The anti-CD6 antibody itolizumab provides clinical benefit without lymphopenia in rheumatoid arthritis patients: results from a 6-month, open-label Phase I clinical trial.

Itolizumab is a humanized anti-CD6 monoclonal antibody (mAb) that has previously shown encouraging results, in terms of safety and positive clinical effects, in a 6-week monotherapy clinical trial conducted in rheumatoid arthritis (RA) patients. The current Phase I study evaluated the safety and clinical response for a longer treatment of 12 itolizumab intravenous doses in subjects with active RA despite previous disease-modifying anti-rheumatic drug (DMARD) therapy. Twenty-one subjects were enrolled into four dosage groups (0·1, 0·2, 0·4 and 0·8 mg/kg). Efficacy end-points including American College of Rheumatology (ACR)20, ACR50 and ACR70 response rates and disease activity score in 28 joints (DAS28) were monitored at baseline and at specific time-points during a 10-week follow-up period. Itolizumab was well tolerated up to the highest tested dose. No related serious adverse events were reported and most adverse events were mild. Remarkably, itolizumab treatment did not produce lymphopenia and, therefore, was not associated with infections. All patients achieved a clinical response (ACR20) at least once during the study. Eleven subjects (55%) achieved at least a 20% improvement in ACR just 1 week after the first itolizumab administration. The clinical response was observed from the beginning of the treatment and was sustained during 24 weeks. The efficacy profile of this 12-week treatment was similar to that of the previous study (6-week treatment). These results reinforce the safety profile of itolizumab and provide further evidence on the clinical benefit from the use of this anti-CD6 mAb in RA patients.

[Spontaneous rupture of the esophagus: diagnostic problem in the emergency service]. / Rotura espontánea de esófago: un problema diagnóstico en la urgencia.

We present two case of a spontaneous perforation of the esophagus (Boerhaave's syndrome), they were associated with different symptoms. Both of them the diagnosis was make on the second admission to the emergency service. The Boerhaave's syndrome is potentially lethal, relatively rare and the difficult diagnosis in the initial phases. It's a life threatening condition demanding early diagnosis and rapid aggressive management to prevent fulminant death.

[Congenital anomalies of the first branchial cleft. Retrospective study]. / Anomalías congénitas de primera hendidura branquial: estudio retrospectivo.

Anomalies of the first branchial cleft are occasional problems putting up diagnostic and therapeutic difficulties, because the imperfect settlement of reminders of this cleft, which can appear as cysts or branchial fistula, among patients of any age. Though there are several recommended classifications in order to achieve a precious diagnosis and a total surgical removal, sometimes is laborious to correlate the clinical and the histological findings. We report a sequence of congenital periauricular anomalies operated in our Department during a ten-years-term and compare our findings of those quoted after the literature series.

[Thyroglossal cyst: retrospective study of 58 cases. Results of the Sistrunk operation]. / Quiste tirogloso: estudio retrospectivo de 58 casos. Resultados de la operación de Sistrunk.

Cysts of the thyroglossal duct are one of the most common causes of benign neck masses. They generally occur in young patients and are caused by a defect in thyroglossal duct closure, which sometimes is in close contact with the hyoid. Often several tracts are present. The most effective surgical procedure was originally described by Sistrunk in 1920 and modified in 1928. This technique is based on the removal of the central portion of the hyoid bone. This procedure has successfully reduced the number of recurrences compared to local excision of the cyst. A retrospective review was made of 58 cases to evaluate surgical results, especially recurrence rate, in relation to the resection or preservation of the hyoid bone. Results were compared with published series.

Revisión de evidencias sobre la influencia de la dieta en la evolución de la EPOC / Review of evidence on the influence of the diet on the evolution of COPD

La Enfermedad Pulmonar Obstructiva Crónica (EPOC) ocasiona una importante morbimortalidad, con un gran consumo de recursos sanitarios. La causa principal es el consumo de tabaco. La EPOC es evitable y aunque no es curable, sí es susceptible de mejoría en términos de calidad de vida y aumento de la supervivencia, utilizando los recursos terapéuticos disponibles entre los que se encuentra la rehabilitación y la educación sanitaria. La rehabilitación incluye programas de entrenamiento cuyo fin es mejorar la disnea, el cansancio y la tolerancia al ejercicio. Se compone de programas de entrenamiento físico, educación sanitaria, intervención psicológica, intervención sobre el comportamiento y educación sobre dieta y nutrición. En el presente trabajo se realizó una recopilación bibliográfica de los artículos publicados en los últimos cinco años sobre la educación dietética a los pacientes con EPOC. Se usó la herramienta de lectura crítica CASPE, para seleccionar los de mayor calidad metodológica, con el objetivo de revisar los estudios existentes sobre la influencia de la dieta en los pacientes diagnosticados de EPOC, evaluar las evidencias existentes e incorporarlos a la pauta de actuación ante este tipo de pacientes. La conclusión de esta revisión es que los pacientes con EPOC podrían beneficiarse de una dieta rica en hortalizas, frutas y verduras, soja, fibra y aceite de oliva; mientras que las dietas ricas en azúcares y carnes curadas podrían empeorar su enfermedad. Aunque se recomienda realizar estudios complementarios que corroboren dichas afirmaciones (AU)

Chronic Obstructive Pulmonary Disease (COPD) causes significant morbidity and mortality, with a large consumption of health resources. The main cause is smoking. Despite the fact there is no cure for COPD, it can be avoided resulting in an improvement in the quality of life and an increase the survival rate, through available therapeutic resources, among which are the rehabilitation and health education. Rehabilitation includes training programs designed to improve dyspnoea, fatigue and exercise tolerance. It consists of physical training programs, health education, psychological intervention, conduct intervention and education on diet and nutrition. This study has been performed on an extensive bibliographic compilation of published articles on dietary education patients with COPD in the last five years. In order to get the highest methodological quality articles and perform a review of the existing studies on the influence of diet in patients diagnosed with COPD and evaluate the evidence of those patients, it was necessary to implement a critical reading tool (CASPE), to incorporate them into the pattern of performance against these patients. The conclusion of this review is that patients with COPD may profit from a diet rich in fruit, vegetables, soy, fiber and olive oil, while a diet rich of sugars and cured meat may worsen your condition. However additional studies to corroborate these claims are recommende (AU)

Tratamiento conservador de la escoliosis: ortesis / Conservative treatment of scoliosis: orthosis

El tratamiento conservador de la escoliosisidiopática del adolescente (EIA) no se puede establecer actualmentede manera categórica e irrefutable, y es relativoel nivel de evidencia existente.Objetivo. Realizar un análisis de la efectividad de los principalescorsés utilizados en el tratamiento de la EIA.Estrategia de búsqueda. Medline, PubMed, Cochrane Librarydesde 1992 a 2009.Selección de estudios. Aquellos que cumplen unos requisitosmínimos de calidad en cuanto a metodología de investigación.Síntesis de resultados. Análisis de los factores que más influyenen el resultado final del tratamiento ortésico, tiempo deutilización de la ortesis al día y global durante el cre cimiento,criterio de efectividad/inefectividad, abandono de la ortesis yevolución de la curva tras la retirada de la ortesis.Conclusión. El nivel de evidencia del tratamiento conservadorortésico de la EIA es de grado de recomendaciónB-plata, por lo que sería aconsejable una investigación demayor calidad metodológica en el futuro usando los sistemasdefinidos por la Scoliosis Research Society y el Spinal Orthopaedicand Rehabilitation Treatment, así como evaluar laincidencia sobre la calidad de vida de estos pacientes(AU)

At the moment is controversial the levelof evidence about the preservative treatment of the adolescentidiopathic scoliosis (AIS). Objective. To analyse the evidence about effectiveness ofbrace used in the treatment of the AIS.Search strategy. Medline, PubMed, Cochrane Library from1992 to 2009.Selection of studies. Those that satisfy minimum requirementsof quality methodological investigation.Synthesis of results. Analysis of the factors that influencethe final result of the orthotic treatment, time of use ofbrace, effectiveness, abandonment of orthesis and evolutionof the curve after the use of the brace.Conclusion. The level of evidence of the orthotic treatmentfor AIS is of recommendation degree B-silver, reasonwhy an investigation of greater methodological quality inthe future using the systems defined by the Scoliosis ResearchSociety and the Spinal Orthopaedic RehabilitationTreatment would be advisable and as well as to evaluate theincidence on the quality of life of these patients(AU)

Mujer de 26 años con náuseas y distensión abdominal / A 26 years woman with nauseas and abdominal distension

No disponible

Rotura espontánea de esófago: un problema diagnóstico en la urgencia / Spontaneous perforation of the esophagus: difficult diagnosis on the emergency service

Presentamos dos casos de rotura espontánea de esófago (síndrome de Boerhaave) que acudieron a urgencias por distintos síntomas, en ambos casos el diagnóstico se realizó en una segunda visita tras varias horas de evolución del cuadro. El síndrome de Boerhaave es una entidad grave, infrecuente y de difícil diagnóstico debido a su presentación inespecífica, y en el que es fundamental lograr un diagnóstico y tratamiento precoz por su alta morbimortalidad (AU)

Disfagia súbita en un varón de 60 años / Sudden dysphagia in a 60-year old male

No disponible

Quiste tirogloso: estudio retrospectivo de 58 casos. Resultados de la operación de Sistrunk / Thyroglossal cyst: Retrospective study of 58 cases. Results of the Sistrunk operation

Los quistes del conducto tirogloso son una de las masas cervicales benignas más frecuentes. Suponen un fallo del cierre del conducto tirogloso que en ocasiones está en íntimo contacto con el cuerpo del hioides, con múltiples tractos, que se presentan especialmente en pacientes jóvenes. La técnica quirúrgica que hasta hoy ha demostrado mejores resultados es el procedimiento que introdujo Sistrunk en 1920 y que modificó en 1928, basado en la extirpación de la porción central del hueso hioides. Con esta técnica se consiguió reducir el número de recidivas con respecto a la excisión local del quiste. Presentamos una revisión retrospectiva de 58 casos valorando los resultados quirúrgicos, especialmente la tasa de recidiva encontrada en relación a la extirpación o no del hioides, comparándolo con las series publicadas (AU)

Cysts of the thyroglossal duct are one of the most common causes of benign neck masses. They generally occur in young patients and are caused by a defect in thyroglossal duct closure, which sometimes is in close contact with the hyoid. Often several tracts are present. The most effective surgical procedure was originally described by Sistrunk in 1920 and modified in 1928. This technique is based on the removal of the central portion of the hyoid bone. This procedure has successfully reduced the number of recurrences compared to local excision of the cyst. A retrospective review was made of 58 cases to evaluate surgical results, especially recurrence rate, in relation to the resection or preservation of the hyoid bone. Results were compared with published series (AU)