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Leishmania infantum is the etiological agent of zoonotic visceral leishmaniasis. In endemic areas, canine infections are considered the main source of infection for human populations. Therefore, any control of human leishmaniasis must include the control of canine infections. Chemotherapy of leishmaniasis is inadequate and canine immunoprophylaxis has important limitations. Reports on the response of infected dogs are abundant but no clear picture of immune events has emerged. To shed some light on these shortcomings the specific IgG subclass response was followed in 20 Beagle dogs experimentally infected with L. infantum using monoclonal antibodies (MAb) specific for canine IgG1, IgG2, IgG3 and IgG4, along with ELISA and flow cytometry. Results showed that parasitic infection elicits a general response of all IgG subclasses, with a predominant IgG1 response and without any evidence of IgG1/IgG2 dichotomy. These findings suggest that the inconsistent results reported previously could be related to the lack of specific reagents and not to the actual differences in the immune response of infected animals. Differential IgG subclass reactivity in ELISA and cytometry and the analysis of the reacting antigens could facilitate the diagnosis and prognosis of the disease and provide a useful tool for adequate therapeutics and vaccine development against leishmaniasis.

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BACKGROUND AND STUDY AIMS: There is little information on the incidence of autoimmune hepatitis (AIH) because on many occasions the disease can progress asymptomatically, different diagnostic criteria have been proposed during the last 20 years, and many epidemiological studies are based on retrospective clinical series. The aim of this study was to determine the incidence of AIH in the province of Valencia, Spain, during the year 2003. PATIENTS AND METHODS: The Services of Gastroenterology of eight acute-care reference hospitals in the province of Valencia, Spain, covering 1,774,736 inhabitants over 14 years of age, participated in a prospective study. All newly diagnosed patients with AIH between January 1, 2003 and December 31, 2003 were eligible. The diagnosis was based on criteria of the International Autoimmune Hepatitis Group revised in 1999. RESULTS: There were 19 new cases of AIH, 18 females and 1 male [mean (SD) age of 54.3 (11.2) years, range 23-73]. Incidence peaked in the 45-54 year age group. Eighteen cases were classified as AIH type 1 and one case as AIH type 2. The incidence rate of AIH for the year 2003 in people older than 14 years of age was 1.07 new cases per 100,000 inhabitants, with 1.96 cases per 100,000 inhabitants in females and 0.12 cases per 100,000 inhabitants in males. CONCLUSIONS: The 2003 annual incidence of AIH in Valencia, Spain, was similar to that reported in other European countries. AIH occurred more frequently in women and in the 45-54 year age group, type 1 being the most common.

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OBJECTIVE: the clinical phenotype of autoimmune hepatitis (AIH) varies among geographical areas. The aim of this study is to determine the salient features of AIH in adult patients from the province of Valencia, Spain. MATERIAL AND METHODS: eighty-one patients with AIH attended to in eight acute-care hospitals between 1994 and 2003. New patients diagnosed with AIH during year 2003 were evaluated prospectively. Data from patients currently attending follow-up visits and diagnosed before 2003 were collected retrospectively. RESULTS: a total of 94% of patients were females. Forty-three percent were asymptomatic, 27% had acute hepatitis, and 30% had chronic hepatitis. Type 1 AIH was diagnosed in 90% of cases. Type 2 AIH was more frequent in younger patients, and presented with an acute pattern. One third of patients had cirrhosis at onset. Patients with cirrhosis were older than 60 years more frequently. Immunosuppressants were given to 57 patients, with complete or partial remission in 87.7%. There were no significant differences in response to immunosuppression according to presentation pattern or AIH subtype. CONCLUSIONS: AIH in Valencia was predominantly diagnosed in asymptomatic women. Most cases were type 1, and in 25% of patients another autoimmune disease coexisted. At the time of diagnosis one third of patients had cirrhosis, particularly those over 60 years.

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OBJECTIVES: To evaluate the utility of C-reactive protein (CRP) in the detection of necrosis in acute pancreatitis and to determine the best cut-off point for CRP used for this purpose. MATERIAL AND METHODS: We performed a retrospective study of 157 patients with acute pancreatitis who underwent computed tomography (CT) with intravenous contrast material between 72 h and 8 days after the onset of symptoms and whose serum CRP values were determined by nephelometry 24 h or later after the onset of pain. RESULTS: Ninety-four patients were men and 63 were women, with a mean age of 61 years (range, 15-96 years). The cause of pancreatitis was biliary lithiasis in 53.5%, alcohol in 20.4%, and idiopathic in 10.8%. Other causes were found in 15.3%. The mean (standard deviation) time elapsed between symptom onset and extraction to evaluate CRP was 3.21 (1.7) days. The patients were divided into two groups according to the results of CT: 132 patients with acute intersitial edematous pancreatitis and 25 patients with acute necrotizing pancreatitis. The mean CRP concentrations were: 322 mg/l (range, 10.7-538) in patients with acute necrotizing pancreatitis and 133 mg/l (range, 3-442) in those with acute interstitial pancreatitis; this difference was statistically significant (p < 0.001). The area under the ROC curve of CRP vs. the occurrence of necrosis was 0.862 (95% CI, 0.778, 0.946). To evaluate the presence of pancreatic necrosis a cut-off level of 200 mg/l showed a sensitivity of 88% and a specificity of 75% while a cut-off level of 279 mg/l presented a sensitivity of 72% and a specificity of 88%. CONCLUSIONS: In acute pancreatitis, a CRP value of less than or equal to 200 mg/l obtained at 72 h of symptom onset is useful for ruling out, with a high degree of probability, the presence of necrosis. With higher values, additional investigations should be performed to determine the presence of pancreatic necrosis; nevertheless, with values higher than 279 mg/l the risk of necrosis markedly increases.

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It has been suggested that pancreatitis could be an extrahepatic manifestation of inflammatory bowel disease, since its incidence in this disease is greater than that in the general population and in many cases no etiological factor is found. We present a case of chronic idiopathic pancreatitis as the initial presentation of Crohn's disease of the colon.

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Abdominal lymphadenomegaly is a frequent ultrasonographic finding in patients with chronic liver disease. Its clinical significance is not well understood. The aim of this study was to determine the relationship between this finding and several characteristics of liver disease in 44 patients with chronic liver disease (79.5% due to hepatitis C virus). To do this, all patients underwent simultaneous liver biopsy and abdominal ultrasonography, in which the number and localization of the enlarged abdominal lymph nodes were confirmed. Viral load in patients with chronic hepatitis C virus infection was determined. No significant differences were found in serum hepatitis C RNA concentrations between patients who presented lymphadenomegaly and those who did not. However, the presence of lymphadenomegaly was associated with greater histological activity. If this finding were confirmed in studies with larger samples, the presence of ultrasonographically-detected enlarged abdominal lymph nodes in patients with chronic liver disease due to hepatitis C virus infection would indicate more severe histological lesions.

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OBJETIVO: en pacientes cirróticos, la creación de una derivación percutánea portosistémica intrahepática reconduce el flujo portal hacia la circulación sistémica, lo que puede motivar una hipoperfusión del hígado con deterioro de su función residual. El objetivo del estudio fue valorar si dicha derivación reducía realmente la perfusión hepática y esplácnica. MÉTODOS: se estudiaron 25 pacientes que requirieron una derivación percutánea portosistémica intrahepática por hemorragia, por varices esofágicas en 20 y por ascitis refractaria en cinco. Se evaluó el estado clínico y bioquímico general, la función hepática, la velocidad del flujo en la porta y arteria hepática por eco-Doppler y el estado hemodinámico y oxigenación sistémico, en venas suprahepáticas y en la porta. Las determinaciones hemodinámicas se realizaron en situación basal, a los 15 minutos y a los treinta días tras la derivación. La perfusión hepática y esplácnica se valoraron con los gradientes arterio-venosos de contenido de 02 y con los índices de extracción de02 correspondientes a ambos territorios. Los cambios se contrastaron con el Test de Wilcoxon para medidas apareadas. RESULTADOS: la derivación percutánea portosistémica intrahepática provocó un descenso inmediato de la presión portal, un aumento del estado hiperdinámico sistémico y de las velocidades del flujo portal y arterial hepático. Estos cambios persistían al mes, aunque atenuados. No se apreciaron cambios significativos en la perfusión hepática y esplácnica durante el mes de seguimiento, aunque se observó una ligera tendencia a disminuir. CONCLUSIONES: la derivación percutánea portosistémica intrahepática aumentó el estado hiperdinámico sistémico. Sin embargo, el desvío del flujo portal no cambió la perfusión global hepática y esplácnica (AU)

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Technological analysis of lithic artefacts recovered at the Aurora stratum of Atapuerca-TD6 shows that this Lower Pleistocene assemblage is similar to Mode I Technology (=Oldowan tradition) documented at many African sites. Diachronic comparison of the different levels of Gran Dolina allows us to conclude that this particular form of early European technology lacks the production of big flakes to manufacture large tools such as bifaces and cleavers. Rather, it is characterized by the presence of small artefacts, including flakes, denticulates, notches, and side-scrapers, many of which bear use-wear traces of butchery and woodworking. The dominant production technique is orthogonal, which is also reflected in the core recovered at the slightly older level of TD4. The raw materials also found in the Middle Pleistocene occupations at Atapuerca, though with significant proportion differences, have a local origin and include varieties of flint, quartzite and sandstone as well as limestone and quartz. TD6 small artefacts were made from most of these, although the retouched pieces seem to have been preferentially made of the best quality flint, i.e., Cretaceous flint, pointing to the existence of differential use of lithic material, and therefore, some degree of planned knapping behaviour. Most of the "chaînes opératoires" or reduction sequences took place inside the cave, although some artefacts, elaborated on Cretaceous flint, seem to have been retouched off site, possibly near the supply sources.

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We studied 104 patients diagnosed with hepatocellular carcinoma on the basis of pathological findings, in order to establish differences between patients with and without liver cirrhosis in addition to carcinoma. Among the former we also tried to identify differences between patients with previously diagnosed cirrhosis and those in whom cirrhosis was diagnosed at the same time as carcinoma. No significant differences were observed between patients in whom cirrhosis was diagnosed before or at the same time as carcinoma in relation to age, sex, etiologic factors or Child-Pugh grade. Differences were found with regard to motives for suspecting a tumor, frequency of splenomegaly, and platelet and leukocyte counts. No significant differences were found between patients with and without cirrhosis except in some laboratory findings (leukocytes, platelets, erythrocyte sedimentation rate and gammaglutamyl transpeptidase higher in the latter group, and alpha-fetoprotein higher in the former). There were no significant differences between cases of hepatocellular carcinoma that appeared as the first manifestation of liver cirrhosis and those that were diagnosed in patients with known cirrhosis. The clinical and biological differences between patients with and without cirrhosis can be explained by the associated chronic hepatic disease.

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BACKGROUND: The massification of pediatric hospital emergency departments (PED) is due to bad use of the same by a large number of users. The causes related with this inadequate use have not been properly evaluated. METHODS: A sample representative of the population demanding medical care in a PED of a regional hospital was studied with the motives and sociodemographic and cultural factors presumably related with this inadequate demand being analyzed. RESULTS: 52% of the cases had had no previous contact with the primary level of health care and 79% had gone to the PED on their own initiative. With regard to consultations, 65.0 +/- 4.8% were catalogued as inadequate and a statistical relation was found with the age of the patient (less than one year), place of residence (urban) and the arrival by initiative of the patients themselves. CONCLUSIONS: Pediatric hospital emergency departments receive a high number of inadequate consultations at the second level of health care. The importance of the age of the patient, accessibility of pediatric hospital emergency departments and who takes the initiative to come must be emphasized as predictive variables of the bad use of these pediatric departments.

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