Primary Parotid Tumor Thrombosis: Immunohistologic Features and Awareness of Metastatic Potential.

Tumor thrombosis is a poor prognostic feature and an exceptionally rare occurrence in salivary gland malignancies. We present a case of primary parotid myoepithelial carcinoma (MC) with tumor thrombosis in the external jugular vein (EJV). An 82-year-old man presented with a right-sided facial mass. MRI with and without gadolinium demonstrated a mass of the right parotid gland with a filling defect of the right EJV. The patient underwent right parotidectomy and selective neck dissection. Tumor thrombosis was found intraoperatively within the EJV. Final pathology demonstrated a poorly differentiated MC. Adjuvant radiation therapy without concurrent systemic therapy was administered. Three months later, restaging positron emission tomography (PET) with CT revealed numerous bilateral pulmonary nodules with biopsy, demonstrating poorly differentiated MC without locoregional relapse. Given that primary parotid tumor thrombosis is associated with a poor prognosis, the use of early systemic therapy should be investigated.

Fotoféresis extracorpórea y trasplante renal / Extracorporeal photopheresis and renal transplantation

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Pattern of blood concentrations of 47 elements in two populations from the same geographical area but with different geological origin and lifestyles: Canary Islands (Spain) vs. Morocco.

The Canary Islands are one of the outermost regions of the European Union (EU), which are located barely 100 km from the coasts of Morocco. Although these islands are located in Africa, the degree of socioeconomic development and lifestyle in this archipelago is comparable to that of any other region of Europe. It is well established that the main determinants of human exposure to elements have to do both, with their place of residence and with habits related to their lifestyle. For this reason, we wanted to study the pattern of contamination by elements of these two populations so geographically close, but so different both in their lifestyle, and the geological origin of the territory where they live. Thus, we have determined the blood concentrations of 47 elements (including 25 rare earth elements (REE) and other minority elements (ME) widely employed in the hi-tech industry) in a paired sample of Moroccans (n = 124) and Canary Islands inhabitants (n = 120). We found that the levels of iron, selenium, zinc, arsenic, cadmium, strontium, and specially lead, were significantly higher in Moroccans than in Canarians, probably due to the intensive mining activity in this country. We also found significantly higher levels of the sum of REE and ME in Moroccans than in Canarians, possibly related to the inappropriate management of e-waste in this country. On the other hand, in the inhabitants of the Canary Islands we found higher levels of manganese, probably related to a higher degree of exposure to heavy traffic and exposure to Saharan dust of the people living in this region, and niobium and bismuth, probably related to the higher economic development in these islands. Our results indicate that the vicinity of both territories is not a major determinant of each other's contamination.

[Automated erythrocytapheresis as treatment of severe malaria. Study of 6 patients]. / Eritrocitaféresis automatizada en el tratamiento de la malaria grave: estudio de 6 pacientes.

BACKGROUND AND OBJECTIVE: The high mortality attributable to severe malaria by Plasmodium falciparum is related to the grade of parasitemia. Automated erithrocytapheresis (AE) is a safe alternative to exchange transfussion, with the same potential benefits but less undesirable side effects. Literature on this technique is scarce, consisting of isolated reports or short series. The objective of this study is to describe the clinical picture and outcome observed in 6 severely ill malaria patients in whom EA was applied as complimentary therapeutic technique. PATIENTS AND METHOD: An observational prospective descriptive study was carried out of all inpatients with severe malaria in a single hospital between 1996 and 2006 in whom clinical, epidemiological and parsitological data were analyzed. RESULTS: This series included 2 women and 4 men, with a median age of 43 years. In all cases, the infection was acquired in West Sub-Saharan Africa. No patient had received antimalarial prophylaxis and all were infected by Plasmodium falciparum. The grade of parasitemia was between 10% and 35%. The number of severity criteria was between one and 4, the more frequent being hyperbilirrubinemia. All patients received conventional intravenous treatment. The total length of admission oscillated between 5 and 37 days, while the length of stay in the Intensive Care Unit varied between one and 17 days. All patients survived. CONCLUSIONS: AE is a safe technique, with the same advantages that blood exchange but lacking many of its disadvantages. A isolated parasitemia above 10%, or when a parasitaemia above of 5% is associated with any additional World Health Organization-2000 criteria of clinical severity, should constitute an indication for AE.

[Reference values in the usual laboratory data for sub-Saharan immigrants. Importance in the management of infectious diseases]. / Valores de referencia en los datos de laboratorio habituales en inmigrantes subsaharianos. Importancia en el manejo de las enfermedades infecciosas.

BACKGROUND AND AIMS: The progressive increase in the number of immigrants to Spain in recent years has made it necessary for health-care professionals to be aware about the specific characteristics of this population. An attempt is made in this study to define the normal range of common laboratory values in healthy sub-Saharan adults. SUBJECTS AND METHODS: Common laboratory values were studied (blood cell counts, clotting tests and blood biochemistry values) and were measured in 150 sub-Saharan immigrants previously defined as healthy according to a complete health evaluation that included a clinical history, physical examination, serologic tests and study of stool parasites. These results were compared to those from a control group consisting of 81 age-and-sex matched healthy blood donors taken from the Spanish native population. RESULTS: Statistically significant differences were obtained in the following values. Mean corpuscular volume (MCV), red cell distribution width (RDW), total leukocytes, and serum levels of creatinine, uric acid, total protein content, creatin-kinase (CK), aspartate aminotransferase (AST), gamma-glutamyl-transpeptidase (GGT), Immunoglobulin G (IgG) and M (IgM). If evaluated according to the normal values in native people, a considerable percentage of healthy sub-Saharan immigrants would present <> values (with potential clinical relevance) in the following parameters. MCV, RDW, total leukocyte counts and serum levels of CK, IgG and IgM. CONCLUSIONS: A proper interpretation of the common laboratory values in sub-Saharan immigrants, and probably in other foreign collectives, requires a previously-established range of normality in these parameters for those populations in order to avoid diagnostic mistakes and inadequate work-up and management.

Eritrocitaféresis automatizada en el tratamiento de la malaria grave: estudio de 6 pacientes / Automated erythrocytapheresis as treatment of severe malaria. Study of 6 patients

FUNDAMENTO Y OBJETIVO: La elevada mortalidad de la malaria grave por Plasmodium falciparum serelaciona con el grado de parasitemia. La eritrocitaféresis automatizada (EA) es una alternativasegura a la exanguinotransfusión, con los mismos beneficios potenciales pero menores efectossecundarios. Sin embargo, son escasas las referencias sobre la eficacia e indicaciones de estatécnica. El objetivo de este trabajo ha sido describir las características clínicas y evolución de6 pacientes con malaria grave en los que se empleó esta técnica terapéutica complementaria.PACIENTES Y MÉTODO: Se ha realizado un estudio observacional, descriptivo y retrospectivo de todoslos pacientes con malaria ingresados en un único hospital entre 1996 y 2006. En cadacaso se recogieron los datos clínicos, epidemiológicos y parasitológicos básicos.RESULTADOS: La serie se compone de 2 mujeres y 4 varones, con una media de edad de 43años. En todos los casos la infección fue adquirida en África subsahariana. Ningún pacientehabía efectuado quimioprofilaxis antipalúdica y la especie causal fue Plasmodium falciparum.El grado de parasitemia osciló entre el 10 y el 35%. De los criterios de gravedad, cuyo númeroosciló entre 1 y 4, el más frecuente fue la hiperbilirrubinemia. Todos los pacientes recibierontratamiento convencional. La duración total del ingreso osciló entre 5 y 37 días, y la estanciaen la unidad de vigilancia intensiva, entre 1 y 17 días. Todos los pacientes sobrevivieron.CONCLUSIONES: En resumen, la EA es una técnica segura, con las mismas ventajas que la exanguinotransfusión,pero sin muchos de sus efectos adversos. De acuerdo con los datos de la bibliografíay estas observaciones, podemos señalar que una parasitemia aislada mayor del 10%o una parasitemia superior al 5% asociada a algún criterio de gravedad son indicación para larealización de EA

BACKGROUND AND OBJECTIVE: The high mortality attributable to severe malaria by Plasmodium falciparumis related to the grade of parasitemia. Automated erithrocytapheresis (AE) is a safe alternativeto exchange transfussion, with the same potential benefits but less undesirable sideeffects. Literature on this technique is scarce, consisting of isolated reports or short series. Theobjective of this study is to describe the clinical picture and outcome observed in 6 severely illmalaria patients in whom EA was applied as complimentary therapeutic technique.PATIENTS AND METHOD: An observational prospective descriptive study was carried out of all inpatientswith severe malaria in a single hospital between 1996 and 2006 in whom clinical, epidemiologicaland parsitological data were analyzed.RESULTS: This series included 2 women and 4 men, with a median age of 43 years. In all cases,the infection was acquired in West Sub-Saharan Africa. No patient had received antimalarialprophylaxis and all were infected by Plasmodium falciparum. The grade of parasitemia was between10% and 35%. The number of severity criteria was between one and 4, the more frequentbeing hyperbilirrubinemia. All patients received conventional intravenous treatment. Thetotal length of admission oscillated between 5 and 37 days, while the length of stay in the IntensiveCare Unit varied between one and 17 days. All patients survived.CONCLUSIONS: AE is a safe technique, with the same advantages that blood exchange but lackingmany of its disadvantages. A isolated parasitemia above 10%, or when a parasitaemia above of5% is associated with any additional World Health Organization-2000 criteria of clinical severity,should constitute an indication for AE

Valores de referencia en los datos de laboratorio habituales en inmigrantes subsaharianos. Importancia en el manejo de las enfermedades infecciosas / Reference values in the usual laboratory data for sub-Saharan immigrants. Importance in the management of infectious diseases

Fundamento y objetivos. El incremento progresivo del número de inmigrantes en España en los últimos años ha obligado a los profesionales sanitarios a considerar las características específicas de esta población. En este estudio se intentan determinar los valores normales de los inmigrantes procedentes del África subsahariana en los valores analíticos solicitados con mayor frecuencia en la práctica clínica. Sujetos de estudio y métodos. Se estudiaron los valores habituales de laboratorio (hemograma, pruebas de coagulación y estudios bioquímicos sanguíneos) en 150 inmigrantes previamente definidos como sanos tras efectuar un examen de salud que incluía una historia clínica protocolizada, estudios serológicos y estudio coproparasitario. Estos datos se compararon con los de un grupo control de 81 donantes sanos, de edad y sexo similares, de población autóctona. Resultados. Se encontraron diferencias estadísticamente significativas entre ambos grupos en la determinación de volumen corpuscular medio(VCM), amplitud de distribución eritrocitaria, leucocitos totales, creatinina, ácido úrico, proteínas totales, creatin quinasa (CK), aspartato aminotransferasa, gamma glutamil transpeptidasa, inmunoglobulinas G y M (IgG, IgM). Teniendo en cuenta los valores de referencia, un porcentaje significativo de personas subsaharianas sanaspresentarían valores «anormales» en las siguientes magnitudes: VCM, ADE, leucocitos totales proteínas totales, CK, IgG e IgM. Conclusiones. La valoración de los datos de laboratorio en la población subsahariana, y posiblemente en otros grupos de inmigrantes, requiere establecer previamente el rango de normalidad adecuado para evitar errores diagnósticos y actitudes terapéuticas erróneas (AU)

Background and aims. The progressive increase in the number of immigrants to Spain in recent years has made it necessary for health-care professionals to be aware about the specific characteristics of this population. An attempt is made in this study to define the normal range of common laboratory values in healthy sub-Saharan adults. Subjects and methods. Common laboratory values were studied (blood cell counts, clotting tests and blood biochemistry values) and were measured in150 sub-Saharan immigrants previously defined as healthy according to a complete health evaluation that included a clinical history, physical examination, serologic tests and study of stool parasites. These results were compared to those from a control group consisting of 81 age-and-sex matched healthy blood donors taken from the Spanish native population. Results. Statistically significant differences were obtained in the following values. mean corpuscular volume (MCV), red cell distribution width (RDW), total leukocytes, and serum levels of creatinine, uric acid, total protein content, creatin-kinase (CK), aspartate aminotransferase (AST), gamma-glutamyl transpeptidase(GGT), Immunoglobulin G (IgG) and M(IgM). If evaluated according to the normal values in native people, a considerable percentage of healthy sub-Saharan immigrants would present «abnormal» values (with potential clinical relevance) in the following parameters. MCV, RDW, total leukocyte counts and serum levels of CK, IgG and IgM. Conclusions. A proper interpretation of the common laboratory values in sub-Saharan immigrants, and probably in other foreign collectives, requires a previously-established range of normality in these parameters for those populations in order to avoid diagnostic mistakes and inadequate work-up and management (AU)

Variation in the prevalence of gastric cancer in Perú.

Most cases of gastric cancers occur in non-industrialized countries but there is scarce information about the epidemiology of this illness in these countries. Our study examined whether there was a variation in the prevalence of gastric cancer in Lima, Perú over the last 2 decades. Subjects older than 29 years of age were included. They underwent an esophagogastroduedonoscopy at 3 socioeconomically different health facilities in Lima: a county hospital (7,168 subjects), a Peruvian-Japanese Clinic (14,794 individuals) and a private hospital (4,893 individuals). Birth cohort prevalence of gastric cancer was used. Regression models were calculated to predict the future prevalence of gastric cancer. It was found that the birth cohort prevalence of gastric cancer decreased in Perú from 22.7 to 2% (p < 0.001), from 12 to 0.5% (p < 0.001), and from 6.5 to 0.1% (p < 0.001) in the low, middle and high socioeconomic group, respectively. The prevalence of intestinal metaplasia decreased from 44.3 to 12.5% (p < 0.001), from 28.4 to 5% (p < 0.001), and from 19.4 to 2.2% (p < 0.001) in the low, middle and high socioeconomic status, respectively. These trends will likely persist over the future decades. Nevertheless, the prevalence of gastric cancer remains high in subjects older than 59 years of age in the low socioeconomic status. It is concluded that the prevalence of gastric cancer is decreasing in Perú, similar to the current trend undergoing in industrialized nations. However, there are still specific groups with high prevalence that might benefit from screening for early detection and treatment.

[Diabetic foot, a severe complication]. / El pie diabético, una grave complicación.

In this research project, the authors carried out a prospective descriptive study over a nine month period on 74 diabetic patients checked into the Vascular Surgery Ward at the Ramón y Cajal Hospital. The authors have compiled and analysed the diverse risk factors and variables which can bear an influence on this pathology; to do so, the authors collected the necessary data by means of a personal interview, medical records, analytical tests and readings as well as a direct inspection of the lesions. Among the results obtained, the authors emphasize the long average hospital stay, the poor control of their glycemia upon hospitalisation and the percentage of important ampulations these patients underwent; the authors were unable to corroborate other results present in articles consulted such as the relationship between the variables for years a patient had been suffering diabetes and the degree of the lesion on the Wagner scale.

El pie diabético, una grave complicación / Diabetes effect on a foot, a serious complication

En este trabajo se llevó a cabo un estudio descriptivo prospectivo durante nueve meses, incluyendo 74 pacientes diabéticos ingresados en la unidad de Cirugía Vascular del Hospital Ramón y Cajal. Hemos recogido y analizado los diversos factores de riesgo y variables que pudieran influir en esta patología; para ello se tomaron los datos necesarios mediante encuesta personal, historia clínica, determinaciones analíticas e inspección directa de las lesiones. De los resultados obtenidos destacamos la elevada estancia media, el mal control de la glucemia que presentaban al ingreso y el porcentaje de amputaciones mayores que se realizaron a estos pacientes; no pudiéndose corroborar otros resultados presentes en la bibliografía consultada, como la relación entre las variables años de evolución de la diabetes y el grado de la lesión en la escala Wagner (AU)

Oral surgery in patients undergoing oral anticoagulant therapy.

UNLABELLED: There is an evident need for procedural protocol for oral surgery patients who undergo oral anticoagulant treatment (OAT) because of: 1) the possible severity of complications and 2) the growing demand for OAT, which in some cases may be as much as 8% of the oral surgery patients that are referred to the hospital from primary care centers. In this study, the authors define the parameters for creating a proto- col applicable to this group of patients. The conclusion is that it is not necessary to suspend OAT before surgery; rather, these procedures should be performed under multidisciplinary medical control. OBJECTIVE: The authors demonstrate that it is possible to perform oral surgery on OAT patients, without having to sus- pend treatment beforehand. STUDY DESIGN: A longitudinal study was performed in OAT patients that required some type of oral surgical procedures. After an INR control, the patient underwent surgery and afterwards the patient was given tranexamic acid as a mouth rinse. Postoperative hemorrhage was classified as slight when it lasted less than 5 minutes, moderate when it lasted longer than five minutes, and severe when it required blood transfusion. RESULTS: The study was performed over a 5-year period (1996-2000), by the maxillofacial surgery department. In that time period, 125 patients with OAT were treated; 90 of them were males and 35 were females. Tooth extraction was per- formed in 229 sessions and a total of 367 teeth were extracted, with an average of 1.6% per session. With regards to postoperative hemorrahage, it was slight in 210 cases (91.7%), moderate in 18 (7.9%) and severe only in one case (0.4%). All the variables were compared and no statistically significant differences were found. CONCLUSIONS: We believe that OAT should not be suspended before oral surgery, but it surgery should be performed under multidisciplinary control-especially in the case of the elderly (over 65) or with those patients that have other concomitant illnesses such as renal insufficiency or anemia or other medical treatments.

Cirugía oral en pacientes en tratamiento con anticoagulantes orales. Pauta de actuación / Oral surgery in the patients undergoing oral anticoagulant therapy

Hay una necesidad evidente de protocolizar los procedimientos de cirugía oral en pacientes sometidos a tratamiento anticoagulante por vía oral (TAO), tanto por la gravedad de las complicaciones como por la frecuencia creciente de la demanda, que puede cuantificarse en algunos casos en el 8 por ciento de los pacientes referidos desde atención primaria al hospital para tratamiento quirúrgico oral. En este estudio se definen los parámetros para crear un protocolo aplicable a este grupo de pacientes. Se concluye que los pacientes en TAO no deben suspenderlo previamente a la cirugía oral si bien debería realizarse con control multidisciplinario. especialmente si se trata de mayores de 65 años o con patología concomitante como insuficiencia renal o anemia o con otros tratamientos médicos, Objetivo: Pretendemos demostrar que es posible la realización de cirugía oral en pacientes anticoagulados, sin necesidad de retirar el tratamiento previamente. Diseño del estudio: Se realizó un estudio longitudinal en aquellos pacientes que precisaron algún procedimiento quirúrgico a nivel oral de los que estaban en TAO. Tras un con trol de INR se procedía a la intervención quirúrgica y posteriormente se suministraba al paciente ácido tranexámico para enjuagues bucales. La hemorragia postoperatoria se catalogó leve cuando el sangrado fue inferior a 5 minutos, moderado mavor de 5 minutos e intenso cuando se precisó transfusión. Resultados: Durante 5 años (1996-2000) se atendieron en nuestro Servicio 125 pacientes con TAO, 90 hombres y 35 mujeres, a los que se les exodonciaron 367 piezas dentarias, en 229 sesiones, con una media de 1,6 exodoncias por sesión. Con respecto a la hemorragia postoperatoria, fue leve en 210 casos (91,7 por ciento), moderada en 18 (7,9 por ciento) y grave en un solo caso (0,4 por ciento).Se compararon todas las variables observándose que no existieron diferencias estadísticamente significativas. Conclusiones: Consideramos que el TAO no debe suspenderse previamente' a la cirugía oral si bien debería realizarse bajo control multidisciplinario, especialmente si se trata de mayores de 65 años o con patología concomitante como insuficiencia renal o anemia o con otros tratamientos médicos (AU)