[Biliary microbiote in cholecystectomized patients: Review of empirical antibiotherapy]. / Microbiota biliar en pacientes colecistectomizados: Revisión de la antibioterapia empírica.

OBJECTIVE: Cholecystitis is an important cause of hospital admission. In moderate or severe cholecystitis, the delay in treatment can lead to serious complications. Our objective is to analyze the microorganisms isolated in bile from cholecystectomized patients and their sensitivity pattern, to evaluate the empirical treatment in those cases in which the surgical removal of the gallbladder should be delayed. METHODS: Prospective descriptive study of biliary cultures of patients undergoing cholecystectomy from May 2013 to February 2015, in the Surgery Department of the Hospital General Universitari de Castelló. RESULTS: We studied 196 patients, 83 women (42.3%) and 113 men (57.7%), with an average age of 61.5 years. The most used antibiotics as empiric treatment were piperacillin/tazobactam (77.8%) and amoxicillin/clavulanic (14.8%). In 46.4% of patients (91/196) bile cultures were positive. 165 microorganisms were isolated. The majority were Gram-negative bacilli (60.5%), mainly of the Enterobacterales order (91/54.5%), with Escherichia coli being the most frequent microorganism (24%) followed by Klebsiella spp. (12.5%). 3 E. coli with extended-spectrum beta-lactamase (ESBL) and 1 K. pneumoniae with ESBL were isolated. Microorganisms producing carbapenemase and methicillin-resistant Staphylococcus aureus were not isolated. CONCLUSIONS: The bile microbiota, with a predominance of Enterobacterales is similar to that found in european studies..

Proteomic analysis of Strongyloides stercoralis L3 larvae.

Strongyloidiasis can be perpetuated by autoinfection with the filariform larvae L3, causing asymptomatic chronic infections and creating a population of carriers, affecting not only developing countries. So far, very little is known about the proteins that interact with the human host, and few proteins from the infective Strongyloides stercoralis L3 have been characterized. Here, we report results obtained from a proteomic analysis of the proteins from S. stercoralis L3 larvae obtained from patients. Since the genome of S. stercoralis is not yet available, we used proteomic analysis to identify 26 different proteins, 13 of them released by short digestion with trypsin, which could represent surface-associated proteins. The present work extends our knowledge of host-parasite interactions by identifying proteins that could be of interest in the development of diagnostic tools, vaccines, or treatments for a neglected disease like strongyloidiasis.

Temporomandibular joint discectomy for treatment of unilateral internal derangements--a 5 year follow-up evaluation.

Fifteen fully dentated patients with pain and functional impairment due to unilateral temporomandibular joint disc displacements, who had undergone unsuccessful nonsurgical treatment, were treated with discectomies without any disc substitutes and followed for 5 years. Their contralateral temporomandibular joints were without any clinical or radiographic evidence of pathology. Functional pain was reduced and mandible opening ability increased although a full range of motion was not restored. This study verified that discectomies can reduce pain on chewing, however, pain at rest was not significantly changed. At 5 years 87% of the patients fulfilled the criteria for a successful result of TMJ surgery.

High prevalence of Strongyloides stercoralis among farm workers on the Mediterranean coast of Spain: analysis of the predictive factors of infection in developed countries.

Strongyloidiasis is a parasitosis characterized by persistent infection before dissemination and the development of potentially fatal disease. Since diagnosis is difficult, knowledge of the prevalence and geographic distribution of the disease is of practical importance. A study was made of Strongyloides stercoralis infection in a random and representative sample of farm workers in a tourist region in Spain based on the detection of larvae of triple stool samples. The prevalence of infection was 12.4% (95% confidence interval [CI] = 8.4-16.4). None of the 26 clinical or epidemiologic variables analyzed were found to be predictive of infection. Only eosinophilia (> 400 eosinophils/mm3) was significantly greater among the infected individuals (odds ratio = 73.4, 95% CI = 16.3-327.0), with a sensitivity of 93.5% and a specificity of 93.1%. A screening program is proposed to detect eosinophilia, to provide treatment without stool examinations, and thus afford a cost-effective policy for preventing the development of severe forms of the disease among specific risk groups where the prevalence of other parasitoses is low.

Tratamiento empírico de las eosinofilias.Prevenir las complicaciones de la estrongiloidiasis / Empirical treatment of eosinophilas. Prevent the complications of srongyloidiasis

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[Is mucinous colorectal adenocarcinoma a distinct entity?]. / Es el adenocarcinoma colorrectal mucinoso una entidad diferente?

INTRODUCTION: Several publications have demonstrated that mucinous carcinomas of the colon and rectum are associated with certain clinicopathological and genetic peculiarities that distinguish them from non-mucinous carcinomas. The principal aim of this study was to evaluate whether the biological behavior of mucinous carcinomas differs from that of intestinal carcinomas in patients undergoing surgery for colorectal cancer. PATIENTS: Between January 1993 and December 2000, 215 patients. underwent surgery in our hospital for colorectal cancer. The patients were divided into two groups according to histological type: tumors were intestinal in 169 patients (82%) and mucinous in 36 (17.6%). Patients undergoing non-resective surgery and those with tumors of other histological types (n = 10) were excluded. RESULTS: The percentage of patients aged less than 50 years in the group with mucinous carcinoma was 19% (7/36) compared with 4% (7/169) in the non-mucinous group (p = 0.001). Regarding presenting symptoms, anemia was more frequent in patients with mucinous carcinoma (18.2% [n = 6] vs 5.7% [n = 8]) and a change in bowel habits was less frequent (15% [n = 5] vs 34.3% [n = 48]; p < 0.05). A total of 63.9% of mucinous carcinomas (n = 23) were located in the proximal colon (cecum, ascending and transverse colon) compared with 21.3% (n = 36) of non-mucinous carcinomas (p < 0.001). Surgical intention was palliative in 41.7% (n = 23.7) of mucinous carcinomas and in 23.7% (n = 40) of non-mucinous carcinomas (p < 0.05). The mean tumoral size was 6.2 2.5 cm in mucinous carcinomas and 4.7 2 in non-mucinous carcinomas (p = 0.001). Patients with mucinous carcinoma presented a higher percentage of nodal and distant metastases and a lower percentage of early stage tumors (p < 0.05). However, no differences were found in survival between the two histological types. CONCLUSION: Mucinous tumors were more frequently located in the right colon and in patients less than 50 years old and were more likely to be in more advanced stages than non-mucinous tumors but no differences were found in survival according to tumor type.

Revascularisation of costochondral grafts: an experimental study in domestic pigs.

Mandibular condyles are reconstructed immediately with costochondral grafts (CCGs) in children for several temporomandibular conditions, including ankylosis, benign neoplasia, and chronic arthritis. A prerequisite for growth of CCGs is that they are properly revascularised, but the revascularisation process has not to our knowledge so far been examined. The aim of the present study was therefore to investigate the revascularisation of CCGs when they were used for immediate reconstruction of the mandibular condyle in juvenile domestic pigs. Eleven mandibular condyles were experimentally resected and immediately reconstructed with CCGs. Microangiograms with an Indian ink solution were done 2, 4, 8, and 12 weeks after the reconstructions. The density of vessels was higher in measurement zones facing soft tissues than in those facing mandibular bone at all time points. Revascularisation of the growth plate originated from the surrounding recipient soft tissues and not from an endosteal blood supply from the host mandible ramus.

Growth of costochondral grafts in reconstruction of the mandibular condyle: an experimental study in domestic pigs.

Reconstruction of the mandibular condyle with costochondral grafts (CCGs) in children may result in overgrowth at the reconstructed side of the mandible. In this study we report on the effects of functional stimuli on growth and morphology of growth plates of CCGs used for immediate mandibular condyle replacement in 10 juvenile pigs. The mandibular condyles were resected unilaterally and immediately reconstructed with autogenous CCGs. Another CCG was placed submuscularly on one tibia. The lengths of both CCGs and of one rib before resection were measured at operation and 12 weeks later. The grafts were labelled with intraperitoneal injections of oxytetracycline and alizarin eight and 12 weeks postoperatively, respectively. The extent of growth of the CCGs in the two environments was similar, so we concluded that the functional stimuli in the TMJ environment had only a minor influence on the extent of growth of the CCGs. The morphology of the growth plate of the CCGs had changed considerably.

The mandibular condyle in juvenile chronic arthritis patients with mandibular hypoplasia: a clinical and histological study.

In 12 JCA patients with severe mandibular hypoplasia, who all strongly demanded early treatment, 21 mandibular condyles were replaced by costochondral grafts. All of them had radiographic morphological changes in the mandibular condyles with varying degrees of destruction of the articular cartilages. Severe pathological changes in the lower joint compartments were consistently observed at surgery. Hence, the lower joint compartments were obstructed with granulomatous tissue, whereas the upper compartments were without macroscopic pathological changes. These findings indicated a polarized involvement of the temporomandibular joint (TMJ) in juvenile chronic arthritis (JCA). The extent of condylar articular surface destruction at histological examination varied from focal to total cartilage destruction. Inflammation of the subchondral bone marrow was a frequent finding. In spite of considerable arthritic destruction of the condyles, only one patient had TMJ pain, while a restricted mouth opening capacity was a more frequent finding. Thus, TMJ pain did not seem to constitute a reliable symptom of serious arthritic destruction of the mandibular condyle.

Endemic strongyloidiasis on the Spanish Mediterranean coast.

Diagnosis and treatment of Strongyloides stercoralis infection can be difficult, and a high degree of clinical suspicion in patients who have visited an endemic area is required. We describe the epidemiology and clinical features of 152 prospectively identified cases of strongyloidiasis in an European region, and identify risk factors for the development of severe forms of the disease. This was a prospective study of all patients admitted to a single institution over an 8-year period. Patients (n=152) were mainly elderly male farmers (79%) who had acquired the disease by working barefoot in contact with soil and ingesting non-drinking water. Eosinophilia was a sensitive marker for the infection (82%). Twenty patients (13%) developed severe forms of the illness and six patients (4%) died. A significant association was found between severe forms of strongyloidiasis and steroid usage (OR 9.0, 95%CI 2.1-37.6), immunodebilitating illness (OR 10.1, 95%CI 3.2-32.3) and other immunosuppressive therapy (OR 13.7, 95%CI 2.9-58.7), but by logistic regression analysis, only immunodebilitating disease was as a risk factor (OR 2.1, 95%CI 1.78-2.43). S. stercolaris infection is endemic in the Spanish Mediterranean coast. The frequent development of severe forms of the disease, with a high mortality, makes early recognition and treatment essential.

[Agricultural occupation and strongyloidiasis. A case-control study]. / Actividad laboral agrícola y estrongiloidiasis. Estudio caso-control.

BACKGROUND: In the last few years, Strongyloides stercoralis has been repeatedly recovered from indigenous farmers in the Safor area (Valencia Community). The relationship between the different occupational activities, mainly farming, and the presence of strongyloidiasis was investigated. PATIENTS AND METHODS: A paired case-control study was designed. The investigation was conducted at Oliva Centro de Salud, from October 1997 to October 1999. Diagnosis was established when Strongyloides stercoralis was observed in any of the three serial fecal samples requested when eosinophilia was observed in the hemogram. Controls were persons matched by sex and age (+/- 5) years, with no eosinophilia in the hemogram and in whom the presence of the parasite was excluded in fecal samples. RESULTS: Participants in the study were 47 cases and their respective controls. Each group included 39 (83%) men and 8 (17%) women. Forty-five cases (95%) and 42 controls (89%) had been born in Safor. Only two cases had travelled to endemic areas. Farming was the main activity in 32 (68%) cases and 31 (66%) controls. The only occupational activity which showed influence on strongyloidiasis was working in ricefields, with an OR of 2.97 (95% CI: 1.16-7.71). Dermatologic symptoms were significant for pruritus, OR 7.39 (95% CI: 2.29-27.60). One case with hyperinfection and another with larva currens were diagnosed. CONCLUSION: In our area, working in ricefields and chronic pruritus are associated with chronic strongylodiasis.

Actividad laboral agrícola y estrongiloidiasis. Estudio caso-control / Farming occupation and strongyloidiasis. Case control study

Fundamento. En los últimos años Strongyloides stercoralis ha sido aislado repetidamente en agricultores autóctonos de la comarca de la Safor (Comunidad Valenciana). Se estudia la relación entre las distintas actividades laborales, principalmente las agrícolas, y la presencia de estrongiloidiasis.Sujetos y métodos. Se diseñó un estudio casocontrol apareado. El trabajo se ha desarrollado en el Centro de Salud de Oliva desde octubre de 1997 a octubre de 1999. En los casos el diagnóstico se estableció al observar Strongyloides stercoralis en alguna de las tres muestras seriadas de heces solicitadas ante la presencia de eosinofilias en el hemograma. Los controles eran personas de igual sexo y edad ñ 5 años, sin eosinofilia en el hemograma y en los que se excluyó la presencia del parásito en las muestras de heces. Resultados. Participaron 47 casos y sus respectivos controles. En cada grupo había 39 (83 por ciento) varones y 8 (17 por ciento) mujeres. Habían nacido en la Safor 45 (95 por ciento) casos y 42 (89 por ciento) controles. Sólo dos casos habían viajado a países endémicos. La agricultura era la actividad principal en 32 (68 por ciento) de los casos y en 31 (66 por ciento) de los controles. La única actividad en la que mostró influencias sobre la estrongiloidiasis fue el trabajo en arrozales, que obtuvo una odds ratio (OR) de 2,97 [intervalo de confianza (IC) 95 por ciento: 1,16-7,71]. Los síntomas dermatológicos resultaron significativos para el prurito, OR de 7,39 (IC 95 por ciento: 2,29-27,60). Fueron diagnosticados un caso con síndrome de hiperinfección y otro con larva currens. Conclusión. En nuestra zona el trabajo en arrozales y el prurito crónico muestran relación con la estrongiloidiasis crónica (AU)

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Temporomandibular disorders in juvenile chronic arthritis patients. A clinical study.

In a prospective study, 105 children with juvenile chronic arthritis (JCA) were clinically and radiographically examined. The aim was to investigate the distribution of symptoms and clinical signs of temporomandibular disorders and to study correlations with radiographic mandibular condylar lesions. The present material appeared to be a representative sample of Swedish JCA children with respect to the distribution of genders and JCA subtypes as well as the peak of onset of the disease. Symptoms from the masticatory system were common (26%) and pain at mandibular function and stiffness at mouth opening the most frequent ones. Restricted maximal voluntary mouth opening (MVM) was the most frequent clinical finding. Radiographic condylar lesions, frequently found in the present material (39%), were significantly correlated with postnormal occlusion, restricted MVM, anterior open bite and mandibular retrognathia. However, most of the JCA children with radiographic condylar lesions did not present with symptoms from the masticatory system, postnormal occlusion, restricted MVM, anterior open bite or mandibular retrognathia.

Perforaciones colónicas. Factores pronósticos / Colonic peforations. Prognostic factors

Objetivos. El objetivo principal del estudio fue valorar la influencia de diferentes factores de riesgo sobre la mortalidad de los pacientes, la influencia de dichos factores sobre la supervivencia en las perforaciones tumorales y finalmente comparar los resultados del grupo de perforaciones de etiología maligna con el de etiología benigna. Pacientes y métodos. En el presente estudio retrospectivo multicéntrico se presenta la experiencia de tres hospitales de la Comunidad Valenciana (Hospital General de Castellón, Hospital Gran Vía de Castellón y Hospital Comarcal de Vinaroz) en perforaciones de colon durante el período de tiempo comprendido entre enero de 1994 y abril de 1998. Fueron incluidos en el estudio un total de 68 pacientes, 38 varones y 30 mujeres con una edad media de 68 ñ 14 años (rango, 29-90). Se recogieron datos referentes a etiología, comorbilidad, clínica de presentación, exploraciones, hallazgos, técnica operatoria, morbimortalidad y seguimiento. Resultados. Se recogieron 13 etiologías diferentes, siendo la diverticulitis (n = 26; 38,2 por ciento) y las neoplasias (n = 21; 29,4 por ciento) las causas más frecuentes. En cuanto a los hallazgos (grado de contaminación), 17 pacientes (25 por ciento) presentaron abscesos, 15 (22,1 por ciento) peritonitis localizada, 21 (30,9 por ciento) peritonitis purulenta difusa y 15 (22,1 por ciento) peritonitis fecaloidea difusa. La estancia media hospitalaria fue de 18,3 ñ 13,8 días. Presentaron complicaciones postoperatorias 45 pacientes (66,2 por ciento), siendo las más frecuentes la infección de la herida quirúrgica (15; 22,1 por ciento), la evisceración (7; 10,3 por ciento) y el fallo multiorgánico (5; 7,4 por ciento). La mortalidad operatoria fue del 26,6 por ciento (14 pacientes). Conclusiones. La mortalidad perioperatoria es más elevada en aquellos pacientes de mayor edad, con clínica de diarrea al ingreso y a los que no se les practica resección de la zona perforada. La perforación es una complicación grave del cáncer de colon, con una mortalidad alta y mal pronóstico, presentando los pacientes con perforaciones tumorales mayor frecuencia de clínica de distensión abdominal y de complicaciones postoperatorias que aquellos con perforaciones benignas (AU)

Costochondral grafts to replace mandibular condyles in juvenile chronic arthritis patients: long-term effects on facial growth.

Long-term facial growth and clinical outcome after replacement of arthritic mandibular condyles by costochondral grafts and postoperative orthodontic guidance of the occlusion were studied until completion of facial growth in patients (n = 12) with juvenile chronic arthritis (JCA) affecting their temporo-mandibular joints (TMJs). The patients were between 10.1 and 16.7 years of age at surgery. Clinical records and radiographs for cephalometric measurements were taken preoperatively, 6-8 weeks after surgery and after completion of facial growth. A considerable potential for growth of the costochondral graft/mandible unit was demonstrated in all patients. The results also indicated a considerable risk of asymmetrical mandibular overgrowth (n = 8), which could not be correctly assessed until after skeletal maturation was complete. Without any active orthodontic treatment, compensatory growth of the alveolar processes closed the lateral open bites, which were created during surgery. The functional results of the reconstructed temporo-mandibular joints were good and the morbidity rate was low. Costochondral grafting is a versatile treatment when the TMJs are severely affected by JCA, but requires supervision of patients until skeletal maturation, to monitor possible mandibular overgrowth. Advantages of this method were re-established mandibular growth, good mandibular function, a low morbidity rate and early aesthetic improvement.

[30 cases of strongyloidiasis at a primary care center: characteristics and possible complications]. / Treinta casos de estrongiloidiasis en un centro de atención primaria: características y posibles complicaciones.

OBJECTIVE: To study the characteristics of the Strongyloides stercoralis infestation in our area. DESIGN: A 30-case series. Survey of workplace behaviour and hygienic conditions in the home. Review of clinical histories to check for factors putting subjects at risk of severe self-infection. SETTING: 21,000 inhabitants covered by the Oliva Health Centre. PATIENTS: All the cases diagnosed between January 1994 and June 1997. MEASUREMENTS AND INTERVENTIONS: The diagnosis was carried out by observing under the microscope both fresh Strongyloides stercoralis larvae and cultures of three serial faecal samples. RESULTS: We found 19 men (63.3%) and 11 women (36.7%), with an average age of 65 (SD, 11.5 years). 28 had been born in the area (93.4%). 15 had never travelled abroad (50%). Of the 19 men, 18 (94%) had done agricultural work barefoot, but none of the women. Clinically, 17 (56.6%) had chronic symptoms; cough was the most common, in 12 (40%). CONCLUSION: Incidence in our area of Strongyloidiasis, although diagnosed infrequently, has increased considerably with the systematic discarding of the infection in non-attributable cases of Eosinophilia.

[Infection by Strongyloides stercoralis in the county of Safor, Spain]. / Infección por Strongyloides stercoralis en la comarca de La Safor (Comunidad Valenciana).

BACKGROUND: Strongyloides stercoralis is an endemic nematode in tropical and subtropical regions, but almost unknown in Spain. PATIENTS AND METHODS: In order to know some epidemiological, clinical and analytic features of this infection in our area (La Safor, Valencia), we performed a prospective study for 19 months. Through the search for the parasite in feces of patients with eosinophilia, we identified 37 subjects who were studied at diagnosis and 4 months later. RESULTS: Thirty-three patients (89%) were currently, or had been agricultural workers, and thirty had worked barefooted and/or had drunk contaminated irrigation water. Twenty-three patients (62%) had a chronic or immunosuppressive diseases, and two of them on steroid treatment, developed a disseminated strongyloidiasis. Thirteen patients (35%) were asymptomatic; the rest had clinical manifestations attributed S. stercoralis, mainly digestive. Two of the patients with disseminated strongyloidiasis also had concomitant bacterial infections by Streptococcus bovis, Streptococcus faecalis and Enterobacter sp. At diagnosis, besides eosinophilia, 86.5% had raised levels of IgE. Four months later treatment, the number of eosinophils was normal and IgE levels significantly decreased. The diagnostic yield of parasitic study of feces was increased with the number of samples examined. Thiabendazole achieved erradication of the parasite in 35 patients, and the other two died because of disseminated strongyloidiasis. CONCLUSIONS: The presence of eosinophilia in patients from rural areas with subtropical climate should raise suspicion about infection by S. stercoralis, which, although sometimes is asymptomatic, may cause systemic bacterial infections in cases of hyperinfestation, specially when glucocorticoid treatment is given.