[Histopathological findings and biomarker analysis in cutaneous graft-versus-host disease ]

Graft-versus-host disease (GVHD) remains the greatest source of morbidity-mortality in allogenic transplant patients. Although in most cases the more easily obtainable clinical and laboratory test parameters suffice to confirm the diagnosis and establish the stage of the disease biopsies of the affected organ are sometimes needed. At present there is great Interest in the study of factors allowing a prognosis of the course and type of response to treatment in patients with CVHD. In this sense, It would be necessary to objectively Identify and validate biomarkers capable of predicting biological or pathological processes in patients with cVHD. To this effect we have performed serial analyses of skin tissue using peripheral blood and tissue biomarkers in a prospective observational study conducted in three transplant centers. The still preliminary results Indicate that certain histopathological findings classically attributed to CVHD ore also seen in patients not clinically affected by the disease--this probably being related to other physiopathological phenomena occurring during transplantation. The study of these findings, combined with biomarker analysis, will allow improved understanding of the underlying etiopathogenesis, as well as the definition of new diagnostic, prognostic and response-evaluating criteria.

[Carotid revascularisation using angioplasty and stent in 134 consecutive cases in a reference hospital: a risky technique?]

INTRODUCTION

Carotid revascularisation (CR) using angioplasty and stent (ASC) is an effective procedure in the prevention of ischaemic stroke, but with a controversial morbidity and mortality in the different studies conducted in this field.

METHODS

The results of the ASCs performed in the Virgen de la Arrixaca University Hospital (Murcia) between January 2006 and April 2009 were analysed (epidemiology, indication, grade of residual stenosis and procedure complications). All patients subjected to ASC were pre-selected and followed up by neurologists, and they followed a strict medical protocol for performing the procedure. All ASCs were performed by a team consisting of two surgeons, an anaesthetist and a nurse.

RESULTS

A total of 134 ASC were performed. The mean age of our patients was 72.7 years, with the large majority (75%) being male. The most prevalent diseases were, high blood pressure (81%), smoking (66.4%), and diabetes (38.1%). The most common indications for CR were symptomatic carotid stenosis with a level of stenosis of 75-99%, either in the left (33.6%) or right (32.1%), followed by asymptomatic stenosis combined with risk factors (11.2% in the left side and 10.4% in the right side). A level of stenosis less than 30% was achieved in 132 of the 134 ASC (98.5%). performed. Five patients (3.7%) had complications associated with the procedure, of which four were different clinical presentations of a re-perfusion syndrome and one an asymptomatic thrombosis of the stent.

CONCLUSIONS

ASC is a complex technique that must be performed by appropriately trained specialists. The performing a minimum number of procedures per year and an admission protocol controlled by Neurology are essential conditions for a low rate of complications. Under these conditions, the morbidity and mortality of the technique is no higher than that of endarterectomy.

[Quantitative salivary gland scintigraphy in head and neck cancer patients following radiotherapy]

OBJECTIVE

To assess the role of quantitative salivary gland scintigraphy (SGS) in the detection of functional impairment of salivary glands in patients with head and neck cancer treated with radiotherapy (RT).

MATERIAL AND METHODS

We studied 19 patients (17 men), mean age 62.4 years (44-75). Three studies were performed to each patient: baseline, 3 and 18 months after RT. SGS was acquired for 25 minutes following injection of 3.7 MBq/kg of (99m)Tc-pertechnetate with lemon juice at the end of minute 15. Excretion fraction (EF), counts per minute/pixel/MBq (CMPM) and uptake percentage were obtained from time-activity curves from ROIs placed over parotid (PG) and submandibular glands (SMG) and related to the doses received by the PG.

RESULTS

EF showed a significant reduction from the baseline to the 3 months study (p<0.001) for the PG and SMG and from the baseline to the 18 months study for the SMG (p<0.001). A significant improvement of EF was seen from the 3 months to the 18 months study for the PG (p<0.05). CMPM did not change significantly from the baseline to the 3 months and 18 months studies for the PG and showed a significant reduction (p<0.01) for the SMG from the baseline to 18 months study. The uptake percentage did not change significantly between studies. A moderate association was observed between the doses to PG and the 3m study parameters.

CONCLUSIONS

EF was more sensitive than uptake in assessing post-RT impairment of salivary function. In addition, it reflected functional recovery of parotid glands over time.

[Epidemiology and clinical presentation of Panton-Valentin leukocidin positive methicillin-resistant Staphylococcus aureus]

INTRODUCTION

the aim of our study was to review the epidemiology and clinical manifestations of infections due to Panton-Valentine leukocidin-positive methicillin-resistant Staphylococcus aureus (PVL-MRSA).

MATERIAL AND METHODS

Medical history of patients infected by MRSA-PVL admitted to our hospital from January 2007 to July 2009 was reviewed. PVL and the type of cromosomic cassette were determined in all strains by PCR.

RESULTS

A total of 37 cases were included. Seventy percent were males and the median age was 39 years. Sixtytwo percent were Spanish, 14 (37.8%) were HIV-positive and 11 (29.7%) were homosexual. The source of the infection was the skin and soft tissue in 36 cases and pneumonia in 1. Sixteen patients were hospitalized, 5 had bacteremia and 5 developed septic metastasis. The relapse rate was 24% (9 cases). The prevalence during the study period was 11.2% of all MRSA isolated (37 out of 329). All the strains had a cromosomic cassette type IV and were susceptible to cotrimoxazole, rifampin, vancomyin, daptomycin and linezolid. The MIC of vancomycin, measured by E-test, was ≥ 1.5 mg/L in 28 out of 34 cases (82.3%).

CONCLUSIONS

Eleven percent of the MRSA strains isolated in our hospital are PVL positive. In general, skin and soft tissue infections are the most common and bacteremia or septic metastasis are frequent. In contrast to previous Spanish studies, more cases are observed in patients born in Spain and the infections are more severe.

Electrical and pharmacological manipulations of the nucleus accumbens core impair synaptic plasticity in the dentate gyrus of the rat

The interest on the physiology of the nucleus accumbens (NAcc) has grown in recent years given its relationship to addictive behaviours, and the possibility to treat them by interacting with NAcc function. We have shown that the prior stimulation of the core region blocks induction of long-term potentiation (LTP) at the dentate gyrus in anaesthetized rats, while the shell facilitated it. In the present study we have confirmed and expanded those results testing the effects of core and shell stimulation in freely moving rats, as well as the effect of blocking D1 receptors in the NAcc. Our results show that shell stimulation had no effect on baseline recordings of the field excitatory postsynaptic potential (fEPSP) or the population spike amplitude (PSA) for 24 h. Core stimulation did not modify baseline-fEPSP, but significantly depressed PSA up to 8 h. LTP maintenance was not modified; neither by core nor shell stimulation after its induction, but LTP induction was impaired (both in the fEPSP and PSA) by core stimulation 15 min before induction. Shell stimulation showed a slight facilitating effect. Previous, topical application of a dopaminergic-receptor antagonist (SCH23390) into the NAcc produced a significantly depressed baseline fEPSP and PSA, as well as LTP measured in both components of the evoked potentials. Our results confirm a dual role of stimulation of NAcc sub-regions on hippocampal baseline synaptic transmission, and LTP induction when activated before induction. In contrast, stimulation of the NAcc had no influence on an already ongoing dentate gyrus LTP. A role for dopaminergic innervation to the NAcc, modifying susceptibility for synaptic plasticity outside the NAcc is also suggested by our results.

[How to identify adverse events in emergency services? A guide agreed for the screening]

OBJECTIVE

Since a third of adverse events (AE) occur outside hospital, the Emergency Services are a suitable place to look at their incidence. We considered designing a screening guide, adapted to the conditions of the emergency services, to identify AE.

MATERIAL AND METHODS

A qualitative technique was applied (nominal group) in which 14 professionals participated. They analysed which factors of intrinsic risk, extrinsic risk, and alert conditions, were suitable for a screening guide of AE in emergency services. The session was chaired by a specialist in these types of techniques.

RESULTS

Consensus was high in that the most frequent AE in emergencies were those related to medicines, diagnostic tests and with the correct identification of the reason for emergency. With respect to screening guide, the group proposed adding alcohol abuse, patient social problems, cognitive deterioration, basal autonomy and disability. In relation to extrinsic risk factors, they pointed to the need of including defibrillation, spinal tap or drainage implantation. With respect to the alert conditions form, the professionals agreed in that all the criteria seemed correct and suitable, except for that related to damage relation childbirth or amniocentesis.

CONCLUSIONS

By using this technique we have managed to validate materials already recognized, and widely used in our country. The screening guide was considered useful, with slight modifications in some risk factors and alert conditions. The professionals agreed that the MRF2 modular questionnaire is appropriate for the characterisation of AE in emergencies.

[Characteristics of the neuropsychological performance in patients with HIV infection]

OBJECTIVE

To describe the characteristics of the neuropsychological performance of patients with HIV infection in the different stages of the infection.

METHODS

A clinical sample made up of 122 patients was obtained: asymptomatic seropositive subjects: Stage A (n = 30), Stage B (n = 17), Stage C or AIDS: Stage C (n = 41) and seronegative subjects: Control Group (n = 34). All the subjects underwent the same evaluation procedure: neuropsychological assessment, an interview on sociodemographic and clinical aspects. The results were compared based on the serological situation and clinical stage.

RESULTS

Performance of the seropositive subjects was lower than that of the seronegative ones (Group Control) in all the studied factors: 1) Visual memory (F = 12.83; p < 0.000); 2) Attention/psychomotor speed (F = 18.25; p < 0.000); 3) verbal intelligence/abstract reasoning (F = 11.97; p < 0.000); 4) Verbal memory for texts (F = 6.43; p < 0.000); and 5) verbal memory for digits and words (F = 6.27; p < 0.001). Inside the group of seropositive subjects, the patients with AIDS (Phase C) presented the lowest levels of execution in all the factors. The functions demonstrating the worse performance were those of: Attention/psychomotor speed, visual memory and verbal intelligence/abstract reasoning.

CONCLUSIONS

Neuropsychological performance is clearly diminished in the advanced phases of the disease, this not being as clear in the asymptomatic phases. In view of the characteristics of the neuropsychological performance observed in the early stages of the infection, we consider that these cannot used as reliable predictors of more severe future neuropsychological alterations characteristic of the most advanced phases of HIV infection.

Electronic band effects on the spin disorder resistivity of Gd(4)(Co(1-x)Cu(x))(3) compounds

We present a study of the spin disorder resistivity ([Formula: see text]) and the electronic specific heat coefficient (γ) in Gd(4)(Co(1-x)Cu(x))(3) compounds, with x = 0.00, 0.05, 0.10, 0.20 and 0.30. The experimental results show a strongly nonlinear dependence of [Formula: see text] on the average de Gennes factor (G(av)) which, in similar intermetallic compounds, is usually attributed to the existence of spin fluctuations on the Co 3d bands. Values of γ were found around 110 mJ mol(-1) K(-2) for the Gd(4)(Co(1-x)Cu(x))(3) compounds, much larger than 38.4 mJ mol(-1) K(-2) found for the isostructural nonmagnetic Y(4)Co(3) compound. Using a novel type of analysis we show that the ratio [Formula: see text] follows a well-defined linear dependence on G(av), which is expected when appropriate dependencies with the effective electron mass are taken into account. This indicates that band structure effects, rather than spin fluctuations, could be the main cause for the strong electron scattering and γ enhancement observed in the Gd(4)(Co(1-x)Cu(x))(3) compounds. A discussion on relevant features of magnetization and electrical resistivity data, for the same series of compounds, is also presented.

Transporte de terneros en España. Aspectos técnicos, administrativos y de bienestar según el destino

Para conocer en detalle como se transporta el ganado vacuno en España según el destino del viaje, entre los años 2004 y 2005 se entrevistaron 44 operadores representativos del sector (27 mataderos, 10 comerciantes y 7 mercados) mediante cuestionarios que recogían información relativa a 119 parámetros. Más del 80% de los viajes fueron de animales cebados/para cebo, y algo más de un 3% de los viajes transportaban animales cebados/para cebo y reproductores. Los transportes a matadero cargaron en un menor número de explotaciones (1,2 vs. 1,4 granjas; p

[Retrorectal cystic hamartoma (tailgut cyst): radiologic and pathologic findings]

Cystic hamartoma is a rare congenital lesion that presents as a presacral mass. It arises from remnants of the embryonic postanal gut. It is more common in women and usually presents in middle age. It is usually asymptomatic. It is difficult to distinguish the imaging appearance of cystic hamartoma from that of many other presacral cysts; therefore, histologic analysis is essential for the definitive diagnosis. Complete surgical excision is indicated to establish the diagnosis and avoid complications (infection and malignant transformation).

Injectable iron-modified apatitic bone cement intended for kyphoplasty: cytocompatibility study

In this study, the cytocompatibility of human ephitelial (HEp-2) cells cultured on new injectable iron-modified calcium phosphate cements (IM-CPCs) has been investigated in terms of cell adhesion, cell proliferation, and morphology. Quantitative MTT-assay and scanning electron microscopy (SEM) showed that cell adhesion and viability were not affected with culturing time by iron concentration in a dose-dependent manner. SEM-cell morphology showed that HEp-2 cells, seeded on IM-CPCs, were able to adhere, spread, and attain normal morphology. These results showed that the new injectable IM-CPCs have cytocompatible features of interest to the intended kyphophasty application, for the treatment of osteoporotic vertebral compression fractures.

Maternal glucose tolerance status influences the risk of macrosomia in male but not in female fetuses

OBJECTIVE

To elucidate whether the risk of macrosomia, large for gestational age (LGA) and small for gestational age (SGA) is influenced by maternal body mass index and glucose tolerance differently in male and female fetuses.

METHODS

A population study was conducted in 16 general hospitals from the Spanish National Health Service that included 9270 consecutive women with singleton pregnancies and without a former diagnosis of diabetes mellitus who delivered 4793 male and 4477 female newborns. Logistic regression analyses were performed to predict the effect of body mass index (BMI) category and glucose tolerance on macrosomia, large for gestational age newborns (LGA) and small for gestational age newborns (SGA) Separate analyses according to foetal sex were carried out for each outcome. The results were adjusted for maternal age, gestational age and pregnancy-induced hypertension.

RESULTS

There were significant differences between males and females in the percentage of infants who had macrosomia, LGA or SGA. Maternal BMI category was positively associated with the risk of macrosomia and LGA in both male and female newborns. In addition, there was a negative association between maternal BMI and SGA that only reached significance in males. In contrast, gestational diabetes was only a predictor of macrosomia exclusively in male fetuses (OR 1.67, 95% CI 1.12 to 2.49)

CONCLUSIONS

There is sexual dimorphism in the risk of abnormal birth weight attributed to maternal glucose tolerance status. A closer surveillance of foetal growth might be warranted in pregnant women with abnormal glucose tolerance carrying a male fetus.

[Diagnostic errors and temporal stability in bipolar disorder]

INTRODUCTION

The diagnosis of bipolar disorder is frequently modified during the course of the illness.

MATERIAL AND METHODS

Diagnostic changes and associated errors are described for 1,153 patients diagnosed as bipolar disorder, aged over 18 years and with at least ten follow-up visits. Data was extracted from a clinical registry of out-patient care specialized in Psychiatry and psychiatric hospitalizations of 25,152 patients representative of an urban area of 240,000 inhabitants. Limit for diagnostic stability was established as the maintenance of the bipolar disorder diagnosis in at least 75% of the visits.

RESULTS

A total of 158 (46.1 %) out of 342 patients diagnosed as having a bipolar disorders in the first visit kept this diagnostic constant in subsequent evaluations. Infradiagnostic initial error was committed with 108 stable patients who were not diagnosed in the first visit. 184 patients diagnosed in the first visit with bipolar disorder had less than 75 % concordant diagnosis along the follow-up and could be considered as initial overdiagnosis. Two hundred and nine out of the 443 patients who were diagnosed as bipolar disorder in their last visit did not keep stability criteria in their follow-up and could be considered therefore as final overdiagnosis. Thirty two stable patients not diagnosed in their last visit could be considered as infradiagnosis final error. Diagnosis from schizophrenia spectrum (F2) appears in one of every four psychiatric visits of the patients included in this study. Overlap was seen in three other categories: anxiety disorders (F4), personality disorders (F6) and substance abuse disorders.

CONCLUSION

Initial course of bipolar disorder causes difficulties in the diagnosis.

[Endoscopic treatment of recurrent tracheoesophageal fistula]

Repermeabilization of the tracheoesophageal fistula (RTE) is one of the major complications of the esophageal atresia with tracheal fistula. We present the long term results of our technique based on broncoscopic treatment with fibrin glue and diathermia.

MATERIAL AND METHODS

A retrospective study of 10 children with RTE treated from 1993 to 2006, their ages ranging from 14 days-old to 4 years-old; there were 4 patients from other hospitals. One of the patients involved had a superior congenital fistula that had not been noticed during open surgery. Broncoscopic procedure was performed using rigid instrumentation. The fistula was sealed with fibrin glue; the last seven patients in the series received previous diathermia with an uretheral catheter. Clinical and radiological follow up took place in all children. Endoscopic evaluation was performed in 6 of them. Follow-up time vary from 1 to 13 years and the number of sessions was limited to 3 per patient.

RESULTS

Closure of the fistula was confirmed in 9 cases (90%) who required a whole number of 15 sessions (Mean: 1.5). The group who received diathermia needed 9 sessions (Mean: 1.2). There were no major complications.

DISCUSSION

Surgery reparation of RTE is often related to serious complications. Therefore, many groups have tried to develop several broncoscopic techniques using different materials. Scientific reviews have not pointed out a definitive option since they involve isolated patients with no long term evolution. Taking this report into account we believe that the application of diathermia and fibrin glue ought to be considered the first choice treatment for the RTE.

Pharmacological compliance and acceptability of lansoprazole orally disintegrating tablets in primary care

OBJECTIVE

To evaluate the pharmacological compliance of patients treated with lansoprazole orally disintegrating tablets (LODT) in Primary Care (PC) and their acceptability of this formulation.

RESEARCH DESIGN AND METHODS

A multicenter, observational, cross-sectional study involving 433 PC physicians that included 433 patients aged at least 18 years, either diagnosed with gastroesophageal reflux disease (GERD) or taking LODT to prevent NSAID-induced gastric ulcers. Compliance with LODT treatment was assessed with the Haynes-Sackett self-reported test. Acceptability was based on global patient assessment, rating the drug's organoleptic characteristics and properties recorded with a self-administered 15-item ad hoc questionnaire with 2 and 5-point Likert-type scales.

RESULTS

423 patients (mean age 50.6 years, SD = 13.4) were evaluable for the main endpoint. Of these, 57.16% were men and 53.5% were treated with 30 mg doses of LODT for an average of 37.8 days (SD = 35.5). Compliance was achieved by 92.4% of the patients, mean percentage of compliance was 93.3. Demographical and clinical variables had no effect on compliance. Treatment with LODT was assessed as 'acceptable' or 'highly acceptable' by 91.7% of the sample. One adverse reaction, not serious, was reported by one patient (0.2%).

CONCLUSIONS

In this observational study, compliance with lansoprazole orally disintegrating tablets was very high. Patients reported that this formulation improved their compliance. LODT was clearly preferred to previous medication and the drug was well tolerated.