Pioderma gangrenoso: revisión de cinco casos / No disponible

Describimos cinco pacientes con pioderma gangrenoso derivados desde la consulta de Atención Primaria al servicio de Dermatología de referencia. Tres de ellos presentaban patología sistémica ya conocida, y en otro paciente se diagnosticó durante el estudio una gammapatía monoclonal. El pioderma gangrenoso es una dermatosis neutrofílica no infecciosa que se manifiesta como una úlcera dolorosa de rápida evolución, que puede asociarse a enfermedad inflamatoria intestinal, discrasias sanguíneas malignas, artritis reumatoide y otras enfermedades sistémicas. Ante la presencia de una lesión ulcerosa cutánea que no mejora con el tratamiento local, con cultivos negativos y sin respuesta al tratamiento antibiótico, se debe sospechar la existencia de pioderma gangrenoso, lo que obliga a descartar patología sistémica asociada y remitir a estos pacientes a consultas de Dermatología de referencia (AU)

We describe five patients with pyoderma gangrenosum who were refered from General Practicer to one Dermatology Department. Three of them presented previously known systemic pathology, and in another patient monoclonal gammapathy was disclosed. Pyoderma gangrenosum is a noninfectious neutrophilic dermatosis that manifests as a painful festering wound with rapid evolution that may be associated to inflammatory bowel disease, hematologic malignancy, rheumatoid arthritis and other internal disorders. Pyoderma gangrenosum should be suspected whenever there is festering skin ulcer that does not improve with the local treatment, with negative cultures and without response to the antibiotic treatment. A diagnosis of pyoderma gangrenosum should be followed by a search of systemic associated disorder and the patient should be sent in consultation to the corresponding Dermatology department (AU)

Anaerobic codigestion of the mechanically sorted organic fraction of a municipal solid waste with cattle manure in packed microcosms under batch conditions.

Packed microcosms, consisting of 0.6 L-flask filled with tire chips (TC, a non-cost-recyclable non-biodegradable material) or ceramic cubes, were employed in the wet batch mesophilic anaerobic codigestion of a mechanically sorted organic fraction of a municipal solid waste with cattle manure. Two different waste mixtures were digested within four successive batch experiments, performed by collecting the digested waste and by refilling each microcosm with the same experimental mixture. Methane production yields related to the first experiment were comparable to those of non-packed identically developed microcosms, while they significantly grew during all the following experiences. No CH4-production lag-phase was observed since the second batch experiment. Similar results were obtained for both packing materials: however, the highest methane yields were achieved within bioreactors packed with TC in the presence of a mixture in which the volatile suspended solids (VSS) provided by the municipal waste represented the 55% of the total ones. Under such condition, a methane yield corresponding to the biochemical methane potential (BMP) calculated through a 6-month experiment with non-packed microcosms (176 ml/gVS) was attained in about 1/4 of the time. Importantly, the BMP can significantly grow up as a consequence of the approach described in this study.

Sirolimus, Tacrolimus and Zotarolimus eluting stents to treat bifurcated lesions: a 7-month clinical outcome comparison.

AIM: Drug eluting stents (DES) have been shown to reduce restenosis compared with bare metal stents in bifurcated lesions. The aim of this study was to evaluate the long-term clinical outcomes of patients with bifurcated lesions treated by 3 different DES. METHODS: Consecutive patients with symptomatic coronary artery disease on one bifurcated lesion with SB>2.25 mm (on visual estimation) undergoing at the Department of Cardiology of the Catholic University of Rome, Italy were screened. Patients treated with Sirolimus-eluting stent (Cypher Select; SES Group), Tacrolimus-eluting stent (Taxus-Libertè; TA Group) and Zotarolimus-eluting stent (Endeavor Driver; ZOT Group) were enrolled in the study. Clinical and angiographic characteristics of all patients were prospectively recorded. Major adverse clinical events (MACE), including death, acute myocardial infarction (MI) or target lesion revascularization (TVR) by either percutaneous coronary intervention (PCI) or coronary surgery were recorded during the follow-up. Incidence of definite or probable stent thrombosis was calculated according to the ARC criteria. RESULTS: Two hundred and forty-one consecutive patients were enrolled (89 Group CY, 98 Group TA and 54 Group EN). Length of follow-up was 235+/-60 days. Baseline clinical and angiographic characteristic were similar across the groups. The adopted technique for stent implantation was provisional stenting (73.4%), T-stenting technique (7%), crush (7%) and V-stenting (2.6%). The rate of patients finally treated with two stents was similar among groups. The cumulative rate of MACE (9% SES, 12% TA, 11% ZOT: P=0.7) and of TVR (2% SES, 9% TA, 7% ZOT) was similar among groups. No definite stent thrombosis was observed during follow-up, while 1 probable stent thrombosis was observed in TA group. CONCLUSION: The clinical outcome of bifurcated lesions using DES and mainly a technique of single stent implantation is good. In the present observational study, clinical adverse events did not differ in patients with bifurcated lesions treated by Cypher, Taxus or Endeavor stent implantation.

Role of videofluorography swallow study in management of dysphagia in neurologically compromised patients.

PURPOSE: The aim of this study was to demonstrate the key role of the videofluorography swallow study (VFSS) in the management of patients with dysphagia and varying degrees of neurological deficit. MATERIALS AND METHODS: In 1 year (March 2004-March 2005) 47 patients with oropharyngeal dysphagia due to different types of neurological deficit and who required rehabilitation were studied. All patients underwent: (1) clinical history assessment, (2) speech therapy assessment and (3) VFSS using digital fluoroscopy (25 frames per second). Patients were divided according to the Waxman classification into seven levels of dysphagia, and the most suitable type of feeding was selected (normal diet, restricted diet, artificial nutrition). At discharge, the possibility of changing the dietary regimen followed in hospital was evaluated based on clinical progress, radiological follow-up and the degree of improvement obtained. RESULTS: VFSS confirmed aspiration in 21/47 (44%) patients, of whom four (8%) had not been suspected at clinical-speech therapy assessment. In 13/47 (28%) patients, VFSS identified changes at the oral (three patients) or pharyngeal stage (three patients) or both (seven patients) but with no signs of silent aspiration. In the remaining 13 (28%) patients, VFSS did not show any changes in swallow dynamics. On the basis of these data, together with the follow-up at the end of rehabilitation treatment, different nutritional strategies were adopted: artificial nutrition [percutaneous endoscopic gastrostomy (PEG) or nasogastric tube], a restricted-consistency diet or normal diet. CONCLUSIONS: Our experience shows that VFSS precisely classifies the degree of dysphagia that conditions the dietary management of each neurologically compromised patient.