Prevalence of chronic kidney disease in Peruvian primary care setting.

BACKGROUND: Chronic Kidney Disease (CKD) is a worldwide public health problem. There are few studies in Latin America, especially in primary care settings. Our objective was to determine the prevalence, stages, and associated factors of CKD in primary care setting. METHODS: We did a retrospective secondary analysis of a database from the Diabetes and Hypertension Primary Care Center of the Peruvian Social Security System (EsSalud) in Lima, Peru. We defined CKD as the presence of eGFR <60 mL/min and/or albuminuria >30 mg/day in 24 h, according to Kidney Disease: Improving Global Outcomes (KDIGO). Factors associated with CKD were evaluated with Poisson Regression models; these factors included age, gender, type 2 diabetes mellitus (DM2), hypertension (HTN), body mass index (BMI), and uric acid. Associations were described as crude and adjusted prevalence ratios (PR) and their 95% confidence intervals (95% CI). RESULTS: We evaluated 1211 patients (women [59%], mean age 65.8 years [SD: 12.7]). Prevalence of CKD was 18%. Using the estimated glomerular filtration rate (eGFR), the prevalence was 9.3% (95% CI 5.3 - 13.3) in patients without HTN or DM2; 20.2% (95% CI 17.6 - 22.8) in patients with HTN, and 23.9% (95% CI 19.4 - 28.4) in patients with DM2. The most common stages were 1 and 2 with 41.5% and 48%, respectively. Factors associated with CKD in the adjusted analysis were: age in years (PR = 1.03, 95% CI 1.01 - 1.04), DM2 (PR = 3.37, 95% CI 1.09 - 10.39), HTN plus DM2 (PR = 3.90, 95% CI 1.54 - 9.88), and uric acid from 5 to <7 mg/dL (PR = 2.04, 95% CI 1.31 - 3.19) and ≥7 mg/dL (PR = 5.19, 95% CI 3.32 - 8.11). CONCLUSIONS: Prevalence of CKD in the primary care setting population was high. CKD is more frequent in the early stages of the disease, and individuals with hypertension, DM2, older age and hyperuricemia have higher prevalence of CKD.

Single-stage treatment with intraoperative ERCP: management of patients with possible choledocholithiasis and gallbladder in situ in a non-tertiary Spanish hospital.

BACKGROUND: The best way to reduce endoscopic retrograde cholangiopancreatography (ERCP) complications is not to perform it if it is unnecessary. Both intraoperative and postoperative ERCP rely on use of intraoperative cholangiography as a final diagnostic test for choledocholithiasis (CLD) whenever clinical data are unable to rule out CLD. Intraoperative ERCP could become a therapeutic option when a previous preoperative ERCP fails. We present our experience with intraoperative ERCP. PATIENTS AND METHODS: This is a descriptive and prospective study of a cohort of 82 patients with moderate risk of CLD. They were operated on by laparoscopic cholecystectomy with intraoperative cholangiography (IOC). We performed intraoperative ERCP using the rendezvous technique. RESULTS: Thirty-six out of 82 patients had an abnormal IOC study. Mean age was 58.7 years (standard deviation, SD 16.6, 25-83 years), and 60.6% were females. Ultrasound study showed that 51.4% of patients had a dilated bile duct. Magnetic resonance cholangiography (MRC) was performed on three patients (8.3%). The success rate of intraoperative ERCP was 88.2%. Three out of the 36 patients (8.8%) had ERCP complications [2 mild papillary bleeding (5.8%), 1 acute pancreatitis (2.9%)]. The rate of conversion to open surgery was 5% with a surgical complications rate of 4% [one injured duct and two surgical bleeding which required re-operation (2.5%)]. There were no mortalities. Four patients (11.1%) needed post-surgical ERCP, with a residual CLD rate of 5.6% (two patients) in the postoperative period. Mean surgical time was 181 min (SD 60, 75-345 min). Mean hospital stay was 6.2 days (SD 4.7, 2-24 days). CONCLUSIONS: Intraoperative ERCP is an option to prevent performing ERCP unnecessarily on patients with moderate risk of CLD not confirmed using appropriate radiological studies. It can resolve the biliary disease in a single step with a similar success rate to standard ERCP, but with low morbidity, especially of acute pancreatitis. The residual CLD rate is also very low.

Delayed cerebral radionecrosis following treatment of basal cell carcinoma.

Delayed radiation necrosis of the brain was found around the right ear in a patient with basal cell carcinoma of the skin. Five months after excision, the tumor recurred. The patient received 5,575 rads in 24 doses during radiotherapy. Thirteen months later, the patient had cerebral radionecrosis, which was the cause of death. At autopsy, typical radionecrotic lesions of the temporal lobe were found. There were widespread metastases.

Successful long-term results with resection of pancreatic carcinoma in children: favorable prognosis for an uncommon neoplasm.

Carcinoma of the pancreas is increasing in incidence and affecting a younger population. However, pancreatic carcinoma in children under 15 years of age is a rarity. Only 28 cases were reported in the literature from 1885 to 1981. All of the known patients who have undergone resection of the tumor are alive at the present time. The differential diagnosis of abdominal masses has been further elucidated by abdominal tomography. Pancreaticoduodenectomy or distal pancreatic resections may be fitted to the individual case with reasonable expectations of patient survival.

Secondary urticaria due to toxocariasis: possibly caused by ingesting raw cattle meat?

Skin affectation in patients infected by Toxocara spp. is rare even in endemic regions. We present a case of a patient that consulted us for a urticarial process and a personal history of eating rat cattle meat. After several studies, the diagnosis of secondary urticaria due to Toxocara spp. infection was made. Improvement of the symptoms was observed after treatment with thiabendazole.

Subacute cutaneous lupus erythematosus--clinical, histopathological and immunophenotypical study of five cases.

Subacute cutaneous lupus erythematosus (SCLE) is a recently described distinct subset of lupus erythematosus (LE) having characteristic clinical, serological and genetic features. The clinicopathological and serological findings of 5 patients are reported. From a clinical point of view, we describe two types of cutaneous lesions: psoriasiform and annular pattern. ANA were present in 80% of the cases, anti-Ro was present in 60%, and anti-La in 20%; anti-RNP was positive in 1 patient. Circulating immune complexes were detected in 2 patients, and low levels of complement factors (C3, C4) in another 2 patients. The B- cell alloantigens HLA-A2, HLA-Bw4 or HLA-DR3 were present in 60% of the cases. The cutaneous histopathology revealed important changes in the epidermis. Our findings are similar to those described by most other authors. Also, we would like to emphasize the low disease activity and benign course of our patients.

A combination therapy of calcipotriol cream and PUVA reduces the UVA dose and improves the response of psoriasis vulgaris.

BACKGROUND: The addition of calcipotriol ointment to PUVA therapy for psoriasis vulgaris results in a lower total UVA dose and a faster onset of response. The addition of calcipotriol cream to PUVA, however, has not been studied. OBJECTIVE: To investigate whether combining calcipotriol cream with PUVA therapy has a UVA sparing effect. METHODS: We performed a randomized, multicentre, vehicle-controlled, double-blind, 12-week comparative study including 120 patients with psoriasis covering 20-50% body surface area. The study consisted of a washout phase followed by a 10-week treatment phase. PUVA therapy three times weekly was added within 1 week after randomization. Efficacy was assessed by the Psoriasis Area and Severity Index (PASI). RESULTS: At baseline the mean PASI scores were 17.5 and 19.2 in the calcipotriol and vehicle (placebo) groups, respectively. At the end of treatment, the mean PASI scores were 2.65 and 7.03 (p<0.01), respectively. A reduction in PASI score >90% was observed in 69% of the patients in the calcipotriol-treated group and in 36.4% of the patients in the vehicle group (p<0.01). CONCLUSION: Calcipotriol cream plus PUVA clearly reduces the cumulative dose of UVA and improves the response of psoriasis vulgaris to PUVA.

Generalized skin reaction following tinea pedis (dermatophytids).

An 11-year-old boy presented with inflamed tinea pedis followed by a generalized id type skin eruption, with disappearance of the rash after treatment of the mycotic foot lesions. The pathogenesis of this process is not precisely known. Fungal infection was not detected from the generalized skin lesions. Various clinical forms of dermatophytid reaction are discussed.

Metastatic melanoma of unknown primary tumor.

The appearance of metastasis without clinically demonstrable primary tumor is one of melanoma's challenges. The aim of this study was to recognize the specific characteristics of this occurrence. Based on our study of three patients, we have proposed theories to explain this behavior, its clinical approach, and therapeutic management. We conclude by stressing the importance of finding the primary tumor or traces of it.

[Neurocutaneous syndromes with vascular alterations]. / Síndromes neurocutáneos con afectación vascular.

There are several syndromes in which neurological and cutaneous alterations of vascular origin, among other symptoms, occur. The key point of this fact is that these cutaneous signs permit early diagnosis, thus helping in further recognition of more complex syndromes and preventing unnecessary, harmful and costly diagnostic procedures or having to wait until the appearance of neurological signs. Therefore, these diseases should be classified attending to the most notorious vascular lesions they show, though they may show other less frequent cutaneous vascular lesions. In this way, these syndromes can be classified as associated with nevus flammeus (Sturge-Weber, Shapiro-Shulman, Bonnet-Dechaume-Blanc, Cobb, Klippel-Trenaunay, Fegeler, Robert), cavernous hemangiomas (Maffucci, blue-rubber-bleb-nevus, Proteus, Bannayan-Zonana, Riley-Smith, familial cavernous angiomatosis, POEMS syndrome), capillary hemangiomas (Rubinstein-Tayabi, Coffin-Siris, PHACE syndrome), telangiectasia (congenital telangiectatic cutis marmorata, Rendu-Osler-Weber, ataxia telangiectasia, Cockayne, De Sanctis-Cacchione), livedo reticularis (Sneddon, Divry-van-Bogaert), angioqueratoma (Fabry disease, Fucosidosis) and hemangioblastoma (Von Hippel-Lindau). Though we have tried that these vascular lesions should be named as angiomas if they are malformations and hemangiomas if they are benign neoplasias, they are called following morphological aspects rather than other criteria, due to their unknown origin.

[Psoriatic arthropathy. A study of its frequency and clinical features in 112 psoriatic patients]. / Artropatía psoriásica. Un estudio de su incidencia y características clínicas sorbre 112 pacientes psoriásicos.

In order to determine the incidence and clinical features of psoriatic arthropathy 112 psoriatic patients have been studied. The following conclusions have been shown: 1. the incidence ratio male: female was near 2: 1 in the skin disease; 2. a prevalence of 15% has been observed in the psoriatic arthropathy, showing similar incidence in both sexes; 3. when the onset of the skin disease were analyzed either alone or with arthropathy, different frequency profiles were demonstrated; that suggest they are different biological events; 4. neither the age of onset nor the severity of the arthropathy, show any relationship with the severity of the skin disease; 5. both, negative latex and the elevation of the sedimentation rate are of value for diagnostic purposes.

[Dermatomyositis. Clinico-histologic study of its skin manifestations]. / Dermatomiositis. Estudio clínico-histológico de sus manifestaciones cutáneas.

The clinical and pathological findings in five patients with dermatomyositis are described. The diagnostic value of the cutaneous lesions in the disease, indicating the histological patterns of each cutaneous sign is stressed. Based in our experience and in the reviewed literature, we consider that Gottron's papules and poikilodermatomyositis present histological aspects that allow us to confirm the diagnosis suspected by clinical findings. Likewise we review some special difficult aspects of the disease such as infantile forms, association with neoplasias and overlap syndromes.

[Familial cutaneous leiomyomas and their association with uterine myoma. Study of a 3-generation pedigree]. / Leiomiomas cutáneos familiares y su asociación con el mioma uterino. Estudio de un linaje de tres generaciones.

A review of the classification, localization, symptoms, age of on-set and incidence according to sex of the cutaneous leiomyomas in done. Besides the hereditary aspect and the association of extracutaneous lesions, especially the uterus, are considered. We present the case two sisters affected by multiple cutaneous leiomyoma in association with uterine leiomyoma. Both, members of a family in which the father and 4 of the 8 offsprings present multiple cutaneous leiomyoma, and the daughter of one of the female members (third generation) is also affected of leiomyoma of the uterus. We conclude that the presentation of the leiomyoma in this family is more than a mere coincidence and that there must be some hereditary mechanism, which is interpreted as dominant and the penetrance of the autosomal dominant gene would be about 56%.

[Cutaneous pigmentation caused by amiodarone. Optical and ultrastructural study]. / Pigmentación cutánea por amiodarona. Estudio óptico y ultraestructural.

Thirteen biopsies from 8 patients with amiodarone-induced skin pigmentation were studied. Light microscopy showed that skin pigmentation of these patients was produced by solar elastosis, increase of melanin and accumulation of the properly called amiodarone pigment in the upper dermis. The degree of solar elastosis and the amount of amiodarone pigment was related to total doses of amiodarone. This pigment was negative for fat stains and positive for Masson-Fontana stain, and had neither birrefringency nor autofluorescence. Ultrastructurally, the granules of amiodarone pigment appeared as membrane-bound granules with a fingerprint-like lamellated structure, which others have related to lipofuscin. We conclude, however, that this pigment may be a metabolite of amiodarone, morphologically and histochemically related to melanin.

[Mycosis fungoides. Clinical study and immunologic response to chemotherapy in 2 cases]. / Micosis fungoide. Estudio clínico y respuesta inmunológica a la quimioterapia en dos casos.

We have presented a study of two cases of Mycosis Fungoides with special emphasis on the staging of the disease as well as on the immunological findings and their modification with chemotherapy. Our objective, to relate the immunological response to clinical evolution, proposes a way of determining prognosis in the evolution of this poorly understood disease.

[Ultrastructural aspects of juvenile xanthogranuloma]. / Aspectos ultraestructurales del xantogranuloma juvenil.

An ultrastructural study of a juvenile xanthogranuloma is presented. Foamy histiocytes reveal several vacuoles of irregular profile containing a type of lipid which is not fixed by osmium tetraoxide. There are also myelin figures. Plasmatic membrane shows numerous digit-like foldings related to collagen fibers. Cytoplasm containing few organelles are restricted to a narrow band around the nucleus and delicate trasverse bandings among the vacuoles. Several intranuclear spheroidal corpuscles have been identified in the histiocytes. Genesis of these foamy histiocytes is discussed probably related to a metabolic derangement of an organelle but in no way related to phagocytosis of fragmented polymorphonuclear leukocytes or Lymphocytes.

[Keratoacanthoma over the donor site of a laminar skin graft]. / Queratoacantoma sobre zona dadora de injerto laminar.

We present a case of keratoacanthoma type II in a 38-year-old female patient, which developed in the thigh over the donor site of a laminar skin graft, six weeks after the procedure. The graft was utilized to cover the defect secondary to the resection of a melanoma. The possible role played by mechanical trauma in the development of this tumor, rare under such circumstances, is discussed. Similar previously published cases are reviewed.