[Incidence of pulmonary tuberculosis: application of the capture-recapture method]. / Incidencia de tuberculosis pulmonar: aplicación del método de captura-recaptura.

OBJECTIVE: To determine as accurately as possible the incidence of pulmonary tuberculosis within Health Area 15 of the Community of Valencia during the period 1990-1993, using the capture-recapture method. METHOD: Descriptive study on the population of Health Area 15 (population: -139.903) divided into 4 large groups according to age (0-14, 15-34, 34-54 and 55+). Data was obtained from the statutory notification system of infectious disease (SNSID) and from the registry of the said area's Hospital Microbiology SERVICE: The main variable under study was the number of cases of pulmonary tuberculosis, both as notified under the SNSID and in terms of cases in the microbiology register in which M. tuberculosis was isolated. The incidence-rates were calculated by age and year of study for both registries employing the capture-recapture method. RESULTS: The mean annual incidence obtained for the SNSID register during the study period was 15.85 cases x 10(-5), and for the microbiology registry it was 23.29 x 10(-5). When the capture-recapture method was employed the mean annual incidence for the study period was 34.81 x 10(-5) (CI 95%: 31.82-39.92). In each of the years studied the number of cases identified was greater for the microbiology register than for the SNSID. Around half the cases of tuberculosis are below 34 years of age, with the larger section, and that having the highest incidence of tuberculosis being the 15 to 34 years age-group. There is no apparent upward trend in incidence rates calculated for this period. CONCLUSIONS: The data from the SNSID system on incidence of pulmonary tuberculosis within Health Area 15 of the Community of Valencia tends to underestimate the true incidence rate. The factual resources of the Hospital Microbiology Service are underutilized, considering the quantity and quality of information it can provide. The capture-recapture method is a good choice of method for measuring tuberculosis incidence. This method merits greater use within the field of epidemiology as much in order to assess the representativeness and thoroughness of surveillance systems as to identify inadequacies in their reporting and localisation of disease outbreaks.

Priapism of the clitoris.

Priapism of the clitoris is a rare entity. A case of painful priapism is reported in a patient who had previously suffered a radical cystectomy for bladder carcinoma pT3-GIII, followed by local recurrence in the pelvis. From a symptomatic point of view she showed a good response to conservative treatment (analgesics and anxiolytics), as she refused surgical treatment. She survived 6 months from the recurrence, and died with lung metastases. The priapism did not recur. The physiopathological mechanisms involved in the process are discussed and the literature reviewed.

[Tetracycline pleurodesis for treatment of malignant pleural effusions. Retrospective study of 91 cases]. / Pleurodesis con tetraciclinas en el tratamiento del derrame pleural maligno. Estudio retrospectivo de 91 casos.

BACKGROUND: Malignant pleural effusions (MPE) are a common complication in patients with advanced neoplasms. Even though no large series confirming this exist, tetracycline pleurodesis has become the therapy of choice. The aim of this retrospective study was to evaluate its efficacy, adverse effects and possible factors predicting the success of the method. METHODS: Between 1985 through 1991, 91 patients with cytologically or histologically confirmed MPE were treated with 1,000-1,500 mg tetracycline pleurodesis. There were 49 females and 42 males, with a mean age of 59 years. The most common malignancies were lung, breast and unknown primary carcinomas. 85% patients complained of dyspnea and the volume of the effusion was moderate in half the cases. 12 variables were analyzed in relation with the probability of response through chi 2 test; survival and recurrence times were calculated with Kaplan and Meier's method. RESULTS: 73 patients were evaluable, with a 67% response rate (22 complete, 27 partial). Time to relapse was significantly higher for partial responses (mean 112 days) than for failures (mean 33 days). 37 patients presented mild complications (pain and fever). Karnofsky performance status (70% or greater), size of the effusion (small or moderate), chest radiograph (only effusion) and pleural LDH (600 U/l or less) attained favourable prognostic significance. Median survival was reached at 6 months. CONCLUSIONS: Tetracycline pleurodesis is an effective and well-tolerated paliative treatment for MPE. Along with other known parameters (pleural pH and glucose levels), Karnofsky performance status, size of the effusion, chest radiograph and pleural LDH allow to predict its results and optimize its indications.

[Emphysematous cystitis caused by Klebsiella pneumoniae]. / Cistitis enfisematosa por Klebsiella pneumoniae.

Emphysematous cystitis is a very uncommon clinical activity as compared to the high incidence of urinary infections in diabetic patients. The paper explains the pathophysiological mechanisms and updates its clinical and therapeutic diagnostic choices regarding one case of favourable evolution following medical treatment.

[High pressure filling bladder]. / Vejigas de alta presión de llenado.

A complete urodynamic study was carried out on 41 consecutive patients presenting in the cystomanometry a vesical filling pressure at maximum capacity higher than 30 cm H2O. Two groups were evident: group I with neurogenic etiology, and group II without an obvious neurogenic etiology. From its results it can be seen that a diminished vesical accommodation is not a urodynamic fact restricted to vesicourethral neurogenic dysfunction, but it happens in several non-neurogenic conditions. Within the neurogenic group, the urodynamic element most frequently associated to a diminished vesical accommodation was an inferior motor neuron-like vesicourethral dysfunction. An increased vesical filling pressure was not enough to produce urinary incontinence, being also necessary an added factor to prompt involuntary loss of urine.

[Bladder carcinosarcoma with osteosarcomatous differentiation]. / Carcinosarcoma vesical con diferenciación osteosarcomatosa.

Osteoid tissue can eventually be identified outside the bone skeleton adopting the form of metastasis, osteoid metaplasia or primitive osteosarcoma. This latter presentation is most frequently located in soft tissues and exceptionally at the visceral level. The term used for any of these forms is extra-bone osteogenic sarcoma. This paper reports the case of a 62 year-old female patient diagnosed with vesical urothelial carcinosarcoma treated with external radiotherapy. After a disease-free period of 20 years the patient developed osteosarcomatous-differentiated vesical carcinosarcoma. A literature review is made to analyze, from a clinical and histopathological perspective, several items of interest presented by this pathology. The role of sarcomatous radio-induction is also highlighted. Finally, we emphasize the relevance of using radical treatments from the start, so as to restrain the highly malignant potential of this condition.