[Thyroid dysfunction in hospital worker population]

INTRODUCTION

The prevalence of thyroid dysfunction (TD) and thyroid autoimmunity (TA) in hospital employees in our country is unknown.

OBJECTIVE

To study the prevalence of TD and TA in a group of hospital employees.

STUDY SUBJECTS AND METHODS

We studied thyroid function (thyrotropin, TSH, free thyroxine, T4, and free triiodothyronine, T3) and thyroid autoimmunity (anti-thyroglobulin, antiTg and anti-thyroid peroxidase, antiTPO) in 310 adult subjects (18-70 years) from the hospital General, Segovia, Spain during 2007.

RESULTS

Eleven subjects (3.5%, 10 women) had previously known TD. Thirty-four subjects (11.0%) were diagnosed of unknown TD, mainly subclinical hypothyroidism (8.4%). Prevalence of total TD was 14.2%. TA was positive in 44 (14.2%) subjects. Both TD (P<0.05) and TA (P<0.05) were associated with female sex, and antiTPO levels were related to the presence of unknown TD (OR 1.007; 95% CI, 1.004-1.010; P<0.001).

CONCLUSION

In this population, total prevalence of TD and TA is similar (14%). Increased antiTPO titers are predictors of unknown TD.

Long-term overall survival (os) and prognostic factors of patients (pts) with surgery of liver metastases from colorectal cancer origin (lm/crc): Retrospective analysis of a Spanish single institution

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Background: Hepatectomy is the only potentially curative treatment for LM/CRC. Long-term survival following liver resection (LR) has improved. The aim of this study was to analyze prognostic factors and OS after LR Methods: A retrospective review of the medical records of pts who underwent LR for LM/CRC from 1997 to 2007 was conducted. Multiple potential prognostic factors for survival were analyzed: synchronic vs. metachronic, post-op chemotherapy (CT) vs. no, lymph node (LN) status of primary tumor, R0 vs. R1–2 resection, gender, location of primary tumor, number and size of metastases, and unilobar vs. bilobar disease. Results: 190 pts (colon 130, rectum 60) underwent LR. Pts’ characteristics: 123 male, 67 female; median age 63 yrs (32–85); 95 pts synchronic, 95 metachronic; 145 pts (76%) received post-op CT; LN status was pN0 in 61 (32%) pts, pN1 in 74 (39%) and pN2 in 52 (27%). A R0 resection was performed in 164 (86%) and R1 in 25 (13%). Post-op mortality was 2.6%.Median OS was 68 months with 5- and 10-year OS of 52% and 31%, and 5- and 10-year disease free survival of 36% and 18%. 5-year OS differed between metachronic and synchronic (64% vs. 39%; p<0.001); LN-status (73% for pN0 vs. 41% for pN1–2; p<0.001); R0/R1–2 surgery (58% for R0 vs. 21% for R1- 2; p=0.002). With a median follow-up of 70 months, 71 (37%) pts remained free of disease, 60 (32%) had new metachronic LM/CRC, 18 (9.5%) had LM/CRC and extrahepatic disease and 36 (19%) had extrahepatic disease alone. Non-significant factors for prognosis were gender, location of primary tumor, number and size of metastases, bilobar disease and adjuvant CT. Conclusions: Pts with LM/CRC who undergo liver resection can achieve long-term OS, our data identifying as prognostic factors: LN status, synchronic/metachronic disease and Type of resection (R0).

No significant financial relationships to disclose.

[The doctor-patient relationship in history]

In the final decades of the XX century the way doctors and patients related to each other changed more than in the twenty-five preceding centuries. The change from a paternalistic to an autonomous model represented a transformation with few historical precedents. The evolution of this phenomenon over time affected the three elements involved: 1. The patient, who had traditionally been considered as a passive receiver of the decisions that the doctor took in his name and for his benefit, was transformed at the end of the XX century into an agent with well-defined rights and a broad capacity for autonomous decision-making on the diagnostic and therapeutic procedures, which were offered to him and no longer imposed on him. 2. The doctor, from being a priestly father-figure (as corresponded to the traditional role of his profession) was transformed into a technical adviser to his patients, to whom he offered his knowledge and advice, but whose decisions were no longer taken for granted. 3. The clinical relationship, from being bipolar, vertical and infantilising, became more collective (with the involvement of numerous health professionals), more horizontal and better adapted to the type of relationship appropriate to adult subjects in democratic societies.

Foreign body post-varicella granulomas due to talc

Foreign body granulomas in the skin have been described frequently and may have various causes. Diagnosis is relatively easy in most cases, as most are related to foreign material penetrating into the skin due to different kinds of traumas. We present the case of a boy with multiple facial granulomas, persisting more than 6 months and related to the use of topical anti-pruriginous talc powder applied to papuloexudative lesions caused by varicella. Data gathered in the anamnesis, examination with polarized light and images seen through the electron microscope enabled us to identify the causal agent talc as the inducer of the granulomatous lesions that the patient presented, discarding other types of foreign body granulomas of exogenous origin.

Magnetic characterisation of rat muscle tissues after subcutaneous iron dextran injection

Ex vivo freeze-dried rat muscle tissues, collected at different times t after a single dose of subcutaneously injected iron dextran, have been magnetically characterised. The AC susceptibility of the tissues shows an overall superparamagnetic behaviour and the dependence on t of, especially, the out-of-phase component is remarkably systematic despite the fact that each tissue originates in a different rat individual. The experiments show that the akaganéite (beta-FeOOH) nanoparticles contained in the injected drug are progressively degraded in the living tissue and, at times of the order of 1 month and for all the analysed rat individuals, converge to a magnetically well-defined species with much narrower magnetic activation energy distribution than iron dextran. Thorough transmission electron microscopy experiments of the same tissues indicate the presence of oxyhydroxide particles, whose size decreases for increasing t in agreement with the interpretation of the magnetic susceptibility. The conclusions drawn from the magnetic study do well correspond to the properties of the whole tissue since no biochemical extraction work has been done. The AC susceptibility appears to be a valuable and complementary tool in pharmacological studies of iron-containing drugs.

[Archivos de Neurobiología: seventy five years of Spanish psychiatry]

One might consider that the first Spanish psychiatrists were a group of alienists, that have been forgotten for many years, who worked in isolated conditions in the asylums of the 19th Century. On the other hand, there were a group of personalities, university professors specialised in other disciplines, that were not psychiatrists but had a much greater influence than the former during the early stages of the development of Spanish psychiatry as a differentiated medical speciality. This development was produced (considerably later than in other European countries) in two successive stages: a preliminary one, with local or aborted institutions (from the 15th Century to the year 1919) and a further one, with institutions that extended throughout the entire country, and were developed between 1920 and 1936. These national institutions were the ones that defined the beginning of Spanish psychiatry. The first one, that appeared in January of 1920, was the journal Archivos de Neurobiología, that related each other, stimulated and served as on organ of expression to the remaining institutions that established this specialty. Finally, a summary is offered of the characteristics and the historical evolution of this journal emblematic of Spanish psychiatry, that is currently commemorating its 75th anniversary.

The vasectomized testis

We have performed a qualitative study on effects of vasectomy on the testicular structure. Vasectomy performed with the traditional technique changes testicular structure. At first, the injuries are slight and restricted, but gradually, and in a time-dependent manner, become more severe and extensive. Ultrastructure studies indicate that the spermatogonia and Sertoli's cells are the most resistant to vasectomy, and are even observed in some regenerating testes lacking a complete germinal epithelium. Morphometric studies revealed a decrease in epithelial depth, an increase in the thickness of the basement membrane and in surface of the interstitial space, all significant (P < 0.01) with respect to the control. However, the percentage of the interstitial tissue occupied by cells, did not show any significant difference. We propose that the increase of intraluminal pressure is the essential factor that provokes testicular atrophy.

Analysis of the complications of the piggy-back technique in 1,112 liver transplants

BACKGROUND

The "piggy-back" technique has gained acceptance in adult orthotopic liver transplantation during the last few years, especially in European countries. At the moment, however, there is controversy over advantages or specific complications (suprahepatic thrombosis or narrowing, etc.) related to this surgical technique. The aim of this study is to know of the immediate per-and postoperative morbidity and mortality rates in 1112 orthotopic liver transplantations performed with a vena cava preservation technique.

METHODS

All liver transplant units in Spain were sent a questionnaire on retrohepatic vena cava preservation during orthotopic liver transplantation. The number of orthotopic liver transplantations that had been performed in the seven centers that answered the questionnaire, because the beginning of the program, was 1674, with the vena cava preservation technique used in 1112.

RESULTS

Twenty-eight patients (2.5%) had intraoperative complications related to the vena cava preservation technique, which were treated during the operation. Eleven patients (1%) had early postoperative complications (first week), the most frequent (nine cases) being an acute Budd-Chiari syndrome in the first 48 hr. Three patients developed symptoms of massive ascites between 2 and 3 months (late postoperative complications), with patency of the retrohepatic cava verified by cavography. A hemodynamic study revealed a hyperpressure at the suprahepatic veins. This chronic Budd-Chiari syndrome was controlled in all patients with diuretics. Only six patients (0.5%) died as a result of complications related to the "piggy-back" technique. These complications were more frequent when venous reconstruction was done using two suprahepatic veins than when the three veins were used (P<0.001).

CONCLUSIONS

The vena cava preservation technique can be used routinely in orthotopic liver transplantation because it is safe and efficient and involves few surgical complications especially if for venous reconstruction we use the patch obtained by joining the three suprahepatic veins.

[The concept of delirium in Spanish psychiatry (19th-20th century)]

The history of psychiatric knowledge in Spain can be divided into four differentiated periods (up to the eighteenth century; nineteenth century; first third of the twentieth century and the two final thirds). These four periods provide a framework within which theories about delusion can be explored. Spanish psychiatrists have not been very original. Nonetheless, some of them (Sanchís Banús, López Ibor, Martín Santos, Llopis, Valenciano, Sarró or Castilla del Pino) have tried to make personal contributions to the subject of delusion that deserve attention. Their theories (and some others) are reviewed in this paper.

The concept of 'delusion' in Spanish psychiatry

The history of the concept of delusion can be used to explore the general history of psychiatry in Spain and assess the contribution of her most distinguished practitioners. As this paper shows, the latter have not been as creative as their fellow artists or writers. Nonetheless, the ideas on delusions that some of them formulated deserve attention. The history of Spanish psychiatry (qua science) can be divided into four historical periods. (1) The native origins (up to the end of the eighteenth century). (2) The introduction of European psypchiatry (nineteenth century). (3) The period of consolidation (first third of the twentieth century). (4) From the Civil War (1936-39) to the present. These four periods provide a framework within which theories about delusion can be explored. Aspects of these four stages have been dealt with in earlier papers.

[Analytic preoperative control and serum alaninaminotransferase (ALT) activity]

A standard model of analytical preoperative profile does not exist, so we decided to perform a wide profile. In this revision, we studied the utility of determining serum ALT activity in analytical preoperative controls, searching for the causes of its elevation in pediatric patients who would undergo minor surgery. Of the 3,750 patients analysed, 1.57% showed elevated serum ALT activity. Searching for the main cause, we found the following groups: I) patients with diseases unrelated to the surgical procedures that cause elevated serum activity; II) patients on pharmacological treatments which may produce transitory elevations of serum ALT activity, and III) patients with elevated serum ALT activity that has no evident clinical or pharmacological cause. The high incidence of patients with this abnormality justified the inclusion of serum ALT activity in the profile. We conclude that: a) the reasons for this elevation should be investigated, b) pediatricians should consider postponing surgery, and c) resumption of normal serum ALT activity should be monitored.

[Neurofibroma of the lower lip]

Reporting a nervous tumor diagnosed as Neurofibroma, which owing to its localisation, on the lower lip, and its possible origin, from a salivary gland, should be considered an extraordinary rarity. The AA, make a bibliographic review of the commonest sites of the growth, the histological description and consider some possible differential diagnosis with special emphasis to the schwannoma and the Recklinghausen's disease.

A quantitative approach to the classification of hypospermatogenesis in testicular biopsies for infertility

Absolute counts of germ cells were performed in 110 testicular biopsy specimens from 59 patients with either idiopathic infertility or varicocele and in a series of five autopsy specimens from age-matched controls. The tubular diameter, thickness of the tubular wall, and density of Leydig cells were measured. The following patterns were identified by germ-cell counts in the biopsy specimens: normal cell population, mild decrease in germ cells with normal ratio of cell types, advanced hypospermatogenesis with abnormal ratio of cell types, and Sertoli cell only. This sequence of progressive hypospermatogenesis was remarkably similar in both series. A separate category of maturation arrest was not recognized. Cell counts also correlated between right- and left-sided samples from the same patient in both series of biopsies. Reduction of tubular diameter, thickening of the tubular wall, and increase in Leydig cell density were often seen in severe stages of germ-cell impairment, although with an irregular distribution.

Physical map of bacteriophage phi29 DNA

Restriction endonuclease EcoRI cleaves linear phi29 DNA at four points yielding five fragments (A-E) of molecular weights 6.0 x 10(6), 3.8 x 10(6), 1.3 x 10(6), 0.6 x 10(6), and 0.3 x 10(6). The relative order of the fragments was shown to be A, B, E, D, C by analysis of the EcoRI partial digestion products and from the study of the fragments obtained by treatment of protein-containing DNA with EcoRI and trypsin. The EcoRI cleavage map of phi29 DNA has been ordered relative to the genetic map by marker rescue experiments.