Quantification of bone marrow edema by MRI of the sacroiliac joints in patients diagnosed with axial spondyloarthritis: results from the ESPeranza cohort.

OBJECTIVE: To evaluate whether the quantification of bone marrow edema (BMO) of the sacroiliac (SI) joints by magnetic resonance imaging (MRI) improves capacity for axial spondyloarthritis (axSpA) classification in comparison with the assessment of sacroiliitis by Assessment of SpondyloArthritis international Society (ASAS) classification criteria. METHOD: This prospective study from the ESPeranza cohort involved 66 subjects with an available MRI of the SI joints at baseline. This subgroup includes patients with axSpA (n = 28), peripheral spondyloarthritis (n = 10), and other diagnoses that were not spondyloarthritis (n = 28). Measures of diagnostic usefulness [area under the curve (AUC), sensitivity, specificity, Youden's J statistic, positive and negative likelihood ratios (LR+ and LR-)] were calculated for MRI of the SI joints according to ASAS criteria and for MRI quantified by means of SCAISS (Spanish tool for semi-automatic quantification of sacroiliac inflammation by MRI in spondyloarthritis). This analysis was stratified in patients who were human leucocyte antigen (HLA)-B27 positive and negative. RESULTS: The AUC value with BMO quantification was 0.919 [95% confidence interval (CI) 0.799-1] for HLA-B27-positive patients and 0.884 (95% CI 0.764-1) for HLA-B27-negative patients. A SCAISS cut-off point of 80 units obtained a specificity of 94.4% and LR+ 7.5, while assessment by ASAS criteria showed a specificity value of 90% and LR+ 6.4. CONCLUSION: For patients with suspected axSpA, quantification of BMO improves the predictive capacity of MRI of the SI joints, for both HLA-B27-positive and HLA-B27-negative patients. Axial spondyloarthritis (axSpA) has a dramatic impact on physical function and quality of life (1). Despite its significant impact, patients with axSpA are normally diagnosed several years after presenting symptoms (2). In this respect, magnetic resonance imaging (MRI) of the sacroiliac (SI) joints has gained significance over the past decade, particularly in the early stages of the disease. Nowadays, imaging tests and human leucocyte antigen (HLA)-B27 testing are among the most important diagnostic procedures for patients with suspected axSpA.

Fibromyalgia in patients with ankylosing spondylitis: prevalence and utility of the measures of activity, function and radiological damage.

OBJECTIVES: To determine the prevalence of fibromyalgia (FM) in ankylosing spondylitis (AS). To evaluate the effect of FM on the measures of activity in AS. To analyse predictive factors in order to identify this group of patients. PATIENTS AND METHODS: A cross-sectional study based on 462 patients with definite ankylosing spondylitis included in the REGISPONSER. Sociodemographic data, clinical features, Bath AS disease activity index (BASDAI), Bath AS functional index (BASFI), Bath AS radiology index (BASRI), Stoke modified index (Sasss-m), laboratory data, Short-Format 12 (SF-12), AS specific quality of life (ASQoL), Fibromyalgia Impact Questionnaire (FIQ) and treatments used were all documented. To diagnose FM, the ACR 1990 criteria had to be fulfilled. All statistical tests were performed using STATA. RESULTS: The prevalence of fibromyalgia in all AS was 4.11%. Among the women with AS, the prevalence of FM increased to 10.83%. The BASDAI, BASFI and total BASRI were strongly influenced by the presence of FM. The inverse relationship between BASDAI or BASFI and total BASRI was taken to generate a ratio. Accordingly, if the patient presented BASDAI/BASRI ≥1.5 or BASFI/BASRI ≥1.08, the probability of having FM was very high. CONCLUSIONS: There is an increased risk of FM in females with AS. The fact of having FM distorts the measures of activity and functional damage of AS. As a result, it is possible that some patients with AS and FM are being overtreated. The BASDAI/BASRI and BASFI/BASRI ratios are very useful to identify these patients.

Relationship between spinal mobility and disease activity, function, quality of life and radiology. A cross-sectional Spanish registry of spondyloarthropathies (REGISPONSER).

OBJECTIVE: To determine the relationship between anthropometric measurements and disease activity, functional capacity, quality of life and radiology in Spanish patients with ankylosing spondylitis (AS). PATIENTS AND METHODS: A cross-sectional study was made of 842 patients with definite ankylosing spondylitis (REGISPONSER). Sociodemographic data, spinal mobility measurements, Bath AS disease activity index (BASDAI), nocturnal pain, Bath AS radiology index (BASRI), Bath AS functional index (BASFI), the Short-Format 12 (SF-12) and the AS specific quality of life (ASQoL) questionnaire were applied. Pearson correlation coefficient analysis and regression models were constructed. RESULTS: There was moderate correlation between fingertip-to-floor distance and lateral cervical rotation with the BASFI (p<0.01). Good correlation was evident between wall-occiput distance and lateral cervical rotation with the BASRI (p<0.01). Moderate correlation was found between chest expansion, the Schober modified test and fingertip-to-floor distance with the total BASRI (p<0.01). The anthropometric measurement with the lowest correlation value was lateral lumbar flexion. Significant association was found between the Schober modified test and BASFI, BASDAI and BASRI (R(2) = 0.37; p<0.001); chest expansion and BASFI, BASDAI and BASRI (R(2) = 0.25; p<0.001); wall-occiput distance and BASFI, BASRI and ASQoL (R(2) = 0.44; p<0.001); fingertip-to-floor distance and BASFI and BASRI (R(2) = 0.30; p<0.001); and lateral cervical rotation and BASFI and BASRI (R(2) = 0.34; p<0.001). CONCLUSION: In our study, wall-occiput distance and lateral cervical rotation showed the strongest correlation to BASRI. Similarly, fingertip-to-floor distance and lateral cervical rotation exhibited the closest correlation to BASFI.

Evaluation of a multidisciplinary training program in magnetic resonance imaging of patients with axial spondyloarthritis: PROGRESSES Project. / Evaluación de un programa de formación multidisciplinar en resonancia magnética en espondiloartritis axial: Proyecto PROGRESSES.

OBJECTIVE: To analyze the impact of a multidisciplinary training program in magnetic resonance imaging (MRI) for axial spondyloarthritis in daily clinical practice. METHODS: After two years of training workshops for radiologists and rheumatologists, we designed a survey to assess changes in: 1) communication and collaboration between departments; 2) radiologists' interest and keeping up to date in axial spondyloarthritis and rheumatologists' training in MRI; 3) number of MRI studies done; 4) availability of protocols about technical requirements for studying axial spondyloarthritis by MRI and of standardized reporting templates; 5) evaluation and management of axial spondyloarthritis; 6) areas of improvement. RESULTS: After 50 workshops, 96 rheumatologists and 51 radiologists completed the survey. CONCLUSIONS: Among radiologists and rheumatologists, multidisciplinary training in MRI for axial spondyloarthritis seems to have a positive influence on teamwork as well as on the management and evaluation of patients with axial spondyloarthritis.

Pulmonary sarcoidosis in a patient with ankylosing spondylitis treated with infliximab.

We present a case of a 34 year-old male diagnosed with ankylosing spondylitis. After two years of treatment with infliximab, the patient developed a clinical picture compatible with stage II thoracic sarcoidosis. These findings resulted in the interruption of infliximab therapy. The patient was not administered new treatment since respiratory function testing did not confirm harmful repercussions. After a follow-up of 1 year, the patient is asymptomatic and radiologic tests show complete resolution of pulmonary infiltrates and mediastinal and bilateral hilar lymphad- enopathy.

Inverse supercritical extraction of acetaminophen from suppositories.

The use of supercritical CO2 for the isolation of acetaminophen from the non-polar matrix of a suppository is demonstrated. Since acetaminophen is not soluble in pure CO2 at low pressure, but the waxy matrix is, the later can be extracted, leaving the acetaminophen behind. After studies on acetaminophen solubility as a function of pressure, temperature flow and supercritical fluid volume, optimal extraction conditions were determined. In this method, the matrix is removed using pure CO2 at 1500 psi and 40 degrees C, and the remaining acetaminophen is then removed from the extraction cell using ultrasound in warm water. This method is an alternative to the US Pharmacopoeia's (USP) method for this kind of formulation, which involves the dissolution of the matrix in hexane with the subsequent liquid-liquid extraction of the acetaminophen into water.

[Endoscopic removal of the ureter prior to nephroureterectomy. Preliminary analysis]. / Desinserción endoscópica del uréter previa a nefroureterectomía. Análisis premilinar.

AIM OF THE STUDY: To describe a simplified technique for nephroureterectomy based on a prior endoscopic disconnection of the ureter or transurethral circumcision of the ureteral orifice. PATIENTS AND METHODS: From November 1993 to December 1997 we treated 16 patients diagnosed with cancer of the renal pelvis of proximal ureter, using this technique. Mean age was 68.8, 15 males and 1 female. RESULTS: There was no operative or postoperative complications. Mean follow up was 17 months and the mean hospital stay was 7.2 days. CONCLUSIONS: We believe that this is an easy technique to learn, that significantly cut down the operating time, reduce postoperative complications and it is adequate for upper tract urothelial cancer treatment.

[Renopleural fistula secondary to xanthogranulomatous pyelonephritis]. / Fístula renopleural secundaria a pielonefritis xantogranulomatosa.

A case is presented of renopleural fistula secondary to xantogranulomatous pyelonephritis in an 18-year-old female patient. Although the renopleural communication was not observed radiologically, concomitant clinical signs, bacteriological isolation of E. coli in renal and pleural content and surgical findings, confirmed the existence of such fistula.

[Inguinal varicocelectomy with sedoanalgesia. Preliminary experience]. / Varicocelectomia inguinal con sedoanalgesia. Experiencia preliminar.

Presentation of 12 cases of inguinal varicocelectomy under analgesic sedation. Details relative to surgery, type of anaesthesia used, and preliminary results are reviewed. We conclude that this technique is excellent because it allows a monitored surgical procedure well tolerated by the patient, and which it would even allow ambulatory surgery and could an alternative to laparoscopic surgery of the varicocele.

[Complex renal cyst. A new case]. / Quiste renal complejo. A propósito de un caso.

Approximately 15% of cases of renal cell carcinoma present cystic configuration on radiologic and pathologic examination. These lesions are often difficult to differentiate from the multiloculated renal cyst or other benign cystic lesions such as hemorrhagic cyst and so on. We report a case of multilocular cyst of the right kidney complicated with clear cell type renal cell carcinoma in which MRI suggested benign cyst. The diagnosis of complicated benign cyst must be proposed very cautiously and the persistence of doubtful images justifies surgical exploration.

[Uterine perforation and vesical migration of intrauterine device]. / Perforación uterina y migración vesical de un dispositivo intrauterino.

Cases of uterine perforation through to the bladder during the placement of an intrauterine device are rare. There have been only 25 previous reported cases. This type of perforation is no different to any other by an intravesical foreign body. A detailed anamnesis and sonographic examination is usually sufficient to provide a diagnosis. Complications can be diagnosed by an uretrocytoscopy which is also therapeutic in non-complicated cases. If there are associated complications surgery can be necessary. In conclusion, quick detection of any complication, by sonographic detection after placement, assists in the extraction of the foreign body and avoids the appearance of associated complications such as lithiasis.

[Massive inguinal vesical hernia. Report of 3 cases]. / Hernia vesical inguinal masiva. Aportación de tres casos.

Vesical hernia is defines as a vesical shift associated to a direct or indirect inguinal hernia. It accounts for 0.4-3% of all inguinal hernias, but the existence of a massive vesical hernia formation at the inguinoscrotal level is uncommon; a total of 114 cases have been found in the literature. Clinically it should be suspected every time an inguinoscrotal hernia is found in patients over 50 years old with urinary flow obstruction. Diagnosis is usually reached through serial voiding cystouretrography (SVCU). The preferred treatment should be extraperitoneal inguinal herniorrhaphy associated to correction of the obstructive process.

[Urethral diverticulum complicated with giant lithiasis]. / Divertículo uretral complicado por litiasis gigante.

Presentation of one case report of acquired urethral diverticulum in a male with giant urethral lithiasis. Urethral diverticulum are rare entities in males, the condition being more frequent in females. In general, they are acquired in up to 90% cases, the remaining 10% being hereditary Giant urethral lithiasis is also uncommon in our milieu, incidence being higher in Eastern Countries; 4-10% of urethral diverticulum are occupied by lithiasis. Diagnosis is mainly through clinical symptomatology involving the development of a perineal mass or phlegmon; however definite diagnosis is made through CUMS. Management of giant diverticulum in males is by open surgery, preferably a one-step diverticulectomy procedure; in cases such as the reported here, where urethral stenosis or a significant inflammatory involvement of the periurethral tissues is present, a two-step urethroplasty should be preferred.

[Major ambulatory surgery in urology. 5 years' experience]. / Cirugía mayor ambulatoria en urología. 5 años de experiencia.

INTRODUCTION: The ambulatory surgery includes those surgical procedures that require a limited period of post-operative recovery, so that patients will be discharged from hospital on the same day of their surgical operation. OBJECTIVES: This publication aims at both, explaining our Service way of working as an integrated unit of ambulatory surgery, and it also tries to revise the results which have been obtained during our first 5 years working together. METHOD AND MATERIALS: Three hundred and thirty-nine patients, with an average age of 37.5 years (3-84), have been included in this report which sets out the medical record of this patients selection, their pathologies, the different procedures used, the kind of anaesthesia as well as the criterion to discharge them from hospital. RESULTS: Intra-surgical complications have arisen in 4 (1.2%) of our patients, immediate complications in 24 patients (7%) and late ones in 33 (9.7%) of our patients. According to the results of an anonymous inquiry which has been polled systematically to all our patients, 95% of those polled are completely satisfied with this new way of medical attention. CONCLUSIONS: The ambulatory surgery means a slight change in our patients' way of life. It also diminishes hospital costs, morbidity is similar to the one produced in hospitalization and it implies an important challenge for the professionals of this Service.

[Vesical endometriosis: report of two cases]. / Endometriosis vesical: dos nuevos casos.

Endometriosis affecting the urinary tract is very rare and the most common site of involvement is urinary bladder. The clinical features are urgency and frequency, hipogastric pain and hematuria. Cistoscopic examination is the most valuable diagnostic test but definitive diagnosis requires histologic confirmation. We report 2 cases of endometriosis in 2 young women, one with previously cesarean section, in which surgical treatment was effective. After 1 and 3 years of follow-up respectively the patients remain assymptomatic.

[Retrovesical schwannosarcoma]. / Schwannosarcoma retrovesical.

Contribution of one case of retrovesical schwannosarcoma in a 23-year-old female patient, with discussion of signs and symptoms, diagnosis and treatment. Retroperitoneal schwannosarcoma is an extremely uncommon tumour. Diagnosis is always histologic and immunohistochemical. This is an extraordinary aggressive tumour, with low response to chemo- and radiotherapy. Surgery is the only curative treatment, and presents a high index of recurrence. Prognosis is sombre. We support the most radical surgical approach possible as the only definite diagnostic possibility, since it provides the best survival indexes and in any case, improves symptomatology of tumours not completely resectable.

[Complications of transurethral resection of the prostate: review of 408 cases]. / Complicaciones de la resección transuretral de la próstata: revisión de 408 casos.

Retrospective study conducted on 408 TUPRs performed in our centre over the time span 1985-1995. Patient's mean age was 68 (51-89) years. In 73% cases regional anaesthetics was used. Mean surgery duration (without anaesthetics) was 41 minutes for prostates under 60 g and 63 minutes for those over 60 g. 40.9% patients had in-dwelling urethral catheter. Early complications were seen in 19.6% patients, of which 9.6% were urinary infections, 4.6% major haematuria requiring transfusion of two or more units of packed blood cells and 12% relevant systemic complications. Overall mortality was 0.5% (2 patients). Late complications affected to 12.7% patients, which in 6.4% were urethral stenosis. Both mean hospital stay and mortality were low. We conclude that TUPR morbidity is not trivial, emphasizing the occurrence of urethral stenosis and urinary infection. In spite of the frequency of these complications, we believe this to be the choice procedure for most patients who require surgical treatment for benign prostate hyperplasia.

[Computerization of protocols for tumor follow-up]. / Informatización de los protocolos de seguimiento tumoral.

OBJECTIVE: Evaluation of the effectiveness of the surveillance tumoral by means of computerized protocols. MATERIAL AND METHODOLOGY: We have carried out a retrospective study, taking as example the superficial bladder cancer, where we have compared the execution of the tumoral surveillance of the computerized protocols regarding the conventional ones. RESULTS: It has been demonstrated that the execution percentage and the adjustment to the predetermined terms of the explorations requested by the facultative are superior in the computerized protocols that in the conventional ones. CONCLUSION: The computerization of the tumoral protocols is user-friendly, it improves the execution degree and it saves time, providing bigger effectiveness and scientific rigor.

[Transitional-cell sarcomatoid carcinoma of the renal pelvis with osteoclast-type giant cells. Review of the literature]. / Carcinoma sarcomatoide de células transicionales de la pelvis renal con células gigantes de tipo osteoclasto. Revisión de la literatura.

One case of transitional cells carcinoma with sarcomatoid pattern, located in the renal pelvis in a 77 year-old male with haematuria. The tumour also expressed a non-neoplastic component of osteoclast-like giant cells which probably represent a stromal reaction of the host to the neoplasia. The tumoral cells co-express keratin and vimentin, two strands of the cytoskeleton specific for epithelial and mesenchymal cells, respectively. We speculate with the possibility of the tumoral cells fusocellular morphology being related to the vimentin expression. A review of the literature is also included.