Trends in celecoxib and etoricoxib prescribing following removal of prior authorization requirement in Spain.

WHAT IS KNOWN AND OBJECTIVE: Previous studies indicate that the implementation of a prior authorization requirement for coxibs was followed by a sharp decline in their use. There are no studies showing what happens if coxib prior authorization is removed. The objective of this study is to assess the trend in the use of coxibs marketed in Spain, following removal of their respective prior authorization requirements in November 2006 for celecoxib and February 2007 for etoricoxib. METHODS: We calculated the monthly number of defined daily doses per thousand inhabitants per day (DDD/TID) of coxibs dispensed in a health area of Spain from mid-2005 to December 2007. Data were analysed both graphically and by means of a segmented regression model. RESULTS AND DISCUSSION: At the start of the study period, use of coxibs showed no growth. At the date when prior authorization of celecoxib was removed (November 2006), however, DDD/TID of the coxib whose prior authorization had not been removed - namely etoricoxib - remained unchanged, whereas consumption of celecoxib increased significantly (by the end of the study period, celecoxib use displayed a relative increase of 615% in terms of the DDD/TID prescribed before the removal of its prior authorization requirement). Similarly, etoricoxib use remained unchanged until its prior authorization was removed (February 2007), from which time DDD/TID of etoricoxib also underwent a considerable increase (by the end of the study period, etoricoxib use displayed a relative increase of 793% in terms of the DDD/TID prescribed before the removal of its prior authorization). Segmented regression analysis showed a sharp, statistically significant rise and change in slope in both celecoxib and etoricoxib use immediately after removal of their respective prior authorizations. WHAT IS NEW AND CONCLUSION: Use of celecoxib and etoricoxib rose sharply after removal of their respective prior authorizations.

Vólvulo yeyunal incompleto por linfangioma quístico mesentérico / Partial jejunal volvulus due to a mesenteric cystic lymphangioma

Los quistes mesentéricos son tumoraciones benignas poco frecuentes entre las que se encuentran los linfangiomas. Su presentación clínica es variable y pueden producir síntomas agudos debido a complicaciones. Se diagnostican sobre todo en edad pediátrica y su pronóstico, tras exéresis completa, suele ser excelente. Presentamos el caso de una paciente de 15 años con dolor abdominal postprandial y palpación de masa blanda en hipogastrio. Los estudios radiológicos mostraron una gran masa polilobulada de contenido quístico que englobaba un asa de yeyuno con volvulación incompleta. El tratamiento fue la exéresis del quiste y del asa de yeyuno y el diagnóstico anatomopatológico fue de linfangiomaquístico mesentérico. La paciente está asintomática después de más de 3 años de la intervención (AU)

Mesenteric cysts are unusual benign tumours thatinclude lymphangioma. Their clinical presentation is variable and acute symptoms can be produced due to complications. This tumour appears especially in childhood, and its prognosis after surgical removal is excellent. We present the case of a 15 year old female patient with symptoms of postprandial abdominal pain and palpation of smooth mass in hypogastrium. Radiological studies showed a big polilobular mass of cystic substance that included a portion of jejune within complete volvulus. The treatment was the removal of the cyst and a je junal portion and the pathological diagnosis was mesenteric cyst lymphangioma. The patient is asymptomatic more than three years after the intervention (AU)

[Partial jejunal volvulus due to a mesenteric cystic lymphangioma]. / Vólvulo yeyunal incompleto por linfangioma quístico mesentérico.

Mesenteric cysts are unusual benign tumours that include lymphangioma. Their clinical presentation is variable and acute symptoms can be produced due to complications. This tumour appears especially in childhood, and its prognosis after surgical removal is excellent. We present the case of a 15 year old female patient with symptoms of postprandial abdominal pain and palpation of smooth mass in hypogastrium. Radiological studies showed a big polilobular mass of cystic substance that included a portion of jejune with incomplete volvulus. The treatment was the removal of the cyst and a jejunal portion and the pathological diagnosis was mesenteric cyst lymphangioma. The patient is asymptomatic more than three years after the intervention.

Intracystic infection of liver hydatidosis.

BACKGROUNDS/AIMS: The aim of this study was to review the clinical presentation and management of patients with intracystic bacterial infection in liver hydatidosis. METHODOLOGY: The records of 480 patients suffering from liver hydatid disease treated at our institution were reviewed. Only 42 patients fulfilled intracystic bacterial infection criteria. We assessed the incidence, clinical and laboratory findings, diagnostic procedures and surgical approach in these cases. RESULTS: The incidence of intracystic bacterial infection was steady throughout the study period. Clinical and laboratory data are non-specific. Diagnostic procedures for intracystic bacterial infection, including liver computed tomography scan, are of limited value. Although both, radical and non-radical surgical approaches, were used in these patients, mortality was associated with non-radical surgery. The morbidity rate was high regardless of the procedure used. CONCLUSIONS: Our current goal in the management of intracystic bacterial infection, if overall condition of the patient is good, is to carry out a total or subtotal cystectomy in order to avoid mortality and hydatid disease relapses.

[Multiple hepatic-splenic abscesses. A favorable result with antibiotic treatment]. / Absceso hepato-esplénico múltiple. Resultado favorable con tratamiento antibiótico.

The authors report a case of multiple and spleen pyogenic abscesses caused by Peptostreptococcus spp., in a patient who recently underwent laparotomy due to duodenal perforation. He was successfully treated by means of intensive and extended antibiotherapy. We would like to stress the importance of an early and etiological diagnosis performed by percutaneous puncture and bacteriological study, in order to start a selective antibiotherapy. Other therapeutical possibilities are discussed.