Fisioterapia respiratoria ecoguiada: a propósito de un caso / Ultrasound-guided physiotherapy: A case report

Introducción: La limitada precisión diagnóstica de la auscultación y la radiografía frente a la ecografía torácica hace que el proceso de decisión clínica en fisioterapia respiratoria no sea el óptimo. El objetivo de este caso es abordar el interés de la ecografía pulmonar aplicado a la fisioterapia respiratoria. Descripción del caso: Mujer de 75 años ingresada en Cuidados Intensivos Respiratorios por insuficiencia respiratoria aguda. Intervención: La utilización de la ecografía torácica nos permite, gracias a su mayor precisión, confirmar el diagnóstico de atelectasia. A continuación, su utilización durante el tratamiento nos permite monitorizar la respuesta del pulmón a nuestra intervención hasta objetivar signos de una correcta aireación pulmonar. Conclusiones: Vistas las ventajas que presenta la ecografía torácica, el fisioterapeuta respiratorio debería integrar la utilización de esta herramienta diagnóstica junto con las tradicionales, tanto en la práctica clínica como en investigación

Background: The limited diagnostic accuracy of auscultation and radiography compared to thoracic ultrasound makes it less than optimal for clinical decision-making in respiratory physiotherapy. The objective of this study is to address the usefulness of pulmonary ultrasound applied to respiratory physiotherapy. Case description: The patient is a 75-year-old woman admitted to the Respiratory Intensive Care Unit due to acute respiratory failure. Intervention: Ultrasound's greater precision confirms a diagnosis of atelectasis. Lung ultrasound helps us in guiding our treatment, acting as a monitor of the lung's response, until signs of pulmonary re-aeration can be observed. Conclusions: The advantages observed of thoracic ultrasound show that respiratory physiotherapists should include this diagnostic tool, in both clinical practice and in research

HIPECT4: multicentre, randomized clinical trial to evaluate safety and efficacy of Hyperthermic intra-peritoneal chemotherapy (HIPEC) with Mitomycin C used during surgery for treatment of locally advanced colorectal carcinoma.

BACKGROUND: Local relapse and peritoneal carcinomatosis (PC) for pT4 colon cancer is estimated in 15,6% and 36,7% for 12 months and 36 months from surgical resection respectively, achieving a 5 years overall survival of 6%. There are promising results using prophylactic HIPEC in this group of patients, and it is estimated that up to 26% of all T4 colon cancer could benefit from this treatment with a minimal morbidity. Adjuvant HIPEC is effective to avoid the possibility of peritoneal seeding after surgical resection. Taking into account these results and the cumulative experience in HIPEC use, we will lead a randomized controlled trial to determine the effectiveness and safety of adjuvant treatment with HIPEC vs. standard treatment in patients with colon cancer at high risk of peritoneal recurrence (pT4). METHODS/DESIGN: The aim of this study is to determine the effectiveness and safety of adjuvant HIPEC in preventing the development of PC in patients with colon cancer with a high risk of peritoneal recurrence (cT4). This study will be carried out in 15 Spanish HIPEC centres. Eligible for inclusion are patients who underwent curative resection for cT4NxM0 stage colon cancer. After resection of the primary tumour, 200 patients will be randomized to adjuvant HIPEC followed by routine adjuvant systemic chemotherapy in the experimental arm, or to systemic chemotherapy only in the control arm. Adjuvant HIPEC will be performed simultaneously after the primary resection. Mitomycin C will be used as chemotherapeutic agent, for 60 min at 42-43 °C. Primary endpoint is loco-regional control (LC) in months and the rate of loco-regional control (%LC) at 12 months and 36 months after resection. DISCUSSION: We assumed that adjuvant HIPEC will reduce the expected absolute risk of peritoneal recurrence from 36% to 18% at 36 months for T4 colon-rectal carcinoma. TRIAL REGISTRATION: NCT02614534 ( clinicaltrial.gov ) Nov-2015.

Validation in colorectal procedures of a useful novel approach for the use of C-reactive protein in postoperative infectious complications.

AIM: Our aim was to validate a novel use of C-reactive protein (CRP) measurement to identify postoperative infectious complications in patients undergoing colorectal surgery, and to compare the predictive value in this setting against white blood cell (WBC) count and neutrophil-to-lymphocyte ratio (NLR). METHOD: This was a retrospective study of CRP, NLR and WBC measurements in patients undergoing colorectal surgery. CRP, NLR and WBC were recorded on the second postoperative day and on the day of infectious complication (patients who developed infectious complications) or within 3 days prior to discharge (subjects with no complications). The test for detecting infectious complications consisted of comparing the value of the inflammatory marker on the day on which a complication was suspected against the value recorded on the second postoperative day. The test was considered positive if a given value was higher than the registered peak at postoperative day 2. Factors influencing the postoperative peak CRP were also studied. RESULTS: A total of 254 patients were retrospectively studied. Patients whose CRP value was higher than on the second postoperative day had a diagnostic accuracy for infectious complications of up to 94.4% and sensitivity, specificity, positive predictive value and negative predictive value of up to 97.4%, 93.4%, 85.7% and 99.1%, respectively. Poorer results were observed when WBC count and NLR were used rather than CRP measurement. Multiple linear regression analysis showed that surgical procedure and approach, as well as additional resections, were independent factors for 48 h peak CRP. CONCLUSION: C-reactive protein is a better parameter than WBC count and NLR for detecting infectious complications. Our proposed methodology presents good diagnostic accuracy and performance and could potentially be used for any surgical procedure.

Study of the kinetics of the transport of Cu(II), Cd(II) and Ni(II) ions through a liquid membrane.

The coupled transport of Cu(II), Cd(II) and Ni(II) ions through a bulk liquid membrane (BLM) containing pyridine-2-acetaldehyde benzoylhydrazone (2-APBH) as carrier dissolved in toluene has been studied. Once the optimal conditions of extraction of each metal were established, a comparative study of the transport kinetics for these metals was performed by means of a kinetic model involving two consecutive irreversible first-order reactions. The kinetic parameters (apparent rate constants of the metal extraction and re-extraction reactions (k(1), k(2)), the maximum reduced concentration of the metal in the liquid membrane (R(o)max), the time of the maximum value of R(o)(t(max)) and the maximum entry and exit fluxes of the metal through the liquid membrane (J(f)max and J(s)max) of the extraction and stripping reactions were evaluated and results showed good agreement between experimental data and theoretical predictions. Complete transport through the membrane took place according to the following order: Cd(II)>Cu(II)>Ni(II), with similar kinetic parameters obtained for Cu(II) and Cd(III). The transport behaviour of Ni(II) was different to that of Cu(II) and Cd(III), probably due to the different stoichiometry of the nickel complex compared to those of the other metal ions and the different chemical conditions required for its formation. The influence of the sample salinity on the transport kinetics was studied. k(1) values decreased slightly when the feed solution salinity was increased for Cu(II) and Ni(II), but not for Cd(II). Values of k(2) were practically unaffected. The proposed BLM was applied to the preconcentration and separation of metal ions (prior to their determination) in water samples with different saline matrices (CRM, river water and seawater), and good agreement with the certified values was obtained.

Disfunción tiroidea en mujeres con sospecha de fibromialgia / Thyroid dysfunction in women with suspected fibromyalgia

Fundamento y objetivo: La fibromialgia (FM), por su prevalencia, morbilidad y tasa de frecuentación, representa un problema de salud y genera un elevado consumo de recursos sanitarios. La medida de tirotropina (TSH) en el suero se recomienda como prueba complementaria de primera línea para descartar hipotiroidismo como anomalía simuladora de la enfermedad. El objetivo fue analizar, en mujeres con sospecha de FM, la prevalencia de disfunción tiroidea (DT), la frecuencia de solicitud analítica de tirotropina, el efecto del tratamiento con levotiroxina y si se justifica o no el escrutinio de DT. Pacientes y métodos: Estudio descriptivo transversal. Desde enero de 2001 a octubre de 2004 se estudió a 400 mujeres consecutivas con sospecha de FM y a 384 controles. La medida de tirotropina se usó como primera prueba para detectar DT. Resultados: La prevalencia de DT en la sospecha de FM (40/400; 10%, intervalo de confianza [IC] del 95%, 7-13%) no difirió de la de controles (46/384; 12%, IC del 95%, 9-15%); tampoco al comparar distintos tipos y grados de DT. En la sospecha de FM, la DT fue más prevalente (p = 0,001) en portadoras (12%) que en no portadoras (5%) de enfermedad del tejido conectivo. La DT más frecuente fue el hipotiroidismo subclínico (5,5% en FM y 6,7% en controles), y en el 93% de casos nuevos la concentración de TSH fue < 10 mUI/l. La FM persistió en todas las pacientes hipotiroideas al lograrse el eutiroidismo. En 360 pacientes eutiroideas con sospecha de FM se realizaron 870 determinaciones de TSH. Conclusiones: En mujeres con sospecha de FM, la prevalencia de DT no difiere de la descrita en la población general, no parece justificarse el escrutinio de DT en no portadoras de enfermedad de riesgo y la demanda analítica es en muchos casos excesiva; el tratamiento del hipotiroidismo no influye en la FM(AU)

Background and objective: Due to its prevalence, morbidity, and frequency rate, fibromyalgia (FM) represents a health problem and produces high healthcare resource utilization. Serum thyrotropin (TSH) measurement is recommended as a first-line laboratory test to exclude hypothyroidism as a cause of FM syndrome. The aim of this study was to analyze the prevalence of thyroid dysfunction (TD), the frequency of TSH measurement, the effect of levothyroxine treatment, and whether screening for TD is justified in women with suspected FM. Patients and methods: A cross-sectional descriptive study was performed in 400 consecutive female outpatients with suspected FM and in 384 controls from January 2001 to October 2004. TSH measurement was used as the first line test to detect TD. Results: The prevalence of TD in patients with suspected FM (40/400; 10%; 95% CI: 7-13%) and controls was similar (46/384; 12%; 95% CI: 9-15%). No differences were found in the types and grades of TD. The prevalence of TD was higher in patients with suspected FM and connective tissue diseases (12%) than in those without these diseases (5%). The most frequent TD was subclinical hypothyroidism (5.5% in suspected FM and 6.7% in controls), and in 93% of these cases TSH concentrations were <10 mIU/L. FM persisted in all women with hypothyroidism even after euthyroidism was achieved with levothyroxine. A total of 870 TSH determinations were performed in 360 euthyroid patients with suspected FM. Conclusions: The prevalence of TD in women with suspected FM does not differ from that in the general population. Screening for TD does not appear to be justified in women without diseases that increase their risk. In many cases the request for thyroid function tests is excessive. Treatment for hypothyroidism does notaffect FM(AU)

Artritis enteropática / Enteropathic arthritis

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[Thyroid dysfunction in women with suspected fibromyalgia]. / Disfunción tiroidea en mujeres con sospecha de fibromialgia.

BACKGROUND AND OBJECTIVE: Due to its prevalence, morbidity, and frequency rate, fibromyalgia (FM) represents a health problem and produces high healthcare resource utilization. Serum thyrotropin (TSH) measurement is recommended as a first-line laboratory test to exclude hypothyroidism as a cause of FM syndrome. The aim of this study was to analyze the prevalence of thyroid dysfunction (TD), the frequency of TSH measurement, the effect of levothyroxine treatment, and whether screening for TD is justified in women with suspected FM. PATIENTS AND METHODS: A cross-sectional descriptive study was performed in 400 consecutive female outpatients with suspected FM and in 384 controls from January 2001 to October 2004. TSH measurement was used as the first line test to detect TD. RESULTS: The prevalence of TD in patients with suspected FM (40/400; 10%; 95% CI: 7-13%) and controls was similar (46/384; 12%; 95% CI: 9-15%). No differences were found in the types and grades of TD. The prevalence of TD was higher in patients with suspected FM and connective tissue diseases (12%) than in those without these diseases (5%). The most frequent TD was subclinical hypothyroidism (5.5% in suspected FM and 6.7% in controls), and in 93% of these cases TSH concentrations were <10 mIU/L. FM persisted in all women with hypothyroidism even after euthyroidism was achieved with levothyroxine. A total of 870 TSH determinations were performed in 360 euthyroid patients with suspected FM. CONCLUSIONS: The prevalence of TD in women with suspected FM does not differ from that in the general population. Screening for TD does not appear to be justified in women without diseases that increase their risk. In many cases the request for thyroid function tests is excessive. Treatment for hypothyroidism does not affect FM.

Enfermedad de Behçet y síndrome mielodisplásico con trisomía 8 adquirida / Behçet's disease and myelodysplastic syndrome with acquired trisomy 8

La asociación de enfermedad de Behçet (EB) con procesos mielodisplásicos es infrecuente. Por otra parte, la presencia de la trisomía del cromosoma 8 se ha relacionado con la presencia de alteraciones gastrointestinales en la EB. Esta trisomía 8 puede también estar presente como alteración cromosómica adquirida en los procesos mielodisplásicos; sin embargo, la coexistencia de EB y de leucemia mieloide crónica con trisomía 8 descrita en este caso se trata de un hecho excepcional. (AU)

Urachal-sigmoid fistula in an adult male without urachal cyst.

Urachal anomalies are uncommon defects arising either by incomplete obliteration of the urachus during the foetal period or by its reopening after postnatal regression. Five anomalies have been described: congenital patent urachus, urachal cyst, umbilical-urachal sinus, vesico-urachal diverticulum, and alternating sinus. Only congenital patent urachus is present at childbirth. The other forms are usually acquired disorders. Nevertheless, they commonly appear in children, being less common in the adult. Colic-urachal fistulas are quite uncommon findings. Only three cases have been reported thus far. The aim of this study is to report the fourth case of sigmoid-urachal fistula, and the first one appearing without an urachal cyst.

Fístula sigmoidouracal en un paciente adulto en ausencia de quiste de uraco / Urachal-sigmoid fistula in an adult male without urachal cyst

Presentamos el caso de un paciente varón de 57 años que consultó por descarga umbilical de material fecaloideo junto con dolor e irritación periumbilical años después de haber comenzado con episodios intermitentes de neumaturia y fecaluria. Ninguna de las exploraciones complementarias realizadas aportaron información relevante para el diagnóstico. La intervención quirúrgica demostró la existencia de una fístula sigmoidouracal. Creemos de interés este caso debido a la rareza de este diagnóstico ya que sólo han sido descritos tres casos en la literatura siendo éste el único caso en que no se apreció la presencia previa de un quiste uracal (AU)

Farmacogenética de la azatioprina y sulfasalazina en la Guía de Práctica Clínica de la Artritis Reumatoide (GUIPCAR) / Pharmacogenetics of Azathioprine and sulfasalazine in the Guía de Práctica Clínica de la Artritis Reumatoide

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Manifestaciones extraarticulares de la artritis reumatoide / Extra-articular manifestations in rheumatoid arthritis

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Comparative double-blind study of droxicam (new NSAID) versus indomethacin in rheumatoid arthritis.

This randomized, controlled and double-blind clinical trial compares the efficacy of droxicam (20mg/day) with that of indomethacin (75mg/day) in 40 RA patients (11 male, 29 female) aged (+/- SD) 53 +/- 12.5 years. After a 7-day single-blind run-in placebo period, patients were divided into two groups and treated for 9 weeks. Assessments were done at baseline and at the end of the 1st, 2nd, 4th, 6th and 9th weeks. Both drugs improved significantly the articular pain, the duration of morning stiffness, the articular index, the functional status and the degree of fatigue. Patient's and doctor's opinions were in accordance with the above-mentioned results. The effect of both drugs was more noticeable in the first 2 weeks of treatment. Droxicam was found to be statistically more active than indomethacin in alleviating morning stiffness and improving the functional status. The improvement of the variables induced by droxicam increased progressively throughout the study whereas that induced by indomethacin remained unchanged after the 2nd or 4th week of treatment. One patient treated with indomethacin withdrew from the study due to staggering and dizziness and several patients reported dyspepsia. Droxicam seems to be as effective as indomethacin (75mg/day) in the symptomatic relief of RA patients. The possibility of the use of droxicam for the relief of morning stiffness is of particular interest.

[An analysis of calcium pidolate absorption and a comparison with that of a salt in common use, gluconate-lactate-carbonate, in postmenopausal osteoporosis]. / Análisis de la absorción del pidolato de calcio y comparación con la da una sal de uso común, el glucono-lactato-carbonato, en la osteoporosis postmenopáusica.

The absorption of calcium pidolate is studied in 10 females suffering from osteoporosis by oral overload compared to the results of the glucono-lactate-carbonate. 405 mq of Ca pidolate produced a higher excretion of calcium by urine and an increase of Ca levels in blood than that produced by 1000 mq of Ca glucono-lactate-carbonate. The tolerance and the lack of side effects were the common feature in both salts. There were no effects on parathyroid glands nor bone resorption. We concluded that calcium pidolate is a safe and efficient treatment for osteoporosis because of easy absorption, which is very helpful in maintaining the calcium balance.