Small intestinal strangulation due to a primary internal paracecal hernia.

The discovery of a paracolic hernia is an unusual event, even for an experienced specialist in colorectal surgery. We report a case of a 59-year-old woman with no previous history of abdominal surgery, who presented to the Emergency Department complaining of episodic abdominal pain and distension accompanied by a palpable mass in the right lower quadrant. At laparotomy, a paracecal hernia with small bowel volvulation was found. The prime objective of this report is to draw the clinician's attention to the necessity of making a rapid diagnosis of internal hernias.

[Effect of Lactobacillus casei on the incidence of infectious conditions in children]. / Efecto de Lactobacillus casei sobre la incidencia de procesos infeeciosos en niñios/as.

AIM: To analyse the effect of continuous consumption of Lactobacillus casei (DN-114001) fermented milk on the incidence of the infectious disorders frequent in children. FIELD: Infant and child population SUBJECTS: children from 3 to 12 years from two schools in Barcelona. A total of 251 children from both sexes participated in the study. INTERVENTIONS: A nutritional intervention study was carried out during 20 weeks with a parallel, prospective, double-blind and randomised by pragmatic clusters design. Participants were children from 3 to 12 years from two schools in Barcelona. One of the centres was assigned to receive two daily units of Actimel" and the other to two units of Placebo. From the 251 participants, 109 receiving placebo and 142 receiving Actimel". Basal demographic characteristics and clinical history data were recorded, and the symptoms related to infectious disorders or other illnesses were monitored at weeks 12, 16 and 20. The analysis of the data was carried out on the intention-to-treat (ITT) population, being the principal endpoint the duration of respiratory and gastrointestinal symptoms. RESULTS: A one day difference, but non-significant, was seen in the median of total duration of days with illness through the study (Actimel group: 1 day vs Placebo group: 2 days). The same nonsignificant difference was also seen in the duration of days with respiratory (high and low respiratory tract infections) and with gastrointestinal (diarrhoea, vomiting, stomach pain and constipation) disorders. There was a statistical significantly difference found in favour of Actimel in the duration of the low respiratory tract infections, bronchitis or pneumonia, and in the duration of fatigue. There was also detected a lower incidence of children with low respiratory tract infections (32% vs. 49%) and with fatigue (3% vs. 13%) in the Actimel group compared to placebo. The satisfaction levels with the nutritional intervention were very high, over 80%. CONCLUSIONS: The study shows a tendency to the reduction of duration and incidence of some infectious disorders in those children receiving two daily Actimel during 20 weeks.

Ginecología infantil y juvenil en atención primaria / Infantile and adolescent gynaecology in primary care

El primer escalón del cuidado en Ginecología Infantil y Juvenil lo ofrecen los pediatras de Atención Primaria. Su integración en una Unidad de Ginecología Infantil y Juvenil es imprescindible para el funcionamiento de la misma. Nuestro objetivo en el presente artículo es repasar las principales patologías que encontramos en nuestra consulta de Pediatría en Atención Primaria y las conductas a seguir ante estos problemas

The first step in Infantile and adolescent gynaecology, is offered by Primary Care Paediatricians, so it is essential their integration in Children and Adolescent’s Gynaecology Unit. The aims of the present topic is to revise the principals pathologies that we can find in our paediatrics surgeries in Primary Care and the ways to act with this problems

Síndrome del ovario poliquístico / Polycystic ovary syndrome

El síndrome del ovario poliquístico (SOP), provoca múltiples consultas en el ámbito de la asistencia médica, tanto en Atención Primaria como en Atención Especializada, por su múltiple sintomatología, alteraciones menstruales, obesidad, acné, hirsutismo, infertilidad, riesgo de desarrollo de diabetes mellitus o enfermedad coronaria. La anovulación persistente es el problema fundamental, relacionada en su fisiopatología con múltiples etiologías, entre ellas la resistencia a la insulina y el hiperandrogenismo. El objeto de este estudio es la revisión de la fisiopatología, manifestaciones clínicas y tratamiento del SOP

Polycystic Ovary Síndrome cause many medical consultations as Primary Care to Specialized Care, by many symptoms as menstrual upset, obesity, acne, haircuts, infertility, diabetes or cardiovascular disease. The more important in SOP is the chronic anovulation, whit very much aetiology factors as insulin resistance and hyperandrogenism. The aims of this chapter is the revision of physiopathology, symptoms and treatment of polycystic ovary syndrome

[Extragonadal germ-cell tumors located in the mediastinum]. / Tumores de células germinales extragonadales de localización mediastínica.

INTRODUCTION: The extragonadal germ-cell tumors (EGGCT) represent 5% of all germ-cell tumors at presentation. Histologically, they are identical to testis germ cell tumors. They may arise in such sites as the mediastinum, retroperitoneal area, sacrococcygeal area, or pineal area without a primary in the testis. MATERIAL AND METHODS: The medical records of 10 patients with mediastinal EGGCT were reviewed between 1973 and 1996. All patients were males and his mean age was 26.7 years old (21-24). Follow-up was 19 months (3-72). RESULTS: The first symptoms are diverse. The histology results nonseminomatous tumor at 9 patients and seminomatous tumor at the restant. All of the scrotal examination was normal and only five patients presented increased tumoral markers (alpha-FP in 4 and beta-HCG in 1). Previous at 1990 didn't exist a standard treatment, resulting the four patients treated in this period exitus. After 1990 the treatment was cisplatin-based chemotherapy: BEP (bleomicyn, etoposide-VP-16- and cisplatin-CDDP) then we obtained the best results, a patient died after 6 months but the restants five are alive and without evidence of disease during a follow-up between 3 and 72 months.

[Analysis of free PSA percentage predicting potential surgical failure in patients treated with radical prostatectomy]. / Análisis del porcentaje de PSA libre en la predicción del fallo quirúrgico potencial en pacientes sometidos a prostatectomía radical.

OBJECTIVE: To analyze if free PSA percentage can help to predict a potential surgical failure (PSF) in patients undergoing radical prostatectomy. MATERIAL AND METHODS: Analysis of serum PSA concentration and free PSA percentage in 92 patients undergoing retropubic radical prostatectomy. In 38 cases, the carcinoma was organ-confined, 26 had capsule penetration, 20 had positive margins, 6 seminal vesicle invasion and 2 lymph nodes. PSF was demonstrated in 28 patients (30.4%) and in 64 (69.6%) the carcinoma was organ-confined. RESULTS: No significant relationship was found between PSA serum concentration or free PSA percentage to the pathological stage. The logistic regression analysis where the clinical status, Gleason sum, and free PSA percentage were included as predictive variables, showed that the latter was the only factor with capacity for PSF prediction. Over all, the probability of a carcinoma being confined in the surgical specimen when percentage of free PSA was greater than 10 was 83.8% and 60% when it was lower or equal, p < 0.03. However, the distribution was only significant when PSA concentration ranged between 4.1 and 10 ng/mL, p < 0.008. In this range of PSA, the relative risk of PSF was 5.5 (95% CI 1.4-21.8) when free PSA percentage was equal or lower than 10, the probability being 50% versus 9.1% when it was greater than 10. CONCLUSIONS: Free PSA percentage can help to predict PSF. PSA serum concentration lower than 10 ng/mL and free PSA percentage greater than 10 allows to detect a subgroup of patients with good prognosis and with less than 10% probability of having positive margins, seminal vesicles invasion or lymph nodes.

[The prevalence and characteristics of breast feeding in the rural environment]. / Prevalencia y características de la lactancia materna en el medio rural.

OBJECTIVES: To find the characteristics of breast-feeding (BF) in our community in terms of the number of women who started it, its prevalence, average duration, reasons for stopping, and related social and family factors. DESIGN: A descriptive, longitudinal study. SETTING: Health District of Piedrabuena, Ciudad Real. PARTICIPANTS: All the 170 children born between January 1993 and March 1995, excluding newly-born low-weight babies or ill ones. MEASUREMENTS AND MAIN RESULTS: On the first visit (15 days after birth) the mother was asked what kind of feeding she gave and, if relevant, the reason for giving up breast-feeding. Age of the mother, whether she smoked, number of children, educational level and job were obtained from medical records or direct questions. New feeding controls were made at 1, 2, 3, 5, 7 and 9 months of life. Giving up BF meant the end of the period of study. CONCLUSIONS: 1) Rate for starting BF and its average duration was below the recommended, but above the rates found in similar studies. 2) There was a tendency to give up BF after three months. 3) Hypogalactia was the main reason for not starting and giving up BF. 4) The negative influence of tobacco on the duration of the BF.

[Vesical endometriosis. Report of a case with immunohistochemical study]. / Endometriosis vesical. Presentación de un caso con estudio inmunohistoquímico.

OBJECTIVE: To analyze the hormonal dependence of estrogen and progesterone receptors in endometriosis of the bladder. METHODS: A case of endometriosis of the bladder that had presented as a tumor in a 30-year-old female is described. Immunohistochemical studies were performed using estrogen and progesterone antireceptor antibodies. RESULTS: A strong positivity for progesterone in the endometriotic stromal cells was demonstrated. A mild positivity for estrogen in the glandular epithelial and stromal cells was observed. CONCLUSIONS: The present case demonstrates the hormonal dependence of endometriosis of the bladder and raises the possibility of utilizing hormone therapy in specific patients.

[Preliminary results of a phase II randomized controlled trial comparing M-VAC and M-CAVI in patients with bladder cancer (T2-4 N0-1 M0)]. / Resultados preliminares de un ensayo randomizado en fase II comparando M-VAC y M-CAVI en pacientes con cáncer de vejiga (T2-4 N0-1 M0).

OBJECTIVES: The combination of carboplatin, methotrexate and vinblastine (M-CAVI) is an active and well-tolerated regimen for patients with bladder cancer who are ineligible for cisplatin-based regimens. We have prospectively randomized patients with locally advanced (T2-4 N0 M0) or locoregional (Tx N1 M0) bladder cancer suitable for subsequent surgical treatment to M-VAC or M-CAVI chemotherapy. METHODS: M-CAVI consisted of carboplatin (300 mg/m2 on day 1 and later adjusted to 4.5 mg/dl/min according to Calvert's formula), methotrexate (30 mg/m2 on days 1, 15 and 22) and vinblastine (3 mg/m2 on days 1, 15 and 22). After 3-4 cycles, the patients were assessed for surgical resection. RESULTS: To date, 60 patients have been included. There were 58 completely evaluable patients, 27 were randomized to M-VAC and 31 to M-CAVI. The overall response rates were similar for M-VAC (48%; confidence interval 95%, 26%-67%) and M-CAVI (45%; confidence interval 95%, 28%-62%). The pathological complete responses were similar for the M-VAC and M-CAVI regimens for both the group with locally advanced (27% vs 39%, p = NS) and locoregional (14% vs 14%, p = NS) bladder cancer. The median actuarial survival for the M-VAC treated group was 23 months and 18 months for the M-CAVI. M-VAC therapy was statistically significantly associated with more events of granulocytopenic fever, grade 2-3 nausea and vomiting, grade 2 alopecia and grade 3-4 mucositis. CONCLUSIONS: The results achieved in the 60 patients included in the study indicate that M-CAVI is better tolerated than M-VAC, although both treatment regimens have similar overall response rates, pathological response rates and survival in patients with locally advanced and locoregional bladder cancer.

[PSA in women. Evaluation of its determination with polyclonal and monoclonal immunoassay]. / El PSA en mujeres. Evaluación de su dosificación mediante inmunoanálisis policlonal y monoclonal.

PSA concentrations were measured in 421 women. In a first group comprising 309 subjects, the assay was carried out with kits containing polyclonal antibodies (PPSA). In the second group with 112 women, the assays used kits containing polyclonal antibodies (PPSA) and kits containing monoclonal antibodies (MPSA), and results obtained with both assays were compared. In the first group PSA levels higher than 0.4 ng/ml were detected in 47.9%. In the second group concentrations higher than 0.4 ng/ml were detected in 52.7% when using PPSA versus 16.7% when using MPSA. The rate of PSA detectable levels in healthy women, with benignant and malignant conditions was 36.7, 42.1 and 84.4% for PPSA, and 16.7, 14.0 and 21.9 for MPSA. This study shows that it is possible to detect PSA levels in women, and that this is more frequent when using a polyclonal antibodies assay.

[The urological complications of anticoagulant therapy]. / Complicaciones urológicas de la terapéutica anticoagulante.

Patients on anticoagulant therapy may develop urologic complications, the most common being hematuria. Other less common but more severe complications are spontaneous hemorrhage arising from urological structures, as spontaneous perirenal hematoma, or from extra-urological structures, such as the iliac psoas muscle or the anterior rectus abdominis muscle. We report on four patients on anticoagulant therapy for different reasons, with no previous history of trauma, who suddenly developed spontaneous bleeding with urologic consequences: spontaneous perirenal hematoma (2), hematoma of the iliac muscle (1) and the anterior rectus abdominis muscle (1). The diagnostic strategy, the usefulness of the different imaging techniques and our approach to these complications are discussed.

[Impact of specific prostatic antigen on the rationalization of the use of bone gammagraphies in the follow-up of hormone-treated non- metastatic prostatic cancer]. / Impacto del antígeno prostático específico en la racionalización del consumo de gammagrafías oseas en el seguimiento del cancer de próstata no metástasico tratado hormonalmente.

Analysis of the evolution of 78 patients with hormonally-treated non-metastatic prostate cancer. During an average follow-up of 62.3 months, local clinical and metastatic progression in 14.1% and 7.7% cases, respectively, was observed. Overall, PSA detected progression of disease in 94.1% cases, with an anticipation which range between 4 and 52 months. Evidence of bone metastatic progression was confirmed in 2.1% of the 286 scintigraphies performed. Following analysis of results, by accepting their indication from a PSA level higher than 100 ng/ml, 97.9% would have been avoided, achieving a 100% sensitivity and 94.1% diagnostic efficacy.

[Does transurethral resection cause metastatic dissemination of hormone treated prostatic cancer?]. / Produce la RTU diseminación metastásica en el cáncer de próstata tratado hormonalmente?

The evolution of non-metastatic prostate cancer treated with hormonal therapy does not appear to be affected by the performance of a transurethral resection (TUR) as a measure to expedite the common urinary tract. Of 82 patients followed for an interval ranging from 6 months to 15 years, 3 of 45 patients (6.7%) undergoing RUT experienced metastatic dissemination, while the same happened in 2 of 37 (5.4%) patients who did not undergo RUT, p being NS. The group of patients requiring RUT, however, experienced higher local progression rates, 22.2% vs 5.4%, a situation not ascribable to the RUT procedure but to the fact that such surgery was selectively indicated in neoplasias with larger tumoral mass.

[Spontaneous perirenal hematoma]. / Hematoma perirrenal espontáneo.

We report 10 cases of spontaneous perirenal hematoma that had been treated from 1974 to 1992. Retroperitoneal hemorrhage was secondary to renal disease in 7 cases, perirenal in 2 and extrarenal in 1. The etiology of the condition is analyzed in detail and the diagnostic usefulness of the different radiologic examinations are discussed. Making a preoperative diagnosis permits a more adequate surgical strategy.

[Complete hormonal blockade vs. monotherapy in the management of metastasizing prostatic cancer]. / Bloqueo hormonal completo versus monoterapia en el tratamiento del cáncer de próstata metastásico.

Evaluation of results obtained in 70 hormone-treated patients with disseminated prostate cancer. Thirty-six of them were treated via orchiectomy and 34 received also flutamide. Initial objective response rates were 47% in the monotherapy group versus 58% for those undergoing complete blockade. Decrease of PSA and PAP was also higher in the group given flutamide. Nonetheless, no significant changes were observed with regard to biological and clinical progression or patients survival.

[Value of prostate-specific antigen as prognostic factor of metastatic cancer of the prostate]. / Valor del antígeno prostático específico como factor pronóstico del cáncer de próstata metástasico.

This paper examines the behaviour of PSA in 70 patients with metastatic prostate cancer. PSA serum concentration, prior to therapy, was directly related to the tumoral mass and inversely related to the histological degree, which does not constitute a prognostic factor with regard to the disease evolution. Within 3 months of therapy, PSA concentration decreased more noticeably in clinically responding patients, down to less than 10 ng/ml in 93% of them. Also, this level represented a prognostic factor with regard to the free-of-progression interval of the disease.

[Medical treatment of benign prostatic hyperplasia in patients with high surgical risk]. / Tratamiento médico de la hiperplasia prostática benigna en pacientes con alto riesgo quirúrgico.

Eight patients with prostate adenoma and high surgical risk were given leuprolide in depot. Prostate volume decreased by 44.7% after 3 months of treatment and by 58.9% at six months. Two of the 7 patients were resident vesical catheter carriers, 28% re-started spontaneous miction.

Clinical behaviour of prostatic specific antigen and prostatic acid phosphatase: a comparative study.

We assayed prostatic specific antigen (PSA) and prostatic acid phosphatase (PAP) serum levels in 1383 patients using a double antibody radioimmunoassay (RIA) I125. Establishing the upper normal limit in 10 ng/ml PSA and 2.5 ng/ml for PAP, the false positive results were only 1.9 and 5.1 percent in men with non-prostatic benign or malignant pathology and respectively 0 and 2.2 percent in women. We detected false positive levels for these two tumoral markers in 3.5 and 4.7 percent of patients with non-complicated benign prostatic hypertrophy, 64.8 and 19.2 percent in complicated benign prostatic hypertrophy, 24 and 16 percent in acute prostatitis and 3.3 percent in chronic prostatitis. The sensitivity in patients with prostate cancer was 87.2 percent for PSA and 64.1 percent for PAP, and there was a better correlation with PSA than PAP for tumoral spread and histological grading. Finally, clinical efficacy was higher with PSA and was no better when both markers were assayed.

[Determination of prostatic specific antigen and prostatic acid phosphatase as tumor markers of cancer of the prostate]. / Evaluación del antígeno prostático específico y de la fosfatasa ácida prostática como marcadores tumorales en el cáncer prostático.

The authors analyzed 3,079 serum determinations for prostate specific antigen (PSA) and prostatic acid phosphatase (PAP) that had been performed in 1,470 patients. The control group was comprised of 370 patients, 444 comprised the patient group with benign non-prostatic disease, 201 had malignant nonprostatic disease, 290 had benign prostatic disease (85 uncomplicated benign prostatic hypertrophy, 125 complicated benign prostatic hypertrophy, 50 acute prostatitis, 30 chronic prostatitis), 78 had untreated prostate carcinoma, and 165 were patients with prostate carcinoma under treatment. Quantification of PSA and PAP was performed by double antibody radioimmunoassay. The upper limit for normal values was set at 10 ng/ml. for PSA and 2.5 ng/ml. for PAP. Statistical analyses were performed with a personal computer using the SPSC program. Non-parametric tests were utilized throughout in the absence of a normal distribution of values for both tumor markers. In the control group, no significant differences in PSA and PAP levels were observed relative to the age group for the female patients; however, for the male patients, a significant increase was observed after age 15 for both markers. Furthermore, after age 50 PAP values became stable whereas a slight increase was observed for PSA. With regard to tumor mass, a significant correlation was found between PSA levels and the different patient groups while no remarkable differences were observed for PAP levels in those patients without or with single metastasis. We can conclude from the foregoing findings that PSA is currently the most useful tumor marker in diagnosing, staging, and monitoring prostate cancer. However, we believe that PSA and PAP are different manifestations of the prostate cell.(ABSTRACT TRUNCATED AT 250 WORDS)