Epiescleritis y edema periorbitario secundario a síndrome VEXAS (vacuoles, E1 enzyme, X-linked, autoinflammatory, somatic) / Episcleritis and periorbital edema secondary to VEXAS syndrome

El síndrome vacuolas, E1 enzyme, X-linked, autoinflammatory, somatic (VEXAS) es una nueva entidad autoinflamatoria descrita recientemente, producida por una mutación del gen UBA-1. Entre los síntomas más frecuentes están la fiebre, las citopenias, la policondritis, los infiltrados pulmonares y hasta en un 40% afectación ocular en forma de edema periorbitario, uveítis, epiescleritis, escleritis y vasculitis retiniana. Los pacientes responden a altas dosis de corticoterapia, sin embargo muchos terminan siendo refractarios a las mismas y a los inmunosupresores clásicos. Se describe el caso de un paciente varón de 77 años con afectación ocular en forma de epiescleritis y edema periorbitario que posteriormente fue diagnosticado de síndrome VEXAS. El paciente, tras fracasar al tratamiento con inmunosupresores, en la actualidad está en tratamiento con esteroides orales y tocilizumab. Los especialistas en oftalmología deben estar al corriente de la afectación oftalmológica de las enfermedades autoinflamatorias, y en especial de esta nueva entidad descrita, como es el síndrome VEXAS (AU)

VEXAS (vacuoles, E1 enzyme, X-linked, autoinflammatory, somatic) syndrome is a newly described autoinflammatory entity caused by a UBA-1 gene mutation. Among the most frequent symptoms it produces fever, cytopenias, polychondritis, pulmonary infiltrates and up to 40% ocular involvement such as periorbital edema, uveitis, episcleritis, scleritis and retinal vasculitis. Patients respond to high doses of corticosteroids, however, many end up being refractory to them and to the classic immunosuppressants. We described the case of a 77-year-old male patient with ocular involvement in the form of episcleritis and periorbital edema who was later diagnosed with VEXAS syndrome. The patient, after failing treatment with immunosuppressants, is currently receiving treatment with oral steroids and tocilizumab. Ophthalmologist must be aware of the ophthalmological affectation of autoinflammatory diseases and especially of this new entity described as the VEXAS syndrome (AU)

Critical review on the mechanistic photolytic and photocatalytic degradation of triclosan.

The environmentally extended presence of triclosan, TCS, component of many pharmaceutical and personal care products, and its known persistent character have awoke the scientific and social concern leading to the study of effective remediation techniques. Advanced oxidation techniques stand out for the effectiveness in degrading many persistent compounds, and as a result, they have been addressed by many researchers. However, the powerful oxidation media might lead to the formation of undesirable by-products, concern that has also been widely addressed. With regard to the presence of TCS, photolytic and photocatalytic processes provide a very effective degradation yield and rate, with a large number of reports addressing its removal from different environmental matrices. But currently, there is no clear understanding of the mechanisms involved and the routes responsible for the formation of degradation products. Thus, this work presents an exhaustive and critical analysis of the state of the art related to the photo-degradation of TCS, with special focus on the formation of oxidation by-products, on the phenomena responsible and on the influence of operation variables. This report aims at offering valuable information to researchers dealing with this environmentally relevant problem.

Potential formation of PCDD/Fs in triclosan wastewater treatment: An overall toxicity assessment under a life cycle approach.

Wastewater may contain a diverse group of unregulated pollutants known as emerging pollutants, such as pharmaceuticals and personal care products (PPCPs). Triclosan (TCS) is a personal care product widely used as an antiseptic or preservative in cosmetics, hand wash, toothpaste and deodorant soaps. Advanced oxidation processes (AOPs) have been used as effective and alternative treatments for complex wastewater. However, an important criterion for the assessment of AOPs and their operation conditions could be the potential formation of new toxic secondary products, such as polychlorinated dibenzo-p-dioxins and furans (PCDD/Fs), especially when emerging pollutants are present in the media. If these are omitted from environmental management studies, the real environmental impacts of a WWTPs (wastewater treatment plants) may be underestimated. Consequently, the current study aims to evaluate the environmental impacts derived from electrooxidation (EOX), one of the most effective oxidation technologies, of emerging pollutants using Life Cycle Assessment. The analyses were performed for the treatment of effluents containing TCS, firstly without considering the formation of PCDD/Fs and, thereafter, considering the effects of these compounds. Total toxicity, calculated through different methods and corresponding impact factors, were evaluated for each stage of the process when different electrolytes are used, including PCDD/Fs formation. Finally, a sensitivity analysis was carried out to study i) the effect of the TCS initial concentration on the environmental impacts associated to ecotoxicity for the different life cycle methods and ii) the influence of changing the organic pollutant on PCDD/Fs formation employing 2-chlorophenol (2-CP). As a result, LCIA methods demonstrate that they are not fully adapted to the computation of PCDD/Fs in the water compartment, since only 2,3,7,8-tetraclorodibenzo-p-dioxina (2,3,7,8-TCDD) is present as a substance in the impact categories assessed, ignoring the remaining list of PCDD/Fs.

Ankle pain in rheumatoid arthritis: comparison of clinical and sonographic findings.

To describe the prevalence and distribution of clinical and ultrasound (US) pathological findings at ankle level and to compare them, in patients with rheumatoid arthritis (RA). This is a descriptive, cross-sectional study assessing patients diagnosed with RA according to the 2010 ACR criteria, who were recruited consecutively and independently of disease status or treatment and of the presence of pain at ankle level. Clinical and US findings were acquired by two independent rheumatologists. US assessments were performed according to the EULAR and OMERACT indications. A total of 224 ankles of 112 RA patients were examined. One hundred (89.3%) patients were women and 12 (10.7%) were men, with a mean age of 51 years. RA mean disease duration was 72 months. Ankle spontaneous pain was found in 56.2% of the patients. In 65.2% of the patients, US found at least one pathologic sign indicative of joint and/or tendon pathology. Using grayscale US, joint involvement was more frequently found than tendon pathology (37.5% vs 22.3%). Conversely, no substantial difference was found between the prevalence of power Doppler signal at joint and tendon level. There was a significant correlation between clinical findings and US findings indicative of tibiotalar joint synovitis and peroneal tenosynovitis. In the present study, pain and US pathologic findings at ankle level were described and compared in a cohort of RA patients. Spontaneous pain was found in more than half of the patients and US found joint involvement more prevalent than tendon pathology.

PCDD/Fs traceability during triclosan electrochemical oxidation.

5-Chloro-2-(2,4-dichlorophenoxy)phenol (TCS) is a persistent organic pollutant (POP) widely used in different consumer goods. Its recalcitrant nature demands the application of effective remediation technologies in order to avoid the negative environmental impact associated to the discharge of contaminated waters. Although advanced oxidation technologies have been considered the best alternative to destroy bio-recalcitrant compounds, the likely formation of high toxicity byproducts must be analysed before large-scale deployment. In this work, we aim to trace the presence of chlorinated compounds during the electro-oxidation of aqueous TCS samples. First, we analyze the influence of the initial concentration of TCS on the toxicity of the oxidation medium expressed by the International-Toxicity Equivalency Factor (I-TEF); second, we have detected the formation of intermediate organo-chlorinated compounds by GC-MS supported by HPLC and finally, we have quantified the concentration of highly-polychlorinated dibenzo-p-dioxins and dibenzofurans (PCDD/Fs) by HRGC-HRMS within the oxidation treatment. In those samples where TCS had been completely degraded the concentration of PCDD/Fs showed a high increase, especially when NaCl was used as electrolyte, with the initial concentration of TCS. Under these conditions the I-TEF achieved values up to 3.8 × 102 pg L-1.

Fate and hazard of the electrochemical oxidation of triclosan. Evaluation of polychlorodibenzo­p­dioxins and polychlorodibenzofurans (PCDD/Fs) formation.

Triclosan (TCS) is widely used as antiseptic or preservative in many personal care products (PCPs), such as cosmetics, hand wash, toothpaste and deodorant soaps, among others. It is characterized by acute toxicity, resistance to biodegradation, environmental persistence and relatively high lipophilicity. In order to protect the environment and natural resources from the negative effects of the discharge of polluted wastewater with TCS, the application of efficient remediation technologies able to degrade the pollutant to harmless levels becomes crucial. Electrochemical oxidation, among all advanced oxidation processes (AOPs), has been reported as very effective in the complete degradation of a number of persistent pollutants; therefore, its performance using boron-doped diamond (BDD) anodes, and response to operation variables, has been studied in this work. As expected, complete degradation of TCS was achieved in all the studied conditions; however, going a step further and knowing that TCS is a precursor of polychlorinated dibenzo­p­dioxins and dibenzofurans (PCDD/Fs), their quantitative presence in the oxidation media has been assessed. Results showed the dominance of dichlorinated (DCDD) and trichlorinated (TrCDD/Fs) in the homologue profile of total PCDD/Fs, reaching values up to 1.48 × 105 pg L-1 in samples with initial concentration of TCS of 100 mg L-1 and NaCl as electrolyte. Under these conditions, the International Toxicity Equivalency Factor (I-TEF) achieved values up to 2.76 × 102 pg L-1. Nevertheless, the presence of copper in the oxidation medium tends to reduce I-TEF values. Finally, considering the information reported in literature, a mechanism describing the formation of low chlorinated PCDD/Fs from TCS oxidation reactions is proposed.

Theoretical and experimental formation of low chlorinated dibenzo-p-dioxins and dibenzofurans in the Fenton oxidation of chlorophenol solutions.

The formation of chlorinated and non-chlorinated dibenzo-p-dioxins and dibenzofurans (PCDD/Fs) has been experimentally investigated after the Fenton oxidation of 2-chlorophenol (2-CP, 15.56 mM) aqueous solutions by assessing the influence of iron concentration (0.09-2.88 mM), hydrogen peroxide dose (40.44-202.20 mM), temperature (20-70 °C) and chloride concentration (0-56.35 mM). The presence of chloride in the medium together with room temperature and substoichiometric Fenton conditions (40.44 mM H2O2) led to an increase in total PCDD/Fs concentration from less than 1 ng L(-1) to 2 µg L(-1). Results showed a dominance of the dichlorinated species (DCDD/Fs) in the homologue profile of total PCDD/Fs reaching values up to 1.5 µg L(-1). Furthermore, the products distribution exhibited a gradual decrease in the homologue concentration as the chlorination degree increased from di-to octachloro-substituted positions. Considering the characteristics of the reaction medium, the experimental results, and the information gathered in bibliography with regard to the generation of active radicals from 2-chlorophenol, a mechanism describing the formation of low chlorinated PCDD/Fs in a Fenton oxidizing aqueous system has been proposed.

Assessment of PCDD/Fs formation in the Fenton oxidation of 2-chlorophenol: Influence of the iron dose applied.

Toxic polychlorinated dibenzo-p-dioxins and dibenzofurans (PCDD/Fs) may be formed during remediation of chlorinated phenols via Fenton oxidation. To highlight the need for monitoring the production of toxic byproducts in these reactions, this work assessed the influence of iron dose (0.09-0.36 mM) on the Fenton oxidation of 2-chlorophenol (2-CP, 15.56 mM), a potential precursor of PCDD/Fs, by quantifying 2-CP removal and mineralization rates as well as byproducts yields, including PCDD/Fs. Although the increase in the iron dose showed positive contribution to 2-CP oxidation, under the operating conditions of the current study (H2O2 at 20% of the stoichiometric dose and 20 °C), there was no effect on the mineralization rate, and TOC and chlorine balances were far to be closed, depicting the presence of chlorinated organic byproducts in the reaction medium. After 4 h of treatment, the total PCDD/Fs concentrations increased by 14.5-39 times related to the untreated sample when the iron doses tested decreased from 0.36 to 0.09 mM, with preferential formation of PCDFs over PCDDs and dominance of lower chlorinated congeners such as tetra and penta-PCDD/Fs. The treatment with the highest iron dose (0.36 mM) exhibited the lowest PCDD/Fs yields and was thus most successful at mitigating toxic byproducts of the Fenton oxidation, leading to lower sample toxic equivalence (TEQ) value.

Overview of the PCDD/Fs degradation potential and formation risk in the application of advanced oxidation processes (AOPs) to wastewater treatment.

Polychlorinated dibenzo-p-dioxins and dibenzofurans (PCDD/Fs) are a family of unintentionally produced persistent organic pollutants (POPs) that have received considerable public and scientific attention due to the toxicity of some of their congeners, more specifically those with chlorine substitution in the 2,3,7,8 positions. The environmental management and control of PCDD/Fs is addressed at a global level through the Stockholm Convention that establishes that POPs should be destroyed or irreversibly transformed in order to reduce or eliminate their release to the environment. Several technologies, including advanced oxidation processes (AOPs) such as photolysis, photocatalysis and Fenton oxidation, have been considered as effective methods for destroying PCDD/Fs in polluted waters. Nevertheless, during the remediation of wastewaters it is critical that the treatment technologies applied do not lead to the formation of by-products that are themselves POPs, especially if PCDD/Fs precursors or chlorine are present in the reaction medium. Despite the high effectiveness of AOPs in the oxidation of major contaminants, scarce references deal with the monitoring of PCDD/Fs in the course of the oxidation process, revealing that a detailed assessment of non-combustion technologies with respect to PCDD/Fs formation is still lacking. This study reports a review of the state of the art related to the potential remediation and/or formation of PCDD/Fs as a result of the application of AOPs for the treatment of polluted waters, warning on the correct selection of the operating conditions.

The critical role of the operating conditions on the Fenton oxidation of 2-chlorophenol: assessment of PCDD/Fs formation.

This work assesses the influence of the operating conditions H2O2 dose (20 or 100% of the stoichiometric amount), temperature (20 or 70°C), and the presence of chloride in the oxidation medium in the formation of polychlorinated dibenzo-p-dioxins and dibenzofurans (PCDD/Fs) during Fenton treatment of aqueous samples of 2-chlorophenol, 2-CP, one of the strongest precursor of PCDD/Fs. After 4h of oxidation in the experiments carried out with 20% H2O2 chlorinated phenoxyphenols and biphenyls, which are intermediates in PCDD/Fs formation, as well as PCDD/Fs were observed, resulting in concentrations 11 times higher than in the untreated sample. Additionally, when NaCl was also present in the reaction medium, PCDD/Fs were formed at higher extent, with a total concentration 74.4 times higher than in the untreated 2-CP solution. Results depicted a preferential formation of PCDFs over PCDDs, with dominance of lower chlorinated PCDD/Fs (tetra and penta-PCDD/Fs). Besides, the formation of the most toxic PCDD/Fs congeners (2,3,7,8-PCDD/Fs) was not favored under the operating conditions used in this work.

Quantitative assessment of the formation of polychlorinated derivatives, PCDD/Fs, in the electrochemical oxidation of 2-chlorophenol as function of the electrolyte type.

The electrochemical degradation of 2-chlorophenol (2-CP) on boron-doped diamond (BDD) anodes was carried out using two electrolytes, NaCl and Na2SO4. Both electrolytes supported complete mineralization of 2-CP, but faster rates of degradation were observed in NaCl. After 4 h of oxidation, the total organic carbon (TOC) balance neared 100% with Na2SO4 for identifiable compounds, whereas 4 mM of TOC remained unidentified with NaCl. Since chlorophenols are known to be precursors of polychlorinated dibenzo-p-dioxins and dibenzofurans (PCDD/Fs), a rigorous assessment of intermediate products was carried out. When near complete mineralization was achieved, the use of NaCl resulted in the concentration of total PCDD/Fs increasing 2.68 × 10(4) times compared to the untreated sample, and to toxicity values several times higher than the maximum level established by U.S. Environmental Protection Agency for water ingestion. When Na2SO4 was used, the increase in total PCDD/Fs concentration was 134 times lower than with NaCl and there was no significant 2,3,7,8-PCDD/Fs formation. Thus, we emphasize the importance of electrolyte selection in electro-oxidation processes, especially when PCDD/Fs precursors are initially present or may be formed in the treated water samples.

Burkitt's lymphoma treatment in a rural hospital in Sierra Leone.

BACKGROUND: Sierra Leone is a low-income sub-Saharan country in the endemic Burkitt's lymphoma (BL) belt. We performed a prospective trial of a reduced-intensity chemotherapy protocol for the treatment of paediatric BL. PATIENTS AND METHODS: The trial included all children clinically diagnosed with BL between 2005 and 2008. Biopsy, bone-marrow aspiration, analysis of cerebrospinal fluid, abdominal ultrasound and plain x-ray of involved sites were performed when feasible. The treatment protocol was a first i.v. dose of cyclophosphamide (CPM) 40 mg/kg, followed by oral CPM weekly for two doses and then bimonthly to a total of six doses. Treatment was based on clinical diagnosis as it was several weeks before pathology results were available. RESULTS: Eighty-seven patients were included, with a median age 7 years and 4 months; 59/87 (67.8%) were boys. Nearly half (n = 17, 42.5%), presented with moderate or severe malnutrition. Biopsy was performed in 44 patients, BL being verified in 36 (41.4% of all patients). Most children presented with advanced disease: 28 (32%) at stage II, 47 (54%) at stage III and 12 (13.8%) at stage IV. Most patients (71/87, 82%) initially responded to treatment, but just over half (47/87, 54%) experienced relapse and refractory disease. Forty patients (46%) in complete or partial clinical response were lost to follow-up. CONCLUSION: The outcome for BL in rural Sierra Leone according to this protocol is poor. Low-dose CPM was ineffective. Constraints on performing complete diagnosis and staging, frequency of advanced disease at presentation and a high drop-out rate might explain our poor results.

Comparative study of the destruction of polychlorinated dibenzo-p-dioxins and dibenzofurans during Fenton and electrochemical oxidation of landfill leachates.

Two advanced oxidation processes (AOPs) that provide a broad-spectrum contaminant destruction option were applied to the treatment of the leachates, namely electrochemical and Fenton oxidation. Despite the similar efficiency in the oxidation of major organic contaminants, approximately 90% reduction of chemical oxygen demand after 180 min, our results showed a different behaviour of both AOPs in the oxidation of polychlorinated dibenzo-p-dioxins and dibenzofurans (PCDD/Fs). A concentration reduction of 73% for 1,2,3,4,6,7,8-HpCDD and of 71% for OCDD was reached after 180 min of electrochemical oxidation and the total toxic equivalent of the sample was reduced in 58%. However, Fenton oxidation followed a different trend and for similar operation times, it was detected an increase in the concentration of several PCDD/Fs congeners, specially stressed for the major congeners 1,2,3,4,6,7,8-HpCDD, OCDD and OCDF, and in the total toxicity of the sample between 12.5% and 128%. Comparison of the results and the rationale behind their difference are finally discussed.

Trombectomía mecánica en el ICTUS: experiencia con trevo en Hospital Provincial Clínico Barcelona / Mechanical thrombectomy in stroke: experience with trevo at Hospital Provincial Clinic Barcelona

Objectives: to report our experience, the efficiency, safety and results of endovascular mechanical thrombectomy with the Trevo device in acute ischemic cerebral stroke. Materials and Methods: we performed a retrospective study of 145 acute ischemic stroke patients treated with mechanical throm-bectomy using the Trevo system, between october 2008 and march 2012. 87.3percent in anterior circulation and 12.7 percent in posterior circulation. Results: mean age at presentation was 67 years (range 21-82, 54.5 percent males). The NIHSS presentation baseline was 17 (range, 18-22). The median interval from the onset of symptoms to arterial punction was 263 minutes (173-296). Satisfactory recanalization defined TICI (2-3) in 91 percent with 45 percent showing a good functional prognosis (mRS 0-2) at 90 days. 23 percent mortality at 90 days with 11 percent intracerebral haemorrage. Conclusions: in our experience, endovascular treatment of acute ischemic stroke with the Trevo device is safe and effective.

Objetivos: reportar nuestra experiencia, eficacia, seguridad y resultados del tratamiento endovascular mediante trombectomía mecánica con el dispositivo Trevo en el ictus cerebral isquémico agudo. Materiales y Métodos: realizamos un estudio retrospectivo de 145 pacientes con infarto cerebral isquémico agudo tratados mediante trombectomía mecánica con el dispositivo Trevo entre octubre del 2008 y marzo del 2012. 87,3 por ciento circulación anterior y 12,7 por ciento circulación posterior. Resultados: la edad media de presentación fue 67 años (rango 21-82; 54,5 por ciento sexo masculino). El NIHSS basal de presentación fue de 17 (rango, 18-22). La mediana desde el inicio de los síntomas a punción arterial fue de 263 minutos (173-296). Recanalización satisfactoria (TICI 2-3) del 91 por ciento con un 45 por ciento de buen pronóstico funcional (mRS de 0-2) a los 90 días. Mortalidad de 23 por ciento a los 90 días con 11 por ciento de sangrado intracerebral. Conclusiones: en nuestra experiencia, el tratamiento endovascular del ictus isquémico agudo con el dispositivo Trevo es seguro y eficaz.

[Musculoskeletal chronic pain: Latin-American expert panel review based on scientific evidence]. / Dolor musculoesquelético crónico: Opinión de un grupo de expertos latinoamericanos basada en la evidencia científica.

Based on the continual medical education, in the first trimester of 2010 an expert in pain meeting has being made at Mexico City. The priority of the research was on educate residents of medical school or at their post graduate years, and the priority was on investigate of how our residents use adequate pain medication. In that first meeting at Mexico City, from different countries, the agreement was on inadequate use of pain treatment caused from inadequate education of the proper indication of drugs and other therapies for muscle skeletal pain. We decided to make a Latin American expert recommendation in chronic muscle pain where we include: epidemiological and socioeconomic pain data, actual classification of NSAIDs, pharmacological and other treatment in pain, and side effects of most popular drugs with actual recommendations. We include Medline guides, reviews, randomized studies and meta-analysis from 2001 to 2010.

Relación entre concentración intraoperatoria de parathormona y evolución postoperatoria del hiperparatiroidismo primario / Relationship between parathormone concentration during surgery and the post-operative outcome of primary hyperparathyroidism

Introducción Se analiza la relación entre la concentración intraoperatoria de parathormona (IOPTH) y la evolución a largo plazo de pacientes intervenidos por hiperparatiroidismo primario (HPTP). Pacientes y métodos Estudio prospectivo observacional que incluye 120 pacientes. Se realizaron tres determinaciones de PTH en sangre: basal, en el momento de localizar la glándula patológica y a los 10 minutos tras su extirpación. Se determinaron las concentraciones de calcio, PTH y vitamina D (25-OH-D3) durante el seguimiento. Resultados En 96 (80%) pacientes se observó disminución de IOPTH > 50% y el valor postextirpación volvió al rango normal (Grupo I), en 18 (15%) disminución > 50% pero el valor final se mantuvo superior al nivel normal (Grupo II) y en 6 (5%) la disminución fue<50% (Grupo III). Durante el seguimiento se detectó HPTP persistente en 6 pacientes (5%): uno en el Grupo I (1%), 3 (16,7%) en el II y 2 (33,3%) en el III (p<0,001). El riesgo de HPTP persistente fue superior en el Grupo II (odds ratio: 19; IC95%: 1,85-194) y en el III (odds ratio: 47; IC95%: 3,53-639). No se observaron casos de HPTP recidivado. Se detectó calcemia normal con PTH elevada en 20 pacientes del el Grupo I (20,8%), 11 (61,1%) en el II y 3 (50%) en el III (p<0,001). Estos pacientes presentaron menor concentración de vitamina D postoperatoria (17 ng/ml, rango: 24; frente a 28 ng/ml, rango: 21) (p=0,008) y mayor frecuencia de hipovitaminosis D (70,6% frente a 26,2%) (p>0,001).Conclusion El riesgo de persistencia del HPTP es superior cuando la IOPTH disminuye más del 50% pero se mantiene en niveles elevados (AU)

Introduction: The relationship between the intra-operative concentration of parathyroid hormone (IOPTH) and the long-term outcome of patients intervened due to primary hyperparathyroidism (PHPT).Patients and methods: A prospective observational study was performed with 120 patients. Three determinations were made of PTH in blood: baseline, when the diseases gland was located, and 10 minutes after its extirpation. The calcium, PTH and vitamin D (25-OH-D3)levels were measured during follow up. Results: A decrease in IOPTH > 50% was observed in 96 (80%) patients, and the postextirpation value returned to the normal range (Group I), in 18 (15%) a decrease of > 50%but the final value remained higher than normal (Group II) and in 6 (5%) the decrease was < 50% (Group III). Persistent PHPT was detected during follow up in 6 patients (5%): one in Group I (1%), 3 (16.7%) in II and 2 (33.3%) in group III (P < .001). The risk of persistent PHPT was higher in Group II (odds ratio: 19; 95% CI: 1.85-194) and in Group III (odds ratio: 47; 95% CI:3.53-639). There were no cases of recurrent PHPT. A normal calcium with an increased PTH was detected in 20 patients of Group I (20.8%), 11 (61.1%) in II and 3 (50%) in III (P < .001).These patients had a lower concentration of post-operative vitamin D (17 ng/ml, range: 24;compared to 28 ng/ml, range: 21) (P = .008) and higher frequency of hypovitaminosis D(70.6% compared to 26.2%) (P>.001). Conclusion: The risk of persistent PHPT is higher when the IOPTH decreases more than 50%but still remains high (AU)

[Relationship between parathormone concentration during surgery and the post-operative outcome of primary hyperparathyroidism]. / Relación entre concentración intraoperatoria de parathormona y evolución postoperatoria del hiperparatiroidismo primario.

INTRODUCTION: The relationship between the intra-operative concentration of parathyroid hormone (IOPTH) and the long-term outcome of patients intervened due to primary hyperparathyroidism (PHPT). PATIENTS AND METHODS: A prospective observational study was performed with 120 patients. Three determinations were made of PTH in blood: baseline, when the diseases gland was located, and 10 minutes after its extirpation. The calcium, PTH and vitamin D (25-OH-D3) levels were measured during follow up. RESULTS: A decrease in IOPTH > 50% was observed in 96 (80%) patients, and the post-extirpation value returned to the normal range (Group I), in 18 (15%) a decrease of > 50% but the final value remained higher than normal (Group II) and in 6 (5%) the decrease was<50% (Group III). Persistent PHPT was detected during follow up in 6 patients (5%): one in Group I (1%), 3 (16.7%) in II and 2 (33.3%) in group III (P<.001). The risk of persistent PHPT was higher in Group II (odds ratio: 19; 95% CI: 1.85-194) and in Group III (odds ratio: 47; 95% CI: 3.53-639). There were no cases of recurrent PHPT. A normal calcium with an increased PTH was detected in 20 patients of Group I (20.8%), 11 (61.1%) in II and 3 (50%) in III (P<.001). These patients had a lower concentration of post-operative vitamin D (17 ng/ml, range: 24; compared to 28 ng/ml, range: 21) (P=.008) and higher frequency of hypovitaminosis D (70.6% compared to 26.2%) (P>.001). CONCLUSION: The risk of persistent PHPT is higher when the IOPTH decreases more than 50% but still remains high.

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

Tratamiento conservador del embarazo ectópico cornual / Conservative treatment of cornual ectopic pregnancy

El embarazo cornual es una forma infrecuente de embarazo ectópico. El uso de la ecografía vaginal permite hacer un diagnóstico temprano y realizar un tratamiento conservador con metotrexato. La histeroscopia se puede utilizar como técnica complementaria en el seguimiento de estas pacientes. Presentamos 3 casos de embarazo ectópico cornual atendidos en nuestro hospital en el plazo de un año. La introducción de la ecografía vaginal permite hacer un diagnóstico temprano de este tipo de embarazos y plantear un tratamiento conservador con metotrexato, si la situación hemodinámica de la paciente lo permite. De los 3 casos que presentamos, 2 tuvieron una evolución favorable con metotrexato. En el tercer caso se produjo una rotura uterina a pesar del metotrexato y fue necesario realizar una resección cornual de urgencia

Cornual pregnancy is and infrequent type of ectopic pregnancy. With the use of transvaginal ultrasounds we can make an earlier diagnostic and try a conservative treatment with metotrexate. The hysteroscopy can be used as a complementary technique in the following of these patients. We present three cases of cornual ectopic pregnancies diagnosticated in our hospital during a year. With the use of transvaginal ultrasound we can made and early diagnosis and a conservative treatment with methotrexate if the hemodinamyc situation of de patient is good. In two of the cases we observed a satisfactory evolution with the methotrexate. In the third case there was a rupture in the uterus in addition of the methotrexate, and an emergency surgery was needed