Síndrome de Pickering: insuficiencia cardiaca aguda con un actor inesperado / Pickering syndrome: acute heart failure with an unexpected actor

El síndrome de Pickering es una entidad clínica descrita en 1988 que consiste en la presentación de edemas agudos de pulmón «flash» recurrentes y de predominio nocturno e hipertensión arterial secundarios a estenosis bilateral de las arterias renales o unilateral en pacientes monorrenos. Describimos el caso de un varón de 74 años que tras el tratamiento percutáneo de exclusión de un aneurisma aórtico infrarrenal presentó síndrome de Pickering debido a obstrucción hemodinámica de la arteria renal izquierda por la endoprótesis aórtica; con evolución clínica satisfactoria después de la revascularización. (AU)

Pickering's syndrome is a clinical entity described in 1988 that consists of the presentation of recurrent and predominantly nocturnal acute flash pulmonary oedema and arterial hypertension secondary to bilateral renal artery stenosis or unilateral in single-kidney patients. We describe the case of a 74-year-old man who, after percutaneous exclusion treatment of an aortic infrarenal aneurysm, developed Pickering syndrome due to haemodynamic obstruction of the left renal artery because of the aortic endoprosthesis; with satisfactory clinical evolution after revascularization. (AU)

[Pickering syndrome: acute heart failure with an unexpected actor]. / Síndrome de Pickering: insuficiencia cardiaca aguda con un actor inesperado.

Pickering's syndrome is a clinical entity described in 1988 that consists of the presentation of recurrent and predominantly nocturnal acute flash pulmonary oedema and arterial hypertension secondary to bilateral renal artery stenosis or unilateral in single-kidney patients. We describe the case of a 74-year-old man who, after percutaneous exclusion treatment of an aortic infrarenal aneurysm, developed Pickering syndrome due to haemodynamic obstruction of the left renal artery because of the aortic endoprosthesis; with satisfactory clinical evolution after revascularization.

Consensus on the management of advanced radioactive iodine-refractory differentiated thyroid cancer on behalf of the Spanish Society of Endocrinology Thyroid Cancer Working Group (GTSEEN) and Spanish Rare Cancer Working Group (GETHI)

Thyroid cancer is the single most prevalent endocrine malignancy; differentiated thyroid cancer (DTC) accounts for more than 90 % of all malignancies and its incidence has been rising steadily. For more patients, surgical treatment, radioactive iodine (RAI) ablation, and thyroid-stimulating hormone (TSH) suppressive therapy achieve an overall survival (OS) rate of 97.7 % at 5 years. Nevertheless, locoregional recurrence occurs in up to 20 % and distant metastases in approximately 10 % at 10 years. Two-thirds of these patients will never be cured with radioactive iodine therapy and will become RAI-refractory, with a 3-year OS rate of less than 50 %. Over the last decade, substantial progress has been made in the management of RAI-refractory DTC. Given the controversy in some areas, the Spanish Task Force for Thyroid Cancer on behalf of Spanish Society of Endocrinology Thyroid Cancer Working Group (GTSEEN) and the Spanish Rare Cancer Working Group (GETHI) have created a national joint task force to reach a consensus addressing the most challenging aspects of management in these patients. In this way, multidisciplinary management should be mandatory and nuclear medicine targeted therapy, novel molecular targeted agents, and combinations are currently changing the natural history of RAI-refractory DTC (AU)

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Spanish consensus for the management of patients with anaplastic cell thyroid carcinoma

Anaplastic thyroid cancer (ATC) is the most aggressive solid tumor and almost uniformly lethal in humans. The Boards of the Thyroid Cancer Group of the Spanish Society of Endocrinology and Nutrition and the Grupo Español de Enfermedades Huérfanas e Infrecuentes of the Spanish Society of Oncology requested that an independent task force draft a more comprehensive consensus statement regarding ATC. All relevant literature was reviewed, including serial PubMed searches together with additional articles. This is the first, comprehensive Spanish consensus statement for ATC and includes the characteristics, diagnosis, initial evaluation, treatment goals, recommendations and modalities for locoregional and advanced disease, palliative care options, surveillance, and long-term monitoring. Newer systemic therapies are being investigated, but more effective combinations are needed to improve patient outcomes. Though more aggressive radiotherapy has reduced locoregional recurrences, median overall survival has not improved in more than 50 years (AU)

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Spanish consensus for the management of patients with anaplastic cell thyroid carcinoma.

Anaplastic thyroid cancer (ATC) is the most aggressive solid tumor and almost uniformly lethal in humans. The Boards of the Thyroid Cancer Group of the Spanish Society of Endocrinology and Nutrition and the Grupo Español de Enfermedades Huérfanas e Infrecuentes of the Spanish Society of Oncology requested that an independent task force draft a more comprehensive consensus statement regarding ATC. All relevant literature was reviewed, including serial PubMed searches together with additional articles. This is the first, comprehensive Spanish consensus statement for ATC and includes the characteristics, diagnosis, initial evaluation, treatment goals, recommendations and modalities for locoregional and advanced disease, palliative care options, surveillance, and long-term monitoring. Newer systemic therapies are being investigated, but more effective combinations are needed to improve patient outcomes. Though more aggressive radiotherapy has reduced locoregional recurrences, median overall survival has not improved in more than 50 years.

Consensus on the management of advanced radioactive iodine-refractory differentiated thyroid cancer on behalf of the Spanish Society of Endocrinology Thyroid Cancer Working Group (GTSEEN) and Spanish Rare Cancer Working Group (GETHI).

Thyroid cancer is the single most prevalent endocrine malignancy; differentiated thyroid cancer (DTC) accounts for more than 90 % of all malignancies and its incidence has been rising steadily. For more patients, surgical treatment, radioactive iodine (RAI) ablation, and thyroid-stimulating hormone (TSH) suppressive therapy achieve an overall survival (OS) rate of 97.7 % at 5 years. Nevertheless, locoregional recurrence occurs in up to 20 % and distant metastases in approximately 10 % at 10 years. Two-thirds of these patients will never be cured with radioactive iodine therapy and will become RAI-refractory, with a 3-year OS rate of less than 50 %. Over the last decade, substantial progress has been made in the management of RAI-refractory DTC. Given the controversy in some areas, the Spanish Task Force for Thyroid Cancer on behalf of Spanish Society of Endocrinology Thyroid Cancer Working Group (GTSEEN) and the Spanish Rare Cancer Working Group (GETHI) have created a national joint task force to reach a consensus addressing the most challenging aspects of management in these patients. In this way, multidisciplinary management should be mandatory and nuclear medicine targeted therapy, novel molecular targeted agents, and combinations are currently changing the natural history of RAI-refractory DTC.

Consensus on management of advanced medullary thyroid carcinoma on behalf of the Working Group of Thyroid Cancer of the Spanish Society of Endocrinology (SEEN) and the Spanish Task Force Group for Orphan and Infrequent Tumors (GETHI)

Background: Of all thyroid cancers,< 5 % are medullary (MTC). It is a well-characterized neuroendocrine tumor arising from calcitonin-secreting C cells, and RET gene plays a central role on its pathogeny. Methods: The electronic search was conducted using MEDLINE (PubMed), EMBASE and Cochrane Central Register of Controlled Trials. Quality assessments of selected current articles, guidelines and reviews of MTC were performed. Results: This consensus updates and summarizes biology, treatment and prognostic considerations of MTC. Conclusions: Multidisciplinary teams and specialized centers are recommended for the management of MTC patients. In the metastatic setting, those patients with large volume of disease are candidates to start systemic treatment mainly if they are symptomatic and the tumor has progressed in the last 12-14 months. Wait and see strategy should be offered to patients with: disseminated disease with only high levels of calcitonin and no macroscopic structural disease, low burden and absence of progression (AU)

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Consensus on management of advanced medullary thyroid carcinoma on behalf of the Working Group of Thyroid Cancer of the Spanish Society of Endocrinology (SEEN) and the Spanish Task Force Group for Orphan and Infrequent Tumors (GETHI).

BACKGROUND: Of all thyroid cancers, <5 % are medullary (MTC). It is a well-characterized neuroendocrine tumor arising from calcitonin-secreting C cells, and RET gene plays a central role on its pathogeny. METHODS: The electronic search was conducted using MEDLINE (PubMed), EMBASE and Cochrane Central Register of Controlled Trials. Quality assessments of selected current articles, guidelines and reviews of MTC were performed. RESULTS: This consensus updates and summarizes biology, treatment and prognostic considerations of MTC. CONCLUSIONS: Multidisciplinary teams and specialized centers are recommended for the management of MTC patients. In the metastatic setting, those patients with large volume of disease are candidates to start systemic treatment mainly if they are symptomatic and the tumor has progressed in the last 12-14 months. Wait and see strategy should be offered to patients with: disseminated disease with only high levels of calcitonin and no macroscopic structural disease, low burden and absence of progression.

Implementación de la estrategia basal plus en la práctica clínica / Basal plus strategy implementation in clinical practice

El tratamiento con insulina puede ser necesario en la diabetes tipo 2, dado que muchos pacientes, con el tiempo, no consiguen alcanzar o mantener los objetivos glucémicos para prevenir las complicaciones crónicas asociadas a la hiperglucemia sostenida. Inicialmente, la adición de insulina basal al tratamiento previo con agentes orales suele ser la pauta más habitual. Esta estrategia se basa en el control óptimo de la glucemia en ayunas. Sin embargo, un porcentaje significativo de pacientes no consiguen alcanzar o mantener el objetivo de HbA1c <=7%, debido a que presentan elevaciones excesivas de la glucemia posprandial. En consecuencia, el paso siguiente en la intensificación deltratamiento podría ser la adición de una dosis única de insulina prandial antes de la comida que provoca la mayor excursión posprandial (estrategia basal plus), manteniendo el tratamiento previo con insulina basal y agentes orales. Este régimen ha demostrado ser sencillo, eficaz y adecuado para un gran número de pacientes. Además, en caso necesario, facilita la introducción progresiva de inyecciones adicionales de insulina prandial hasta una estrategia bolo basal. En este artículo se resumen las recomendaciones de un grupo de trabajo multidisciplinar para una adecuada implementación de la estrategia basal plus en la práctica clínica habitual (AU)

Insulin treatment may be necessary in type 2 diabetes, because many patients are not able overthe time to achieve or maintain glycemic targets to prevent chronic complications associated to sustained hyperglycemia. Initially, addition of basal insulin to previous treatment with oral agentsis the most commonly used regimen. This strategy is based on optimal control of fasting plasma glucose. However, a significant proportion of patients does not achieve or maintain HbA1c target <=7%, because they show excessive postprandial glucose values. Therefore, the next step for intensification of treatment might be the addition of a single dose of prandial insulin before the main meal, which is associated with the greatest postprandial glucose excursion (basal plus strategy), maintaining previous treatment with basal insulin and oral agents. This regimen has demonstrated to be easy to use, effective and appropriate for many patients. Furthermore, if necessary, it makes easier progressive introduction of additional injections of prandial insulin until the basal bolus strategy. In this manuscript, recommendations from a multidisciplinary working group are summarized for an adequate implementation of the basal plus strategy in the routine clinical practice (AU)

Muertes traumáticas por accidentes laborales en Sevilla. Estudio epidemiológico y toxicológico / Fatal traumatic accidents at the work-place in Seville. Epidemiological and toxicological study

En este trabajo se realiza un análisis retrospectivo de lasmuertes traumáticas ocurridas por accidente laboral en la provinciade Sevilla durante cuatro años (2004-2007). Durantedicho periodo, de un total de 3632 autopsias forenses, se registraron99 muertes por accidentes laborales traumáticos. Trececasos fueron excluidos ya que el accidente había ocurrido enun lugar fuera de la provincia de Sevilla siendo finalmente 86los casos analizados. Todos los casos eran varones con unaedad media de 41±14 años (rango 16-74 años). Los fallecimientosocurrieron con más frecuencia durante el mes de enero, elmartes y de 8-15 h. La tasa media de accidentes laborales traumáticoscon resultado de muerte durante todo el período hasido de 2.6 por 100.000 trabajadores. Los sectores que registraronun mayor número de siniestros son servicios, donde seincluyen los transportes, seguido por la construcción y laindustria. El mecanismo de muerte más frecuente fue la caídaprecipitación,seguido por el aplastamiento y los accidentes detráfico. Las causas de muerte más habituales fueron los traumatismoscraneoencefálicos y el shock hipovolémico. El análisisquímico-toxicológico realizado en 71 casos (los 15 restanteshabían fallecido después de ingreso hospitalario prolongado)identificó sustancias tóxicas en 26 casos (30%), siendo el etanolel tóxico más consumido en 21/26 casos (aislado en 17/21casos y asociado con cocaína y cannabis en 2 casos cada uno)seguido de cannabis en 4/26 y cocaína en 1/26 casos.Las estrategias de prevención de los accidentes laboralestraumáticos deben hacer hincapié en la importancia de laabstinencia en el consumo de sustancias tóxicas como medidapara disminuir el número de estas dramáticas muertes

This retrospective study analyzes the fatal traumaticaccidents (FTA) at the work-place occurred in the province ofSeville during four years (2004-2007).In this period, 99 cases of FTA were registered from a total of3632 forensic autopsies. Thirteen cases occurred in a workplaceoutside the Seville province and were excluded fromthe study being finally 86 cases analyzed. All victims weremen (mean age 41±14 years, range 16-74). Fatalitiesoccurred preferably in January, Tuesday and between 8-15 h.The mean mortality rate of FTA in the whole period was 2.6per 100.000 workers. The sectors that register the highernumber of fatalities were services, including transportation,followed by construction and industry. The most frequentmanner of death was falling and jumping followed bycompression and traffic accidents. Death was usually due tobrain trauma and massive hemorrhage. Toxicological analysesperformed in 71 cases (the remaining 15 cases died afterprolonged hospital admission) demonstrated toxicologicalcompounds in 26 cases (30%) being ethanol the mostconsumed substance in 21/26 cases (alone in 17/21 casesand associated to cocaine and cannabis in 2 casesrespectively), followed by cannabis alone in 4/26 cases andcocaine alone in 1/26 cases. Prevention strategies of FTAmust be focussed in the importance in abstinence of toxicsconsumption as a way to reduce the number of thesedramatic deaths

Afasia de instauración aguda como forma de presentación inicial de una enfermedad de Creutzfeldt-Jakob / Acute-onset aphasia as the presenting symptoms in a case of Creutzfeldt-Jakob disease

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Prevalence of cutaneous manifestations in 200 patients with eating disorders.

BACKGROUND: Eating disorders are increasing and show a variety of symptoms. They mainly include anorexia nervosa (AN), bulimia nervosa (BN), and eating disorders not specified (EDNOS). They predominate in females and represent an important danger, especially in teenagers. In serious cases, they may be life-threatening. Objective To determine the prevalence of cutaneous findings in patients with eating disorders and to compare the results with those found in the literature. METHODS: An observational, transverse, and prospective study was performed. Two hundred patients of recent admission to ALUBA (association that fights against BN and AN), a psychiatric unit for eating disorders, were included: 122 BN; 62 AN; 16 EDNOS. RESULTS: Patients with eating disorders show dermatologic manifestations (alopecia, xerosis, hypertrichosis, caries, nail fragility) that are secondary to starvation. Russell's sign, seen as calluses on the dorsal aspect of the hands, is a consequence of self-induced vomiting and the local trauma of the superior incisors. This sign represents a compensatory behavior to overeating and predominates in the BN group. CONCLUSION: The recognition of dermatologic signs could be of immense value and could lead to the early diagnosis and treatment of these eating disorders.

Usefulness of pp65 antigenemia for the early diagnosis of cytomegalovirus disease in patients with AIDS.

An observational cohort study was performed to assess the effectiveness of a cytomegalovirus antigenemia (CMV-Ag) assay designed to predict clinical CMV disease in patients with AIDS. Eighty-six HIV-infected patients with CD4+ cell counts of < 100/mm3, positive CMV IgG, and no previous CMV disease were enrolled. Thirty-eight (44%) patients had at least one positive CMV antigenemia test, ten of whom eventually developed CMV focal disease. CMV disease was diagnosed in 13 (15%) patients. The CMV antigenemia assay was positive in ten of these 13 patients. Using a cut-off value of five positive cells in every 150,000 leukocytes sampled, the CMV antigenemia assay had a positive predictive value of 89% and a negative predictive value of 94%. The median time from the first positive CMV antigenemia test to the onset of CMV disease was 102 days. CMV disease probability at 6 months in patients with a CMV antigenemia value > or = 5 was 77.8% versus 6% in patients with CMV antigenemia value < 5 (log-rank test = 48.345; P < 0.001). Several independent factors were associated with the development of CMV disease: CMV antigenemia > or = 5 cells (hazard ratio: 20.44), CD4+ count < or = 25/mm3 (HR: 3.12), and sexual transmission of HIV infection (hazard ratio, 3.15). CMV antigenemia seems to be a good predictor of CMV disease in patients with AIDS.