RESUMEN

Since 2009, the largest reported outbreak of leishmaniasis by Leishmania infantum in Europe was reported in Fuenlabrada, Spain. In our hospital, 90 adults with localized leishmanial lymphadenopathy (LLL) or visceral leishmaniasis (VL) were treated during this outbreak; 72% were men, and the mean age was 46.2 years (range 15-95 years). A total of 17 cases (19%) were LLL, an atypical form with isolated lymphadenopathies without other symptoms. All LLL cases occurred in immunocompetent subjects, and only one subject (6%) was a native of sub-Saharan Africa. Diagnosis was performed by fine needle aspiration cytology of the lymphadenopathy. Serology was negative in 38%. LLL outcomes at 6 months were benign, even with doses of liposomal amphotericin B that were often lower (10 mg/kg) than those recommended for VL in Mediterranean areas. A total of 73 subjects (81%) presented with typical VL; 66% of this group were immunocompetent, and 50% of those who were immunocompetent were descendants of natives of sub-Saharan Africa. The rK39 test and polymerase chain reaction were the most useful tests for confirmation of the diagnosis. An initial response to treatment was observed in 99% of cases, and relapses occurred in 14% of cases. Leishmaniasis should be included in the differential diagnosis of isolated lymphadenopathies in endemic areas. LLL could be considered a more benign entity, one different than VL, and less aggressive management should be studied in future investigations.

Asunto(s)

RESUMEN

Objetivos: Los enfermos obesos pueden presentar particularidades en las características de los cálculos urinarios que forman; además el índice de masa corporal (IMC) puede constituir un factor predictivo de recidiva litiásica. Pretendemos evaluar y comparar las características litiásicas según las diferentes categorías de IMC, teniendo también en cuenta la probabilidad de recidiva litiásica en presencia de las covariables edad y sexo .Material y métodos: Análisis transversal retrospectivo sobre 346 enfermos litiásicos: 96 (27,7%) presentaban bajo-normopeso, 151 (43,6%) sobrepeso y 99 (28,6%) obesidad. Se utilizaron los test de la Chi cuadrado y ANOVA. Se realizó análisis de supervivencia para el cálculo de la probabilidad de recidiva litiásica (sí/no) en función del tiempo, sobre 158 enfermos, en los que se consiguió la resolución completa del cálculo inicial empleando el método de Kaplan Meier. Las comparaciones entre las diferentes categorías de IMC se realizaron mediante los test de Log-Rank, Breslow y Tarone-Ware. Se realizó también análisis multivariante mediante modelo de regresión de Cox, introduciendo las covariables edad y sexo. Resultados: Se demostró una tendencia creciente lineal significativa entre multiplicidad e IMC (p=0,03). Las variables tamaño y composición no demostraron diferencias significativas entre los grupos. La mediana de seguimiento de los 158 enfermos incluidos en el análisis de supervivencia fue 1.866 días (IC 95%: 1.602,5-2.129,5). Recidivaron 18 de ellos (11,4%) sin encontrarse diferencias significativas entre grupos: 4 bajo-normopeso (9,8%), 10 sobrepeso (14,1%) y 4 obesos (8,7%). El análisis multivariante tampoco demostró una influencia significativa del IMC sobre la recidiva litiásica (p=0,86: HR = 1,06; IC 95%: 0,56-2,03). Conclusión: Se demuestra una influencia significativa del IMC sobre la multiplicidad litiásica al diagnóstico, aunque no sobre la recidiva litiásica en función del tiempo. Parece necesario llevar a cabo estudios con muestras amplias para calcular la verdadera influencia del IMC sobre la recidiva litiásica (AU)

Objectives: Obese patients may have special characteristics in the urinary stones formed, as the body mass index (BMI) may also be a predictive factor in lithiasic recurrence. We aim to evaluate and compare the lithiasic characteristics according to the different BMI categories, also considering the likelihood of lithiasic recurrence in presence of age and gender covariables. Material and methods: Retrospective, cross-sectional analysis on 346 lithiasic patients, 96 (27.7%) had low-normal weight, 151 (43.6%) overweight, and 99 (28.6%) obesity. The Chi-square and ANOVA tests were used. Survival analysis for the calculation of likelihood of lithiasic recurrence (yes/no) was made based on time on 158 patients in whom complete resolution of the initial stone was achieved by the Kaplan Meier method. Comparisons between the different categories of BMI were made using the log-Rank, Breslow and Tarone-Ware tests. Multivariate analysis was also made with the Cox regression model, introducing the covariables of age and gender. Results: A significant growing linear tendency has been demonstrated between multiplicity and BMI (p=0.03). The variables size and composition did not show significant differences between the groups. Median follow-up of 158 patients included in the survival analysis was 1866 days (95% CI 1602.5-2129.5). Eighteen (11.4%) of them recurred, without finding significant differences between groups: 4 low-normal weight (9.8%), 10 overweight (14.1%) and 4 obese (8.7%). The multivariate analysis also did not show a significant influence of the BMI on lithiasic recurrence (p=0.86; HR =1.06; 95% CI: 0.56-2.03). Conclusion: A significant influence of BMI was shown on lithiasic multiplicity on diagnosis, although not on lithiasic recurrence based on time. It seems to be necessary to carry out studies in larger samples to calculate the true influence of BMI on lithiasic recurrence (AU)

Asunto(s)

RESUMEN

OBJECTIVES: Obese patients may have special characteristics in the urinary stones formed, as the body mass index (BMI) may also be a predictive factor in lithiasic recurrence. We aim to evaluate and compare the lithiasic characteristics according to the different BMI categories, also considering the likelihood of lithiasic recurrence in presence of age and gender covariables. MATERIAL AND METHODS: Retrospective, cross-sectional analysis on 346 lithiasic patients, 96 (27.7%) had low-normal weight, 151 (43.6%) overweight, and 99 (28.6%) obesity. The Chi-square and ANOVA tests were used. Survival analysis for the calculation of likelihood of lithiasic recurrence (yes/no) was made based on time on 158 patients in whom complete resolution of the initial stone was achieved by the Kaplan Meier method. Comparisons between the different categories of BMI were made using the log-Rank, Breslow and Tarone-Ware tests. Multivariate analysis was also made with the Cox regression model, introducing the covariables of age and gender. RESULTS: A significant growing linear tendency has been demonstrated between multiplicity and BMI (p=0.03). The variables size and composition did not show significant differences between the groups. Median follow-up of 158 patients included in the survival analysis was 1866 days (95% CI 1602.5-2129.5). Eighteen (11.4%) of them recurred, without finding significant differences between groups: 4 low-normal weight (9.8%), 10 overweight (14.1%) and 4 obese (8.7%). The multivariate analysis also did not show a significant influence of the BMI on lithiasic recurrence (p=0.86; HR =1.06; 95% CI: 0.56-2.03). CONCLUSION: A significant influence of BMI was shown on lithiasic multiplicity on diagnosis, although not on lithiasic recurrence based on time. It seems to be necessary to carry out studies in larger samples to calculate the true influence of BMI on lithiasic recurrence.

Asunto(s)

Asunto(s)

RESUMEN

Giant cell arteritis is a vasculitis of large and medium size arteries, especially those of the aortic arch with an extracranial distribution, but also the aorta and some of its larger branches. It is characterised by the presence of mononuclear inflammatory infiltrates close to the internal elastic lamina formed by lymphocytes and macrophages, which in slightly more than 50% of the cases contain multinucleate giant cells. The morbidity associated with this disease is related to phenomena of distal ischemia to the luminal stenosis of the inflamed arteries, and to a lesser extent to the formation of aneurisms due to the weakening of the arterial wall. With an unknown aetiology, its pathogenesis is immune through the migration and location of gamma-INF -producing T cells in the adventitia of the inflamed arteries, it being assumed that this is the place of immune stimulation by a still unidentified antigen. The recruitment and activation of macrophages by this cytokine is one of the most important points of its pathogenesis. The destruction by these of the arterial elastic tissue is a relevant phenomenon, as is the production of other factors promoting neoangiogenesis and a proliferation of neointime, responsible through obliterating light for the ischemic manifestations of the disease. The process is accompanied by an important systemic repercussion characterised by a strong reaction of acute phase and general but barely specific symptoms of disease. On the other hand, an important percentage of patients show a clinical picture of polymyalgia rheumatica, an entity that has a historical and controversial relationship to this arteritis. In recent years important contributions have been made to the understanding of the immune mechanisms involved in its pathogenesis.

Asunto(s)

RESUMEN

We report one rare case of squamous cells prostate tumor. This histological pattern accounts for the 0.5-1% of all prostatic malignancies with certain clinical and evolutive aspects that are from those of prostate adenocarcinoma. Review of the literature seems to have a very poor prognosis such that occurred in our patient who died after 2 month of diagnosis with a poor response to the habitual treatment, perhaps due to this different cell of origin.

Asunto(s)

RESUMEN

Transitional cell of bladder carcinoma metastasizing to the skin is uncommon finding, generally appearing in the final stages such that occurred in our patient that indicated a poor prognosis. A lesion located in the pubic region and internal face of the left lower limb with at erythematous, indurated, and aggregated appearance was found. The histological examination of the specimen after cold biopsy demonstrated cutaneous metastasis from transitional cell carcinoma.

Asunto(s)

RESUMEN

Small cell carcinoma (CCP) of the urinary bladder is an uncommon tumor, having usually an aggressive behavior. We report a new case of CCP seen at our centre and we communicate the applied therapeutic method. Although total cystectomy followed by chemo and radiotherapy seems to be the most effective treatment, we have carried out radical RTU of the bladder accompanied by chemo and radiotherapy as conservative therapy obtaining complete remission after 2 year of diagnosis, without local and distant evidence of the disease.

Asunto(s)

RESUMEN

La metástasis en piel por un carcinoma vesical epitelial es una manifestación infrecuente, generalmente aparece en estadios avanzados, tal como sucedió en nuestro paciente y se asocia con un mal pronóstico. Se trata de una lesión localizada en región suprapúbica y cara interna del muslo, con aspecto eritematoso, indurada y confluente; el examen histológico tras biopsia fría resultó una metástasis por carcinoma transicional (AU)

Asunto(s)

RESUMEN

El carcinoma de células pequeñas (CCP) de localización vesical es un tumor poco frecuente, teniendo por lo general una evolución agresiva. Presentamos un nuevo caso de CCP aparecido en nuestro servicio y comunicamos la actitud terapéutica aplicada. Si bien la exéresis total de vejiga seguida de quimio y radioterapia parece ser el tratamiento más efectivo, hemos realizado RTU radical de vejiga asociada a quimio y radioterapia como finalidad conservadora, consiguiendo remisión completa después de 2 años del diagnóstico, sin evidencia local y a distancia de la enfermedad (AU)

Asunto(s)

RESUMEN

OBJECTIVE: To study whether the clinical outcome of Staphylococcus epidermidis-induced endophthalmitis in rabbits is related to the antibiotic resistance pattern of the infecting strain. DESIGN: Experimental animal study. PARTICIPANTS: The right eyes of 36 New Zealand white albino rabbits were inoculated with strains of S. epidermidis that displayed various patterns of antibiotic resistance. METHODS: There were 12 rabbits in each of three study groups: fully antibiotic susceptible (FS), partially antibiotic resistant (PR), and multiresistant (MR). Five days after inoculation, the eyes were enucleated and prepared for histologic studies. MAIN OUTCOME MEASURES: Comparisons among the three groups were made based on electroretinographic (ERG) findings, histologic evaluation by a masked observer, and clinical examination. RESULTS: Electroretinographic findings on all rabbits were made by an unmasked observer. At 30 hours after inoculation, the ERG was diminished to 65% of normal for group FS, compared with a flat ERG waveform for groups PR (P < 0.05) and MR (P < 0.05). The ERG waveform was flat for all three groups at 72 hours after inoculation. Histologic evaluation by use of a histologic score revealed that the degree of inflammation and destruction of the retina was less for group FS (n = 10) compared with groups PR (n = 8) and MR (n = 8). Clinical examination revealed that there was a trend of less ocular inflammation for group FS compared with groups PR and MR. CONCLUSIONS: In a rabbit model of S. epidermidis-induced endophthalmitis, antibiotic-susceptible strains caused less inflammation and destruction of the infected retina than did antibiotic-resistant strains.

Asunto(s)

RESUMEN

AIM: to evaluate bacteremias caused during endoscopic examination of the digestive tract. PATIENTS AND METHODS: prospective study of randomly selected patients who underwent digestive system endoscopic examination. Emergency endoscopic examinations were excluded. RESULTS: a total of 102 patients were analyzed. Of 44 patients who underwent gastroscopy, 11 (25%) subsequently had positive blood culture, and Staphylococcus spp and Streptococcus spp were isolated. Of 30 patients who underwent colonoscopy, 3 (10%) had positive blood cultures, and Staphylococcus spp were isolated. Of 28 patients who underwent endoscopic retrograde cholangiopancreatography, 11 (39.2%) had positive blood cultures, and Escherichia coli, Morganella morganii, Staphylococcus spp and Streptococcus spp were isolated. No deaths, endocarditis or other septic phenomena were attributed to bacteremia. CONCLUSIONS: the incidence of bacteremia ranged from 10% to 39% depending on the type of endoscopy. The microorganisms that were isolated most frequently were Staphylococcus spp and Streptococcus spp. Gram-negative bacilli and enterobacteria were isolated in patients who had undergone endoscopic retrograde cholangiopancreatography.

Asunto(s)

Asunto(s)

Asunto(s)

RESUMEN

BACKGROUND: There are two questions regarding tick transmitted diseases (Ixodidae) not sufficiently elucidated: How to remove the arthropod? and: should antibiotic prophylaxis be administered after the bite? SUBJECTS AND METHODS: From June 1st, 1991, to December, 31, 1992, all patients who were attended at La Rioja Hospital relating immediate bite or tick bite within the 48 hours before were prospectively studied. In all those patients an epidemiological inquiry was obtained, which included, apart from personal data and risk factors for tick bites, how arthropods had been removed, health exam and blood drawn for serological study for Borrelia burgdorferi and Rickettsia conorii. The protocol was repeated at one, two, four and six months after the bite. The removal method used at the Hospital was by pulling with fine tweezers and later disinfection with iodine povidone. RESULTS: Out of a total of 52 individuals who complied with the established criteria, only 41 ended the follow-up. A 63.4 percent of patients experienced some type of complication, including 3 cases of LB (erythema migrans). With regard to the type of removal method and the development of complications, only three patients who had ticks pulled with tweezers experienced complications compared with 23 patients who used other methods (p = 0.0058). With regard to specific complications (LB and/or spotted fever) and/or development of B. burgdorferi or R. conorii infection significant differences were also observed when tweezers were used for removal of ticks compared with other tick removal methods (p < 0.05). CONCLUSION: The removal of ticks with tweezers significantly protects from the development of complications and infection by tick-borne microorganisms. Antibiotic prophylaxis is recommended when the removal of the arthropod is carried out by using a method other than the recommended one.

Asunto(s)

Asunto(s)

RESUMEN

A self-report survey of cigarette use among 10th- and 12th-grade Mexican American students found no differences in rates of use by migrant status. Male students reported higher levels of lifetime, experimental, and daily smoking than female students, and 12th-grade students reported higher levels of daily smoking than 10th-grade students. A socialization model of cigarette use based on peer cluster theory was evaluated using structural equation methods, examining the effects of family strength, family tobacco use, school adjustment, religious identification, and peer tobacco associations. The basic latent-structure socialization model was supported in all groups, but final models including specific effects identified both unique and common relationships by gender and migrant status. Common patterns across groups suggest that completely different prevention programs may not be necessary for these youth. However, program elements based on subtle group differences may serve to tailor prevention efforts and make them more effective.

Asunto(s)

Asunto(s)

Asunto(s)