Colonic perforation secondary to metastatic lung adenocarcinoma during anti-TNF treatment for ankylosing spondylitis.

Biological agents targeting inflammatory cytokines such as tumour necrosis factor alpha (TNF-α) have emerged in recent years as effective medications for a variety of inflammatory arthropathies. Although the relationship between the use of anti-TNF drugs and an increase in the rate of infections is well established, the role of these drugs in the development of different types of cancer is unclear. Randomized clinical trials and national registries have not demonstrated a significant increase in the risk of cancer in patients treated with anti-TNF drugs, but numerous cases of the appearance of malignant tumors in patients receiving these drugs have been reported. We describe the case of a 73-year-old man, ex-smoker, who developed a lung cancer during treatment with infliximab further complicated by perforation of a metastasis in the sigmoid colon, which is a very infrequent event in the course of this malignancy. A few similar cases previously reported in the literature are reviewed.

Fibrodysplasia ossificans progressiva in Spain: epidemiological, clinical, and genetic aspects.

We aimed to investigate the epidemiological determinants, clinical features, and genetic pattern of FOP in our country by evaluating the entire population of patients identified according to a combination of methods. To achieve this, 24 individuals were confirmed as FOP cases, 17 of whom were alive at the end of 2011 (point prevalence=0.36 × 10(-6)). The gender distribution (male/female ratio=13/11) and the concurrent range of ages (from 4 to 53 years; mean ± SD: 30.2 ± 13.8) are in agreement with similar reports. Twenty-one (87.5%) had characteristic congenital malformations of the big toe, and short thumbs were found in 65.2% of cases. In addition, other skeletal malformations such us fusion of the posterior elements of the cervical spine (89.0%), knee osteochondromas (71%), scoliosis (54.5%), and short and broad femoral neck (52.6%) were observed. All had developed mature ossicles of heterotopic bone in typical anatomic and temporal patterns, ranging in number from 1 to 17 (9.5 ± 3.9). Age at appearance of first ossifying lesion varied from 3 months to 15 years. Mean age at diagnosis was 7.3 ± 5.1 years and the average delay in reaching the correct diagnosis after the onset of heterotopic ossification was 2.7 years (range=0-12 years). Biopsy of the pre-osseous lesions was performed in 11 of 20 (55.0%), providing no useful information for the diagnosis of FOP. Seven of 18 (38.9%) reported some hearing loss, and 5 (27.8%) experienced diffuse thinning of the hair or were bald. No patient had relatives with a typical FOP clinical picture. Fourteen of the 16 cases which were genetically investigated displayed the single heterozygous mutation c.617G>A in exon 4 of the ACVR1 gene. One of the two patients who did not present with the canonical ACVR1 mutation showed a heterozygous mutation c.774G>C in exon 5 leading to the substitution of Arginine 258 with a serine. The other patient had a heterozygous c.774G>T substitution in exon 5 leading to the same amino acid change (p.Arg258Ser). These two patients had only nonspecific abnormalities of the great toe, lacked the typical anatomic and developmental pattern of heterotopic ossification, and shared a trend toward uncommon clinical features. These results provide new insight on the epidemiological and clinical traits of FOP, reinforcing the notion of its worldwide homogeneity. The molecular characterization of ACVR1 sequence variation will contribute to the understanding of the genetic profile of this devastating disease in different geographical areas.

Estudio de la serología en la artritis aguda. Aplicación a la práctica clínica / Serological investigation in septic arthritis. Application to the clinical practice

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[Estimate of osteoporosis fracture risk with ultrasound bone assessment]. / Estimación del riesgo de fracturas osteoporóticas mediante medición ultrasónica del hueso.

BACKGROUND: Multiple studies suggest that ultrasound measurement of the bone can be a rapid, cheap, and radiation-free alternative to determine the fracture risk. In this paper the ultrasound measurement of the bone was performed among 288 postmenopausal women, and the influence of gynecologic history and factors related to lifestyle on the obtained values was examined. PATIENTS AND METHODS: One hundred nineteen healthy postmenopausal women and 169 women with previous osteoporotic fractures were included in the study. Both weight and height were determined and a clinical questionnaire was administered to assess factors related to bone mineral density. The values of broadband ultrasound attenuation (BUA) and speed of sound (SOS) were obtained with a contact ultrasound analyzer. RESULTS: Among women without fractures the mean BUA and SOS values (64.1 [14.9] and 1,601.1 [34.5], respectively) were significantly higher than mean BUA (48.8 [17.3]) and SOS (1,573 [57.8]) values among women with fractures (p < 0.001). Using the logistic regression analysis for predicting fracture risk, the model that suited best was that including BUA (OR = 0.668 [0.544-0.818]), age (OR = 1.102 [1.055-1.151]), age at postmenopause (OR = 0.794 [0.731-0.862]) and height (OR = 0.932 [0.883-0.983]). The area under the curve for this model was 0.871. CONCLUSIONS: BUA and SOS values are lower among women with osteoporotic fractures. The fracture risk can be predicted by means of a model including the variables BUA, age, postmenopausal age, and height.

Estimación del riesgo de fracturas osteoporóticas mediante medición ultrasónica del hueso / Assessment of osteoporotic fracture risk by ultrasound measurement of the bone

Fundamento. Múltiples estudios sugieren que la medición ultrasónica del hueso puede ser una alternativa rápida, barata y sin radiación para determinar el riesgo de fracturas. En este trabajo hemos realizado medición ultrasónica del hueso en 288 mujeres posmenopáusicas, analizando la influencia de la historia ginecológica y de factores relacionados con el estilo de vida en los valores obtenidos. Pacientes y métodos. Se incluyeron 119 mujeres postmenopáusicas sanas y 169 con fracturas osteoporóticas previas. Se midió peso y talla y se realizó un cuestionario clínico para valoración de los factores relacionados con la densidad mineral ósea. Se obtuvieron las medidas de atenuación ultrasónica de banda ancha (BUA) y velocidad del sonido (VS) con un analizador ultrasónico de contacto. Resultados. En las mujeres sin fracturas los valores medios de BUA y VS (64,1 [14,9] y 1.601,1 [34,5], respectivamente) fueron significativamente superiores a los de BUA (48,8 [17,3]) y VS (1.573,6 [57,8]) en las mujeres con fracturas (p < 0,001). En el análisis de regresión logística para predicción del riesgo de fracturas el modelo que mejor se ajustaba era el que incluía BUA (OR = 0,668 [0,544-0,818]), edad (OR = 1,102 [1,055-1,151]), edad de la menopausia (OR = 0,794 [0,731-0,862]) y talla (OR = 0,932 [0,883-0,983]).El área bajo la curva receiver operating characteristic (ROC) de este modelo fue 0,871. Conclusiones. Los valores de BUA y VS son inferiores en las mujeres con fracturas osteoporóticas. El riesgo de fractura se puede predecir a través de un modelo que incluya las variables BUA, edad, edad de la menopausia y talla (AU)

[Bone ultrasound in healthy women and bone mass related factors]. / Medición ultrasónica del hueso en mujeres sanas y factores relacionados con la masa ósea.

BACKGROUND: Bone mineral density (BMD) has been related with age, hormonal status, body mass index (BMI) and life style. We have evaluated the influence of these factors on BMD in healthy women, without risk factors for osteoporosis, using ultrasound measures. PATIENTS AND METHODS: We have selected 255 women (136 premenopausal and 119 postmenopausal). We measured the weight and height. Other factors related to BMD were assessed with a clinical questionnaire. With an ultrasonic bone contact analyser broadband ultrasonic attenuation (BUA) and speed of sound (VS) were obtained. RESULTS: Premenopausal women had mean (SD) BUA and VS values (73.4 [13.1] and 1,617.2 [30.4], respectively) significantly higher than postmenopausal women (BDA 64.1 [14.9] and VS 1,601.1 [34.5]; p < 0.001). No relationship between BUA, VS and the style of life related variables was found. Age and weight were significant predictors of BUA in all women in multiple regression model, and the length of lactation in premenopausal women. The association of BUA with age were significantly stronger (p < 0.05) in postmenopausal women. CONCLUSIONS: Age and body weight were the factors more strongly associated with ultrasonic measures in healthy women. The effect of age was different depending on menopausal status. No relation has been found between life habits and bone mass.

Differential-pulse polarographic determination of iron in acids, waters, fruit juices and wines.

A method for the determination of iron by differential-pulse polarography, based on the formation of a 5,5-dimethylcyclohexane-1,2,3-trione 1,2-dioxime 3-thiosemicarbazone-iron(II) complex, is proposed. The method was applied to the determination of iron in acids, waters, wines and fruit juices.

[Antiphospholipid antibodies in systemic lupus erythematosus: incidence, significance and relation to lupus nephritis]. / Anticuerpos antifosfolípidos en el lupus eritematoso sistémico: incidencia, significación y relación con la nefritis lúpica.

The prevalence of three different types of antiphospholipid antibody in 88 consecutive patients with systemic lupus were 27.2% for lupus anticoagulant (LAC), 31.8% for anticardiolipin antibody (aCL), and 13.6% for falsely positive serologic tests for syphilis (FPSTS). The three tests were correlated, thus confirming the overlapping specificities of this family of antibodies. Although FPSTS was not associated with any particular manifestation of systemic lupus, aCL correlated with thrombosis (p = 0.0001), thrombopenia (p = 0.009), neuropsychiatric features (p = 0.02) and membranous nephropathy (p = 0.001), while LAC correlated with thrombosis (p = 0.001) and hemolytic anemia (p = 0.04). The previously unreported association between membranous nephropathy and aCL might explain some features of the former, particularly the higher incidence of thromboembolic complications and the poorly known relation with renal vein thrombosis.