Fracaso de los programas de cribado: cáncer de intervalo / Failure of screening programmes: Interval cancer

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Detection of interleukin-2 is not useful for distinguishing between latent and active tuberculosis in clinical practice: a prospective cohort study.

OBJECTIVE: Previous reports have identified interleukin-2 (IL-2), quantified in the supernatants of QuantiFERON®-TB Gold In-tube (QFT) after 72 h of incubation, as a potential biomarker for distinguishing between latent and active tuberculosis (TB). However, its validity has not been tested in an appropriate clinical cohort. METHODS: A multicentre study of 161 consecutive adult patients undergoing evaluation for active TB at eight TB Units in Spain. Interferon-γ (IFN-γ) and IL-2 were assessed in the supernatant of QFT after 16-24 h and 72 h of incubation. The accuracy of IL-2 for indicating latent TB infection (LTBI) was assessed by receiving operating characteristic curves. . RESULTS: Twenty-eight participants were not infected, 43 had LTBI, 69 had TB, and 21 were not classifiable. Median (interquartile range) IL-2 concentrations after 72 h of incubation were 0.0 pg/mL (0.0-0.0) in uninfected individuals, 261.0 pg/mL (81.0-853.0) in LTBI individuals, 166.5 pg/mL (33.5-551.5) in patients with extrapulmonary TB, 95.0 pg/mL (26.0-283.0) in patients with smear-negative pulmonary TB, and 38.5 pg/mL (7.5-178.0) in patients with smear-positive pulmonary TB (p <0.0001). The area under the curve of the receiving operating characteristic curve (95% CI) of IL-2 after 72 h of incubation for the diagnosis of LTBI was 0.63 (0.53-0.74) when all TB cases were considered as a single group, ranging from 0.59 (0.47-0.71) to 0.72 (0.58-0.85) when only extrapulmonary and smear-positive pulmonary TB cases respectively were considered. CONCLUSIONS: Quantification of IL-2 in the supernatant of QFT after a prolonged incubation is not useful to distinguish between LTBI and active disease in clinical practice.

4 ª Mesa Redonda: Tuberculosis pulmonar: Estado actual / No disponible

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Síndrome de Young en la edad adulta: tratamiento domiciliario mediante un dispositivo mecánico de percusión intrapulmonar / Young´s syndrome in the adult age: home tretatment with a mechanical device of intrapulmonary percusive ventilation

RESUMEN: Se describe el caso de un varón afecto de bronquiectasias, infecciones rinosinusales de repetición y azoospermia obstructiva que fue diagnosticado de síndrome de Young en la edad adulta. Junto con las medidas convencionales, el paciente fue tratado en domicilio mediante un sistema mecánico de cuidados respiratorios consistente en ventilación por percusión intrapulmonar (Percussionaire®) presentando una mejoría significativa clínica y funcional. Se señala la importancia de realizar una correcta historia de fertilidad en pacientes con clínica respiratoria compatible, con el fin de establecer el diagnóstico. Se revisan distintos métodos de asistencia mecánica respiratoria en pacientes con bronquiectasias, como complementarias en cuidado respiratorio domiciliario

We studied a man with bronchiectasis, chronic sinopulmonary infections and obstructive azoospermia daignosed of Young’s syndrome in the adult age. The patient was treated at home by a mechanical system of respiratory care based in intrapulmonary percussive ventilation (Percussionaire®) reaching a significant clinical and functional improvement. Our case enhanced the importance to make a proper history of fertility in patients with bronchiectasis in order to establish the diagnostic. Were view different methods of respiratory mechanical asistance in patients with bronchiectasis

[Young's syndrome in the adult age: home treatment with a mechanical device of intrapulmonary percusive ventilation]. / Síndrome de Young en la edad adulta: tratamiento domiciliario mediante un dispositivo mecánico de percusión intrapulmonar.

We studied a man with bronchiectasis, chronic sinopulmonary infections and obstructive azoospermia diagnosed of Young's syndrome in the adult age. The patient was treated at home by a mechanical system of respiratory care based in intrapulmonary percussive ventilation (Percussionaire) reaching a significant clinical and functional improvement. Our case enhanced the importance to make a proper history of fertility in patients with bronchiectasis in order to establish the diagnostic. We review different methods of respiratory mechanical assistance in patients with bronchiectasis.

Tratamiento con infliximab en la enfermedad de Crohn fistulizante y active: nuestra experiencia / Our experience in treatment of with anti-tumor necrosis factor antibody (infliximab) in Crohn's disease

Introducción. El infliximab es un anticuerpo sintético IgG1, compuesto por una región constante humana y una región variable murina dirigido contra el factor de necrosis tumoral, de tipo quimérico, indicado en la enfermedad de Crohn (EC) refractaria al tratamiento convencional. Objetivo. Valorar la tasa de respuesta y remisión clínica en la enfermedad de Crohn activa refractaria y en la fistulosa tratados con infliximab, y conocer el número de dosis necesarias para remisión clínica (RC/RP). Pacientes y métodos. 14 pacientes con EC (5 varones) edad media 33.3±10 años. Se indicó tratamiento por enfermedad fistulosa (13 casos) y por broto agudo de corticorresistente (1 caso). Administramos 5mg/kg. De infliximab en perfusión durante 2 horas a las 0, 2 y 6 semanas. Tres de los pacientes con fístula perianal se les administró una cuarta dosis. El paciente con brote grave recibió una sola dosis. Definimos como remisión clínica la del CDAI <150 puntos y como respuesta clínica la reducción de 70 puntos del CDAI desde la medición basal. En el paciente fistuloso definimos como respuesta completa (RC) el cierre total de las fístulas, con ausencia de drenaje y por respuesta parcial (RP) el cierre al menos el 50% de todas las fístulas. Resultados. Siete pacientes (60%) con fístulas obtuvieron RC tras la segunda dosis, tres (29%) con RP tras cuatro dosis de infliximab y tres (20%) no mejoraron y tuvieron que ser intervenidos quirúrgicamente. El paciente con brote grave obtuvo una mejoría total y se suspendió la 2º dosis por presentar como efectos secundarios taquicardia, disnea y calor, siendo el único que presentó efectos adversos. Todos habían recibido tratamiento con inmunosupresores. Conclusiones. El infliximab ha demostrado ser eficaz en el tratamiento de la enfermedad de Crohn fistulizada y en el manejo de la enfermedad aguda moderada a grave. Los efectos secundarios fueron generalmente leves y transitorios. En nuestro caso la respuesta al infliximab tuvo lugar con la segunda dosis en el 60%, con ganancial parcial del 20% con cuatro dosis

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[Rectosigmoid endometriosis with lymph node involvement]. / Endometriosis de rectosigma con afección de los ganglios linfáticos.

Endometriosis mainly affects women of a fertile age and is usually located in the pelvis. Extrapelvic involvement is less frequent. We present the case of a female patient with endometriosis of the rectosigmoid and mesenteric lymph nodes, which is an extremely rare finding. Although the most widely accepted theory of the pathogenesis of this disease postulates retrograde menstruation through the Fallopian tubes with subsequent implantation in the peritoneum, these findings support lymphatic dissemination of endometrial cells as a theory of pathogenesis in cases of extrapelvic involvement.

Hematoma subcapsular como complicación de biopsia hepática percutánea / Subcapsular hematoma as complication of percutaneous hepatic biopsy

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Control y supervisión del enfermo tuberculoso / Monitoring and supervision of the tuberculosis patient

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[Contribution of ultrasonography-guided microbiopsy in breast diseases]. / Apport de la micro-biopsie échoguidée dans la pathologie mammaire.

OBJECTIVE: To assess the usefulness of core biopsy under ultrasonography (CBUS). MATERIALS AND METHODS: 165 US guided breast lesions biopsies were reviewed. Forty-eight underwent surgery and the 117 remaining cases were followed up for at least one year. Forty-four lesions were malignant and 89 were no palpable. Lesion size ranged from 3 to 35 mm (mean 14.8 mm). Core biopsy was performed with an automatic device with a 18 Gauge needle using a long-throw (2.2 cm excursion). Needle length was 10 cm. At least two passes were performed. RESULTS: Five false negatives were obtained which were all explained. All the infiltrative carcinomas without microcalcifications as mammographic sign were correctly diagnosed. A resolutive hematoma was the only complication to occur. None of the lesions with follow up showed any evolution. With CBUS, sensitivity for malignancy was 91% and specificity 100%. This is in agreement with previous studies. CONCLUSION: Methodology and indications of such core biopsies are peculiar. Actually, the lesion must be seen with ultrasonography and should not be superficial, be correlated with microcalcifications, or be a cyst even with a thick content. This method is safe and comfortable. It is not expensive when compared with surgery or stereotaxy. It should avoid useless surgical open biopsies as it allows histologic diagnosis with Scarff and Bloom grading and hormonal receptor status. So, US guided core-biopsy should contribute to increase the predictive positive value of surgical biopsy in senologic screening.

[Diagnostic difficulties in infiltrating lobular breast cancer: value of ultrasonography. 33 cases]. / Difficultés du diagnostic du carcinome lobulaire infiltrant du sein: apport de l'échographie. A propos de 33 observations.

Thirty three invasive lobular carcinoma (ILC) were submitted to mammography, ultrasonography and finally surgery. The type of tumor proliferation and the absence of microcalcifications within the invasive tissue led to 15% of false negative responses in the mammographic analysis. Ultrasonography disclosed only 12% of false negatives. Sonographic appearance, especially fine needle aspirations or microbiopsy under ultrasonographic control, allows modification of mammographic and clinical diagnosis errors. Thus, this method appears of importance in diagnosis of ILC.

Use of a renal tubule cell line (LLC-PK1) to study the nephrotoxic potential of a kappa-type Bence-Jones protein.

The cytotoxicity of a Bence-Jones protein was assessed using a porcine renal tubule cell line (LLC-PK1), with the aim of developing a model for studying the potential nephrotoxicity of these proteins. The effects of a kappa Bence-Jones protein on cell viability were studied by means of biochemical methods (supravital dye uptake and measurement of cellular enzyme activities) and morphological electron microscopy. After a 24-h-treatment with Bence-Jones protein, a moderate cytotoxicity (about 15%) was noted but only a minor difference compared to treatment with bovine albumin in the same conditions. The morphological study showed a few cells in the process of lysis, but their numbers were insufficient for the demonstration of a clear cytotoxic effect. Immunocytochemical studies showed Bence-Jones protein fixation on some cells, especially on the outer membrane. Labeling of the hyaloplasm and basal pole of a few cells pointed to internalization of protein by LLC-PK1 cells. Although the cytotoxicity of the Bence-Jones protein tested here was only moderate, the use of this model enabled its cytotoxic effect to be distinguished from that of beta-lactoglobulin. This isolate could serve as a "moderate control" for a later study with a BJP having caused acute renal failure.

[The value of color Doppler ultrasound in the diagnosis of breast tumors]. / Intérêt de l'échographie Doppler couleur dans l'exploration des tumeurs du sein.

A prospective study was performed in 102 patients, including 40 malignant tumors (13 subclinical), to evaluate colour Doppler in breast tumours. All patients had abnormalities that led to their selection for this study. 92 patients had a mammographic examination. 10% of malignant tumours were not detected by mammography. Mammographic abnormalities without any ultrasonographic confirmation were excluded from this series. All the lesions have been proven by cytology or histology. In the assessment of malignancy only one false negative and two false positive results were obtained. The sensitivity and specificity of colour Doppler are both of 97% with radiate vessels beneath the tumour and intratumoral vessels as malignant criteria. This non invasive method should be performed in lesions with tissue ultrasonographic appearances even before fine needle puncture. So it may be possible to select more surgical indications considering an ultrasonographic abnormality atypical, subclinic or post-therapeutic (radiotherapy or surgery).