiento consiste en la reposición de las pérdidas por la tubolopatía, administración de cisteamina, que depleta cistina y favorece su transporte por la pared lisosomal. El objetivo de la presentación es dar a conocer el primer caso de cistinosis documentado y tratado en Chile. Se presenta el caso de un menor hospitalizado a los quince meses de vida, con desnutrición avanzada, raquitismo clínico, deshidratación severa, acidosis metabólica, hipokalemia e hipofosfemia severas, comprobándose tubulopatía de Fanconi. Se detectó concentración elevada de cistina en polimorfonucleares, confirmando diagnóstico de cistinosis. En tratamiento desde hace dos años con cisteamina oral, muestra excelente evolución pondoestatural y conservación de la función renal, persistiendo la tubulopatía

Experiencia nacional en el manejo del síndrome de intestino corto en niños / National experience in the management of short intestine syndrome in children

En un estudio retrospectivo, colaborativo, se analizó la evolución hasta 90 días después de la resección intestinal de 14 niños con intestino corto registrados en 7 hospitales (6 estatales) chilenos entre los años 1989 y 1995. La causa de la resección fue en 6 casos atresia intestinal, en 5 enterocolitis necrosante y en 3, vólvulo y se realizó, en casi todos, en el período de recién nacido. Los pacientes eran preferentemente prematuros (10/14) al nacer y de sexo masculino (10/14). Todos requirieron hospitalización prolongada (mínimo 3 meses), alimentación parenteral, principalmente por vía venosa central a través de catéteres venosos corrientes Arrow (n=14) o especiales Broviac-Hickman (n=9), Porth-a-cath (n=3) y Silastic (n=2) con volúmenes variables de alimentación enteral. Las complicaciones fueron frecuentes, debidas a causas técnicas, metabólicas, sepsis relacionadas a cateter y colestasia. El costo promedio de la alimentación parenteral para el grupo estudiado fue de $10.162 diarios (U$25). Es necesario contar con equipos especializados y normas adecuadas para el manejo de los niños con intestino corto

[Variations in hospitalization rates for selected surgical procedures. Use of small area analysis]. / Variaciones en la tasa de hospitalización por procedimientos quirúrgicos seleccionados. Aplicación del análisis de areas pequeñas.

The analysis of small area variation (SAV) is useful to correlate hospital utilization rates with supply. In this paper the SAV techniques are applied to 26 areas of Catalonia, whose population is covered by the same hospital or group of hospitals in more than 75% of occasions, and hospitalization rates for several surgical procedures (appendectomy, herniorraphy, cholecystectomy, prostatectomy, hysterectomy, tonsillectomy and lens extraction) are analyzed. For these purposes, 26482 discharges recorded in the Minimum Basic Data Set of Hospital Discharges in 1993 were studied. The obtained results show a great variability between areas, which sometimes is larger than the reported in the literature. For amigdalectomy, the ratio between highest and lowest hospitalization rates is 8.8. For prostatectomy and lens extraction the ratios are 4.8 and 4.5, respectively.

Combined therapy in a case of malignant mesothelioma of the tunica vaginalis testis.

Malignant mesothelioma of the tunica vaginalis testis is exceedingly rare. A new case mimicking hydrocele in a 47-year-old man is here reported. Clinical staging revealed scrotal cutaneous and funicular tumor invasion together with retroperitoneal adenopathies. Once visceral dissemination was ruled out, radical orchiectomy, left hemiscrotectomy and modified retroperitoneal lymph node dissection were performed. Adjuvant systemic chemotherapy and radiation were also administered. Histologically, an epithelial neoplasm with papillary pattern was evidenced. CAM 5.2 cytokeratin was positive in proliferating cells, but carcinoembryonic and Leu M1 antigens gave negative results. Three years later the patient is free of disease.