[Sclerosing encapsulating peritonitis: a latent threat. Changes of posture in surgery treatment]

Sclerosing Encapsulating Peritonitis (SEP) is a rare but serious complication of continuous ambulatory peritoneal dialysis (CAPD) with a high morbi-mortality. We describe our experience with patients was diagnostic of SEP, their characteristics in CAPD and their clinic evolution after diagnosis. 190 CAPD patients were follow-up during 17 years. Eight patients (4.2%) developed SEP. Average age 45+/-14 years (range 29-64 years), four was male. Time in CAPD was 72+/-29 months (range 24-120 months). All patients have peritonitis previously (mean 3+/-1). We observe a change in peritoneum characteristics (D/P Cr 4), with an average of 0.6+/-0.1 at one year of CAPD, versus 0.82+/-0.08 at the end of CAPD, with statistic significance (p<0.001). There are increases in use of hypertonic bags: 53%+/-28 at beginning versus 91%+/-27 at end, with statistic significance (p<0.009). All patients show tendency to hyperphosphoremia (mean 6.7+/-0.7 mg/dl), with product calcium-phosphorus 68.4+/-8.3. Five patients (62.5%) have a previous renal transplant, one lost due to early graft thrombosis and two lost due to acute rejection. Six patients (75%) have a previous abdominal surgery, although was extra peritoneal in all cases. The diagnosis of SEP was clinic suspicion in all cases, suggestive radiological data (intestinal handle group) and laparoscopy showing SEP (cocoon) with histological confirmation (fibrosis and peritoneal calcification) in four cases. The treatment was medical in six cases associated with surgery in four of them. The medical treatment was tamoxifen and/or corticosteroids, associated with total parenteral nutrition in two patients and enteral nutrition in one. Surgery in six patients: three as urgent surgery (all died) and three as programme surgery (two live still). Etiology of died was: three for sepsis, one for peritonitis after bowel perforation, one for severe problems of nutrition. The average survival of three patients alive was 38+/-17 months, two of them had programme surgery, and one with functioning transplant we opt for conservative treatment. The actuarial survival at 24 months was 51%.

CONCLUSION

The SEP is a serious entity with high mortality. Although our short experience doesn't can indicate a concrete treatment, our personal impression is that early surgery associated with corticosteroids treatment may improve the prognostic.

[Factors which influence phosphorus removal in hemodialysis]

BACKGROUND

The sustained elevation of phosphorous among patients with end-stage renal failure is associated with elevated mortality rates. Phosphate binding agents are usually necessary to control serum phosphate levels. Phosphate removal during dialysis is limited largely due to the intracellular location of most inorganic phosphorous. The membrane surface, the frequency and the duration of therapy have proved to be very important factors in the serum phosphate control. THE AIM of our work is to investigate the influence on phosphate removal of factors that normally participate in the haemodialysis session: Plasma phosphate level (Php), treatment duration, membrane surface, high or low-flux membranes, the vascular access, dialysate flux , the volume of blood passing through the dialyzer (L) in each dialysis session and the blood flow during the first hour of dialysis. On 16 patients, we also had the possibility of comparing phosphate removal with 1.8 m(2) high-flux haemodialysis, 1.8 m(2) on-line hemodiafiltration and the on-line technique with the new Helixone dialyzer Fresenius Fx100.

METHODS

108 haemodialysis patients, 62% men, 38% women aged 21-82 years (61+/-14;mean+/-sem),) were selected for the study. Mean treatment time 4.14+/-0.41 hours (range 3.5-5 hours). The vascular access was an arterio-venous fistula in eighty five (78%) and a double lumen tunnelled catheter 23 (22%). Patients were studied under their normal every day conditions. High-flux membrane was used by 31 (30%) patients and low-flux membrane by 77 (70%). Membrane surface was: 1.7 m2:17 (16%); 1.8 m2:77 (71%); 2,1 m2:14 (13%). Dialysate flux was: 500 ml/min. 55 patients; 700 ml/min: 53 patients. In 16 out of 108 patients we had the possibility of using on-line hemodiafiltration with ultrapure bicarbonate-buffered dialysate. Phosphate mass removal (MPO4) was calculated using the formula:MPO4=0.1 t-17+50 Cds 60+11Cb 60 (1), where t is treatment time in minutes, Cds60 and Cb60 are phosphate concentrations in dialysate and plasma measured at 60 min from the beginning of hemodialysis in mg/dl, and MPO4 is the estimated phosphate removed in mg/treatment.

RESULTS

We found a good correlation between phosphate removal and serum phosphate levels (p=0.01), but not with the membrane surface or treatment duration. Phosphate removal was 640+/-180 mg/session with low-flux membrane and 700+/-170 mg/session with high-flux membrane (p=0.280). The MPO4 was 720+/-190 mg/treatment in patients with a AV fistula and 620+/-180 in patients with a tunnelled catheter (p=0.023). We found a good correlation between phosphate removal and the volume of blood (L) that passed the dialyzer in each session (r=0.001) but we did not find a correlation between phosphate removal and KT/Vurea, the dialysate flux or the ultra filtration. On-line technique did not increased the MPO4(733+/-280 mg, p=0.383). The on-line technique with the new dialyzer (Fresenius Fx100), increased the phosphate removal to 759+/-199 mg/session (p=0.057).

CONCLUSION

Phosphate removal during dialysis is influenced by Plasma phosphate levels, the volume of blood that passed the dialyzer and the vascular access. Uniformity on time and membrane surface could explain the abs cense of influence in our case. The ultra filtration, dialysate flux, membrane permeability or on-line hemodiafiltration does not influence the phosphate removal. The new membrane helixone with 2,1 m2 (Fresenius Fx100) increases phosphate removal probably because the membrane surface is higher.

Oncogenic human papillomavirus (HPV) type distribution and HPV type 16 E6 variants in two Spanish population groups with different levels of HPV infection risk

The aim of this study is to determine oncogenic human papillomavirus (HPV) types and HPV type 16 (HPV16) variant distribution in two Spanish population groups, commercial sex workers and imprisoned women (CSW/IPW) and the general population. A multicenter cross-sectional study of 1,889 women from five clinical settings in two Spanish cities was conducted from May to November 2004. Oncogenic HPV infection was tested by an Hybrid Capture II (HC2) test, and positive samples were genotyped by direct sequencing using three different primer sets in L1 (MY09/11 and GP5+/GP6+) and E6/E7. HPV16 variants were identified by sequencing the E6, E2, and L1 regions. Four hundred twenty-five samples were positive for the HC2 test, 31.5% from CSW/IPW and 10.7% from the general population. HPV16 was the most frequent type. Distinct profiles of oncogenic HPV type prevalence were observed across the two populations. In order of decreasing frequency, HPV types 16, 31, 58, 66, 56, and 18 were most frequent in CSW/IPW women, and types 16, 31, 52, 68, 51, and 53 were most frequent in the general population. We analyzed HPV16 intratype variants, and a large majority (78.7%) belonged to the European lineage. AA variants were detected in 16.0% of cases. African variants belonging to classes Af1 (4.0%) and Af2 (1.3%) were detected. Different HPV types and HPV16 intratype variants are involved in oncogenic HPV infections in our population. These results suggest that HPV type distribution differs in CSW/IPW women and in the general population, although further analysis is necessary.

Higher prevalence of human papillomavirus infection in migrant women from Latin America in Spain

OBJECTIVES

To estimate prevalence and determinants of high risk (HR) human papillomavirus (HPV) by country of origin in women attending a family planning centre (FPC) in Alicante, Spain.

METHODS

Cross sectional study of all women attending a FPC from May 2003 to January 2004. An ad hoc questionnaire was designed and data were collected prospectively. HR HPV infection was determined through the Digene HPV test, Hybrid Capture II, and positive samples for PCR were directly sequenced. Data were analysed through multiple logistic regression.

RESULTS

HR HPV prevalence in 1011 women was 10% (95% CI: 8.2 to 12). Compared to Spaniards (prevalence 8.2%) HR HPV prevalence in Colombians was 27.5% (OR: 4.24 95% CI: 2.03 to 8.86), 23.1% in Ecuadoreans (OR: 3.35 95% CI: 1.30 to 8.63), and 22.73% in women from other Latin American countries (OR: 3.29 95% CI: 1.17 to 9.19). Women with more than three lifetime sexual partners had an increased risk of HR HPV infection (OR 3.21 95% CI: 2.02 to 5.10). The higher risk of HR HPV infection was maintained in Latin American women in multivariate analyses that adjusted for age, number of lifetime sexual partners, and reason for consultation. The commonest HPV types in women with normal cervical smears were HPV-18 (20%), HPV-16 (14%) and HPV-33 (11%).

CONCLUSIONS

Prevalence of HR HPV is more than three times higher in Latin Americans than in Spaniards. Latin American women's HPV prevalence resembles more that of their countries of origin. It is essential that health service providers identify these women as a priority group in current cervical screening programmes.

Sensitization to Anisakis simplex s.l. in a healthy population

The main objective of this study was to determine the degree of sensitization to Anisakis simplex s.l. in healthy population. Using the determination of specific IgE, we studied the seroprevalence against A. simplex s.l. in blood donors selected at random in the region of Antequera (Southern Spain). We detected 22.1%. The immunoblotting technique revealed a band of approximately 60 kDa in the serum of individuals who also exhibited high values of specific IgE against A. simplex s.l. This band would be useful for diagnosis.

[Telemedicine and follow up of peritoneal dialysis patients]

Mean-term experience in the use of Telemedicine in Peritoneal Dialisis (PD) patients is limited as well as its cost-benefit. The main objective of this work is to evaluate Telemedicine utility in mean-long term control of stable PD patients, analyzing if the televisit (TV) could substitute 50% of the programed inhospital consults (HC) the time spent in both visit modalities, the quality of patient-personel contact as well as how image and sound have been perceived. Visit resolution was analyzed taking into account the need of HC after a TV; We also have studied if it would be possible to retrain patients in the dialisis technique with telemedicine, and we have checked the patient perceived quality and calculate the real and social costs.

METHODS

during 18 months, the system has been implanted to 19 patients with 7 +/- 4 follow up (range 3-17). A Falcon videoconference kit at patient's place was used, connected to the home television set. In the hospital there was a computer with a videoconference card, webcam and software meeting point which permits the control of patient's camera from the hospital. Both are connected by a 3RDSI line system. A monthly programmed HC or TV has been made. If more controls had been required, they have been made by TV Time spent was recorded on each TV and patients and staff questionary were inquired.

RESULTS

(a)

PATIENTS

mean age 44 +/- 8 years, 13 (68%) male. 12 (63%) had elemental educational level and 7 (37%) mean-superior. 17 (89%) were actively working. The PD technique was: CAPD 6 (32%) and APD13 (68%). (b) Televisits: 103 TV have been made. 22 +/- 9 minutes were spent on each TV less than in the HC, 33 +/- 8 minutes (p < 0.01). There were technical problems related with lines in 21 TV, but only in 4 the connection was not possible. 92 TV (89%) were made on time, 99 (96%) had a good image quality and 96 (93%) had a correct sound. 100% of patients perceived TV as close to HC. In 90 TV (87%) medical treatment was modified. Only in 4 cases (3.9%) patients needed an hospital visit. According to patient's valuation, TV replaced correctly to HC in 97 instances (94%) and in 97 (97%) in staff opinion. In all cases (100%) catheter exit site could be evaluated as well as edema presence. Retraining was possible in all cases. There was a save in nurse's time and patient's time and also, a save in physical hospital space. Initial investment apart, the daily cost increment was scarce (1.5 Euro) taking into account that there is a save in time for patients and personnel, save in physical space in hospital and in sanitary transport.

CONCLUSION

Telemedicine is useful from the clinical point of view in the mean-term for stable patients in PD. Daily cost increment is scarce and there is a save in time for patients and personnel, save in physical space in hospital and in sanitary transport.

Pilot-scale production and liquid formulation of Rhodotorula minuta, a potential biocontrol agent of mango anthracnose

AIMS

To develop a pilot-plant fermentation process for the production of the yeast Rhodotorula minuta, to be used as a biocontrol agent of mango anthracnose, using a low-cost culture medium. To develop a stable liquid formulation that preserve high viability of the yeast stored at 4 degrees C.

METHODS AND RESULTS

Keeping constant the volumetric power input, a fermentation process was scaled-up from shake flasks to a 100 l bioreactor. Preharvest applications of the yeast resulted in postharvest anthracnose severity equal or lower than that observed with a chemical fungicide. Glycerol was added to the formulation as water activity reducer and xanthan gum as a viscosity-enhancing agent. Yeast initial concentration of 10(10) CFU ml(-1) resulted in 4-5 orders of magnitude decrease after 1 month of storage at 4 degrees C, whereas when it was formulated at 10(9) CFU ml(-1), the decrease was of two orders of magnitude in 6 months.

CONCLUSIONS

The fermentation process was successfully scaled-up using a low-cost culture medium. Postharvest anthracnose severity could be considerably reduced using this yeast. Formulating the yeast at 10(9) CFU ml(-1) and adding glycerol (20%) and xanthan (5 g l(-1)) avoided both contamination and yeast sedimentation and it was able to preserve up to 10(7) CFU ml(-1) after 6 months at 4 degrees C.

SIGNIFICANCE AND IMPACT OF THE STUDY

The yeast R. minuta is reported as a novel antagonistic micro-organism against the pathogen Colletotrichum gloeosporioides. Pilot plant production of this yeast allowed us to conduct field tests in commercial orchards during three harvest seasons. Yeast suspensions applied to mango trees reduced the fruit anthracnose severity in levels similar or better than chemical fungicides.

The effect of locoregional recurrence on survival and distant metastasis after conservative treatment for invasive breast carcinoma

AIMS

Patients with invasive breast cancer submitted to conservative treatment must be followed for a long period of time to study locoregional control. In this study, we analysed the outcome and relationships between locoregional recurrence (LRR), distant metastases and survival.

MATERIALS AND METHODS

A 15-year study, including 470 women with early breast cancer, stage I and II, who underwent breast conservative treatment. Tumour size, nodal status, age, menopausal status, histological grade and LRR were analysed for their ability to predict overall survival, disease-specific survival and distant disease-free survival.

RESULTS

With a median follow-up time of 6.6 years (3 months to 19.1 years), there were 19 LRR at their first site of recurrence and 53 distant metastases. Tumour size greater than 2 cm, positive lymph nodes and histological grade III were significantly related to lower overall and distant metastases-free survival. On multivariate analysis, nodal status, histological grade III and LRR (coded as a time-dependent variable) were significantly related to overall, specific and distant metastases-free survival, whereas tumour size had only a borderline effect on specific and distant disease-free survival. Landmark analysis showed that women who presented an LRR within 2 years after surgery had significantly lower distant disease-free survival (hazard ratio [HR]: 8.39; 95% CI 2.56-27.47; P < 0.001), specific survival (HR: 8.19; 95% CI 2.45-27.41; P < 0.001) and overall survival (HR: 6.02; 95% CI 2.25-16.11; P < 0.005).

CONCLUSIONS

LRR seems to be a significant predictor of distant metastases and survival, and patients who sustain early LRR tend to display a more aggressive clinical course.

Influence of age and geographical origin in the prevalence of high risk human papillomavirus in migrant female sex workers in Spain

OBJECTIVES

To estimate the prevalence and risk factors of high risk human papillomavirus (HPV) infection in migrant female sex workers (FSW) according to age and geographical origin.

METHODS

Cross sectional study of migrant FSW attending a sexually transmitted infection (STI) clinic in Madrid during 2002. Information on sociodemographic characteristics, reproductive and sexual health, smoking, time in commercial sex work, history of STIs, HIV, hepatitis B, hepatitis C, syphilis, and genitourinary infections was collected. High risk HPV Infection was determined through the Digene HPV Test, Hybrid Capture II. Data were analysed through multiple logistic regression.

RESULTS

734 women were studied. Overall HPV prevalence was 39%; 61% in eastern Europeans, 42% in Ecuadorians, 39% in Colombians, 29% in sub-Saharan Africans, and 24% in Caribbeans (p = 0.057). HPV prevalence showed a decreasing trend by age; 49% under 20 years, 35% in 21-25 years,14% over 36 years% (p<0.005). In multivariate analyses, area of origin (p = 0.07), hormonal contraception in women not using condoms (OR 19.45 95% CI: 2.45 to 154.27), smoking, age, and an interaction between these last two variables (p = 0.039) had statistically significant associations with HPV prevalence. STI prevalence was 11% and was not related to age or geographical origin.

CONCLUSIONS

High risk HPV prevalence in migrant FSW is elevated and related to age, area of origin, and use of oral contraceptives in women not using condoms. These data support the role of acquired immunity in the epidemiology of HPV infection and identifies migrant FSW as a priority group for sexual health promotion.

[Stereotactic radiosurgery in the intracranial benign neoplasms and malignant tumors of the brain]

Stereotactic Radiosurgery has proven to be during the last years the therapy of choice in more and more patients with benign and malignant brain tumors. The potential advantages comparatively to surgery and conventional radiotherapy made this technique a very important tool in the therapeutic armamentarium of neurooncology. This series presents the experience of treating more than 100 intracranial lesions with linear accelerator-based radiosurgery at Hospital de Santa Maria in Lisbon with special emphasis on the indications and results. It also provides a review of the concepts and procedures of this modality as well as a general overview of the main published results in series of patients with brain tumors treated with stereotactic radiosurgery.

[Tubulointerstitial nephritis associated with treatment with selective Cox-2 inhibitors, celecoxib and rofecoxib]

The nephrotoxic effect of nonselective nonsteroidal anti-inflamatory drugs (NSAIDS) has been widely described. The main benefit of the Cox-2 inhibitors in relation to the NSAIDS is the production of a very similar analgesic effect, but with fewer gastrointestinal side effects. However, their effects on renal function are little known as yet and their long-term safety is still pending definition. The use of selective Cox-2 inhibitors as anti-inflamatory analgesic is becoming more and more common in our environment. We report two cases of tubulointersticial nephritis confirmed by renal biopsy, associated with administration of the two Cox-2 inhibitors currently available on the market, celecoxib and rofecoxib. In both cases, we were talking about elderly women, with deterioration of the general condition and acute renal failure. In the former case, renal biopsy showed an acute tubulo-intersticial nephritis (TIN) so highly "variegated" in its histologic expression. In the second case, was associated with strong indications of chronicity. Treatment with steroid was initiated in both patients and improvement of renal function was observed.

[Sequential chemo-radiation in non-small cell lung cancer: a retrospective study of 100 patients]

Combined chemotherapy and radiotherapy has shown to be the correct treatment of unresectable non-small cell lung cancer, after many years of poor survival figures with standard radiotherapy alone. It has also been demonstrated that the benefit of chemotherapy is mainly achieved if cisplatin-based schedules are used. The authors present a retrospective study of 100 cases of stage III non-small cell lung cancer treated with a sequential approach of chemotherapy and radiotherapy and evaluate median and overall survival, local progression-free survival and distant progression-free survival. The results of our series are quite similar to those published in literature.

Alcoholism in 274 patients with panic disorder in Spain, one of the main producers of wine worldwide

BACKGROUND

Though panic disorder (PD) and alcoholism have been found in epidemiologic studies to often co-occur, the influence of cultural factors on the order of onset of the disorders has not been frequently addressed.

METHODS

A sample of 274 patients with PD was assessed and compared according to the presence of alcohol use disorder (AUD) (alcohol abuse or dependence), employing several clinical scales.

RESULTS

A total of 26 subjects were diagnosed from AUD. In 73.1% of patients, onset of alcohol use was previous to PD onset. PD subjects with AUD were found to have an earlier age at PD onset. They were more likely to be males, to have a family history of alcoholism, to abuse other drugs and to experience a more severe PD (more attacks in the last month, higher scores in anticipatory anxiety).

CONCLUSIONS

Patients with PD and alcoholism may represent a distinct clinical subgroup. Our finding of an uncommon order of onset for both disorders may reflect cultural influences.

CLINICAL IMPLICATIONS

(i)The study of panic disorder patients with comorbid alcoholism may help to better characterize this subgroup of patients. (ii) Patterns of alcohol use and the order of onset of both disorders may be influenced by cultural factors, with important practical implications. (iii) Patients with panic disorder and alcoholism may represent a distinct clinical subgroup, with an earlier age at panic disorder onset and greater clinical severity of anxiety.

LIMITATIONS

(i) Our results refer to a clinical sample, which may not be representative of the general population. (ii) Alcoholic patients with a history of other drug abuse or dependence were not excluded. (iii) Owing to the small sample size, patients with alcohol dependence and with alcohol abuse were not separated.

Effect of indenter-radius size on Au(001) nanoindentation

We address the question of whether results obtained for small indenters scale to indenter sizes in the experimental range. The quasicontinuum method is used in order to extend the computational cell size to 2x2x1 micro m(3), nominally containing of order 2.5x10(11) atoms, and in order to permit consideration of indenter radii in the range 70-700 A. The dislocation structures for the large indenter are found to be less sharp and to extend over a larger region than for the small indenter. In addition, the large-indenter force-displacement curve differs from that corresponding to the small indenter in one important respect, namely, the absence of force drops during indentation, despite profuse dislocation activity. Based on these observations, we conclude that the indenter force is not a reliable indicator of the onset of dislocation activity and plastic deformation for indenter sizes in the experimental range.