Alendronate after denosumab discontinuation in women previously exposed to bisphosphonates was not effective in preventing the risk of spontaneous multiple vertebral fractures: two case reports.

At denosumab discontinuation, an antiresorptive agent is indicated to reduce the high bone turnover, the rapid bone loss, and the risk of spontaneous vertebral fractures. We report two cases of postmenopausal women, previously exposed to bisphosphonates, treated with alendronate at denosumab discontinuation. Alendronate was ineffective to avoid spontaneous clinical vertebral fractures. They presented three and nine spontaneous vertebral fractures 8 and 12 months after denosumab discontinuation, respectively. Ineffectiveness of alendronate was attributed to insufficient control of the rebound as assessed by B-crosslaps measures in the first case, and partially to the high risk of fractures in the later. In both situations, the increased fracture risk may have favoured these new fractures. It is urgent to define effective therapeutic strategies to avoid spontaneous vertebral fractures after denosumab discontinuation.

Diagnostic validity of ultrasound including extra-cranial arteries in giant cell arteritis.

OBJECTIVES: Color Doppler ultrasound (CDUS) of the temporal arteries (TA) is becoming the first test to be performed for suspected giant cell arteritis (GCA). Our aim was to assess the added value of including CDUS of large vessels (LV) in the diagnosis of GCA. METHODS: We performed an observational and retrospective study of consecutive patients with suspected GCA. Baseline CDUS of the TA and LV (axillary, subclavian, and carotid) were conducted. We defined the CDUS finding as positive if the halo sign was present. RESULTS: Of 198 patients with suspected GCA, 87 were eventually diagnosed with GCA: 45 (51.7%) had a cranial pattern exclusively, 31 (35.6%) had both a cranial and an LV pattern, and 11 (12.6%) had an isolated LV pattern. CDUS of the TA had a sensitivity of 83.9%, specificity of 97.3%, and positive and negative predictive values (PPV, NPV) of 96.1% and 88.5%, respectively. When LV was added, sensitivity increased to 96.6% and NPV to 98.2%. Specificity was 97.3% and PPV was 96.6%. As for LVs, the axillary, subclavian, and carotid arteries were involved in 87.8%, 77.4%, and 34.4%, respectively. Isolated axillary examination resulted in a loss of 12.2% of patients with LV involvement; however, inclusion of the axillary and subclavian arteries retained 100% of patients with LV involvement. CONCLUSIONS: Detection of GCA by ultrasound should routinely include examinations of the TA and LV (at least the axillary and subclavian arteries) to improve diagnostic accuracy. More than 12% of patients in our cohort had isolated LV involvement. Key Points • Extracranial involvement in GCA is very common: half of patients have extracranial vasculitis and more than 12% isolated LV involvement that can be demonstrated with CDUS. • Adding a CDUS examination of LV to TA increased sensitivity (from 83.9 to 96.6%) and the negative predictive value (from 88.5 to 98.2%) for diagnosis of GCA. • In our cohort, if we only examined the axillary arteries, 12.2% of the CGA with LV involvement would not have been diagnosed. • We propose a CDUS protocol that includes examination of the TA and LV (at least the axillary and subclavian arteries) routinely in cases of suspected GCA.

[Silodosin therapy for lower urinary tract symptoms in men with suspected benign prostatic hyperplasia: results of an international, randomized, double-blind, placebo- and active-controlled clinical trial performed in Europe].

BACKGROUND: Silodosin is a new selective therapy with a high pharmacologic selectivity for the a (1A)-adrenoreceptor. OBJECTIVE: Our aim was to test silodosin's superiority to placebo and noninferiority to tamsulosin and discuss the findings in the context of a comprehensive literature review of the new compound silodosin. DESIGN, SETTING, AND PARTICIPANTS: We conducted a multicenter double-blind, placebo-and active-controlled parallel group study. A total of 1228 men > or = 50 yr of age with an International Prostate Symptom Score (IPSS) < or = 13 and a urine maximum flow rate (Q(max))> 4 and < or = 15 ml/s were selected at 72 sites in 11 European countries. The patients were entered into a 2-wk wash-out and a 4-wk placebo run-in period. A total of 955 patients were randomized (2:2:1) to silodosin 8 mg (n = 381), tamsulosin 0.4 mg (n = 384), or placebo (n = 190) once daily for 12 wk. MEASUREMENTS: We calculated the change from baseline in IPSS total score (primary), storage and voiding subscores, quality of life (QoL) due to urinary symptoms, and Q(max). Responders were defined on the basis of IPSS and Q(max) by a decrease of > or = 25% and an increase of > or = 30% from baseline, respectively. RESULTS AND LIMITATIONS: The change from baseline in the IPSS total score with silodosin and tamsulosin was significantly superior to that with placebo (p < 0.001): difference active placebo of -2.3 (95% confidence interval [CI], -3.2, -1.4) with silodosin and -2.0 (95% CI, -2.9, -1.1) with tamsulosin. Responder rates according to total IPSS were significantly higher (p < 0.001) with silodosin (66.8%) and tamsulosin (65.4%) than with placebo (50.8%). Active treatments were also superior to placebo in the IPSS storage and voiding subscore analyses, as well as in QoL due to urinary symptoms. Of note, only silodosin significantly reduced nocturia versus placebo (the change from baseline was -0.9, -0.8, and -0.7 for silodosin, tamsulosin, and placebo, respectively; p = 0.013 for silodosin vs placebo). An increase in Q(max) was observed in all groups. The adjusted mean change from baseline to end point was 3.77 ml/s for silodosin, 3.53 ml/s for tamsulosin, and 2.93 ml/s for placebo, but the change for silodosin and tamsulosin was not statistically significant versus placebo because of a particularly high placebo response (silodosin vs placebo: p = 0.089; tamsulosin vs placebo: p = 0.221). At end point, the percentage of responders by Q(max) was 46.6%, 46.5%, and 40.5% in the silodosin, tamsulosin, and placebo treatment groups, respectively. This difference was not statistically significant (p = 0.155 silodosin vs placebo and p = 0.141 tamsulosin vs placebo). Active treatments were well tolerated, and discontinuation rates due to adverse events were low in all groups (2.1%, 1.0%, and 1.6% with silodosin, tamsulosin, and placebo, respectively). The most frequent adverse event with silodosin was a reduced or absent ejaculation during orgasm (14%), a reversible effect as a consequence of the potent and selective a(1A)-adrenoreceptor antagonism of the drug. The incidence was higher than that observed with tamsulosin (2%); however, only 1.3% of silodosin-treated patients discontinued treatment due to this adverse event. CONCLUSIONS: Silodosin is an effective and well-tolerated treatment for the relief of both voiding and storage symptoms in patients with lower urinary tract symptoms suggestive of bladder outlet obstruction thought to be associated with benign prostatic hyperplasia. Its overall efficacy is not inferior to tamsulosin. Only silodosin showed a significant effect on nocturia over placebo.

[Temporal and bacteriological comparison of neonatal urinary infections]. / Comparación temporal y bacteriológica de la infección urinaria neonatal.

OBJECTIVE: To find out the epidemiological and management changes of urinary tract infection over the last years. PATIENTS AND METHODS: Descriptive retrospective review of patients with urinary tract infections (UTIs) admitted to our neonatal unit over an 11 year period. A temporal, microorganism group and voiding cystourethrography (VCUG) group comparison. RESULTS: We studied 106 cases (5 cases/1,000 alive newborns). The most commonly isolated microorganisms were Escherichia coli (81.1%), Enterococcus faecalis (6.6%) and Enterobacter cloacae (4.7%). Gentamicin had an overall sensitivity of 93.2%, followed by cefotaxime 91.3% and amoxicillin-clavulanic acid 89.5%. We did not found temporal differences in microorganisms or sensitivities. We found differences in C reactive protein, nitrate and leucocyte values in E. coli versus non-E. coli UTIs, as well as patterns of antibiotic sensitivity with more resistances by non-E. coli microorganisms. No differences were found in patients with normal and pathological VCUG. We found ultrasound and VCGU disturbances in 35.2% and 21.4%, respectively. CONCLUSIONS: UTI is a common problem in our area. The most frequently isolated microorganism is E. coli. Non-E. coli UTIs have more resistances to usual therapies, although these did not show any increase in disease in the imaging tests. We found no increase in resistances throughout the study.

[Usefulness of urine cytology for bladder carcinoma diagnosis: comparative study with biopsy]. / Utilidad de la citología de orina para el diagnóstico del carcinoma vesical: estudio comparativo con biopsia.

OBJECTIVES: Traditionally, urine cytology has been considered as the gold standard for bladder cancer screening. However, new methods are playing new roles in these cases. In order to assess the value of cytology of voided urine we performed one comparative study between cytology and biopsy. METHODS: We retrospectively analyzed the results of urine cytology and biopsy follow-up in 109 patients. All cytologies were from voided urine. They were cytocentrifuged and stained with Papanicolaou stain. RESULTS: We found 70 true positive cases and 24 true negative cases. Sensitivity was calculated to be 97% and specifity 96-100%. 12 cases had the first cystoscopy test and biopsy negative, as the cancer was diagnosed in the second biopsy. CONCLUSIONS: Patients with clearly positive urine cytology, which was not confirmed in a first cystoscopic study, should be carefully followed up to identify a possible bladder or upper urinary tract cancer. The urine cytology still has a significant role as the gold standard for bladder cancer screening.

First clinical isolation report of Shewanella algae from the stools of a patient with acute enteritis in Spain.

We report a case of acute enteritis caused by Shewanella algae in a cirrhotic patient. Biochemical identification systems revealed to be insufficient to identify the Shewanella isolate at the species level, thus requiring 16S rRNA and gyrB partial gene sequencing. Even if co-infection by Clostridium difficile could not be ruled out, this is, to our knowledge, the first report of acute enteritis caused by Shewanella algae in Europe.

[Miliary tuberculosis in a patient treated with BCG intravesical instillation]. / Tuberculosis miliar secundaria a instilación endovesical de BCG.

Intravesical instillation of bacillus Calmette-Guérin is the elective treatment for transitional cell and in situ bladder carcinoma. Severe complications occur very seldom but must be known and promptly recognized. We present a case of miliary tuberculosis reactivation secondary to the mentioned treatment.

Evaluation of HCH isomers and metabolites in soils, leachates, river water and sediments of a highly contaminated area.

In this work we evaluate the contamination caused by HCH residues in the soil, leachates, river water and sediments of an industrial estate of the NW of Spain. We study the distribution of the isomers in the different matrices, analysing 37 soil samples, collected in eight points at several depths, six natural leachates, four river water samples and three river sediments. Soil and leachate samples present very high levels of HCH isomers, higher than the established by legislation, and some pesticides were also detected in the analysed river water whereas no pesticides were detected in the river sediments. The distribution of isomers was different depending on the matrix analysed. Some natural degradation products and also other organochlorine pesticides were detected in the samples analysed.

Changes in sensory properties of Galician chorizo sausage preserved by freezing, oil-immersion and vacuum-packing.

Galician chorizo sausage, a dry-cured meat product from northwest Spain, was conserved by different methods with the aim of increasing its useful life. We studied changes in the sensory properties of this dry-cured meat product conserved by freezing, vacuum-packing and a traditional method involving immersion in sunflower oil. The reasons for the elimination of the samples conserved in sunflower oil at sampling 13 (week 23) was an increase in rancid flavor, acid flavor and external odor intensity. In sampling 18 (week 41) the samples conserved by vacuum-packing were eliminated because of increases in acid flavor, external and internal odor intensity, flavor intensity and after-taste persistence. In the frozen sausages the changes in sensory properties happened very slowly during storage.

[Urachal cyst presenting as acute urinary retention]. / Retención aguda de orina, "RAO", como presentación de quiste de uraco.

About 2% of adults have an urachal cyst. The diagnosis is usually made due to its clinical complications. We report an inusual case of acute urinary retention due to an urachal cyst, with hipogastric pain and anuria as initial syntoms.

[Treatment of female stress urinary incontinence with TVT system (tension-free vaginal tape): complications in our first 100 cases]. / Tratamiento de la incontinencia urinaria de esfuerzo con el sistema TVT: complicaciones en nuestros primeros 100 casos.

INTRODUCTION: The TVT system is the most common surgical technique of female stress urinary incontinence, because of the simplicity. good clinical results and rare complications. MATERIAL AND METHODS: From april, 1999 to march. 2004, it has been done in our department 100 TVT systems with the revision of the result over the six following months. The average follow-up rate was 10.36 months (R: 1-54 months) and looses mean the 11% of the cases. All the patients presented stress incontinence and their average age was 56.6 years old (30-80). The 12% of the cases have been previously operated of urinary incontinence. 21 patients presented previous surgery of pelvic floor. In the 17% of the cases, TVT systems was associated to another surgical technique: 15% of them was operated of cystocele, 1% of them had surgical correction of rectocele, 1% of them had a strong surgery of pelvic floor, that included TVT system, correction of pelvic floor and hysterectomy. RESULTS: We obtained 65% of successful cases, defined as objective confirmation of absence of looses from the observer and the subjective reference of the patient: 17% of clear improvement (clear decrease of looses from the patient and subjective improvement) and 7% of failure of the technique. The total percentage of appearance of novo post-surgery urgency is 9%. There were complications in the 12% of the cases: there were three cases of bladder perforation, two of them intra-operative and one of them deferred and associated to an infection of surgical wound; another three cases of residue in the immediate post-operative that were resolved with bladder catheterization: one case of acute urinary retention that was treated with bladder catheterization with suprapubic cistostomy: one case of chemical peritonitis corrected with a conservative treatment; two cases of vaginal extrusion of sling, which were resolved with the section of the outer sling; one patient presented a hipogastric hematoma resolved with conservative measures: and one patient presented pelvic discomfort with spontaneous resolution. CONCLUSIONS: We consider the TVT system as an effective surgical technique in the treatment of the female stress urinary incontinence. It is a simple technique with a short stay in the hospital and rare complications.

[Surgical stratification of renal carcinoma with extension into inferior vena cava]. / Estratégia quirúirgica en el carcinoma de células renales con extensión a la circulación venosa.

Renal cell carcinoma with inferior vena cava thrombus is relatively uncommon and complicates radical nefrectomy. During the past twenty years our hospital have substantially contributed to the surgical stratification of renal cell carcinoma with extension into inferior vena cava through different techniques. The reason for this article is to discuss the mote efficient and appropiate surgical technique for this pathology. We believe that the diagnosis of vena caval invasion and level of tumoral extension is based on radiological examinations and it is crucial for the success of the surgery. We consider that the use of vena caval filter applied preoperatively could prevent the risk of thromboembolism during and after the surgery. The use of prosthetic grafts is unusual, because the long standing obstruction caused by the tumor thrombus will develope extensive collateral circulation which works as a natural veno-venous bypass. Finally, we try to avoid the use of veno-venous and cardiopulmonar bypass with or without complete hypothermic circulatory arrest due to the high association with adverse outcomes and mortality.

[Hematuria and sharp renal failure as debut of secondary bladder amiloidosis. Presentation of a new case and revision of the literature]. / Hematuria y fracaso renal agudo como debut de amiloidosis vesical secundaria. Presentación de un nuevo caso y revisión de la literatura.

The primary bladder amiloidosis is an uncommon pathology, not existing in the world more than 150 published cases, being even more exceptional the secondary bladder amiloidosis being described around 25 cases. The secondary bladder amiloidosis associates in most from the patients to arthritis reumatoide of long evolution. The diagnoses clinical it is difficult, being necessary the differential diagnosis with the bladder tumour. The pathological study and inmunohistochemics, confirm the diagnosis. We present the case of a patient that I debut with frank hematuria, hemodynamic uncertainty and renal inadequacy that it required combined treatment, doctor and surgical for the resolution of their square.

[Myofibroblastic tumor of bladder]. / Tumor miofibroblástico de vejiga.

The myofibroblastic tumor, is a mesenchymal benign tumor of exceptional character, being its localization but habitual it is the lung; while its appearance in the bladder, is exceptional, not existing but of 100 published cases, of this tumor type in the bladder. This tumor type that clinic and radiologics, behave as a wicked tumor. The pathological diagnosis is complex, due to its similarity with the sarcomas, being necessary to appeal to the inmunohistochemics for a I diagnose of certainty. The treatment by means of wide resection is usually enough not existing any case of metastasis at the present time at distance, neither of malignization. We present a new case of this neoplasm, carrying out a wide bibliographical revision.

Capillary zone electrophoresis for the determination of light-absorbing anions in environmental samples.

A rapid and simple method for separation and determination of inorganic anions by capillary zone electrophoresis was described. The detection was carried out directly with a diode array detector. The experimental conditions, such as concentration of carrier electrolyte, capillary length, voltage, and temperature were optimized. In order to improve selectivity, different organic modifiers were also investigated. The baseline separation of 10 light-absorbing anions was accomplished within 3.5 min with a background electrolyte consisting of 50 mM sodium tetraborate containing 5% MeOH. Linear plots were obtained in the concentration range of 0.1-10 microg/ml. With sample stacking injection, the quantitation limits of the anions were found to be in the range of 0.02-0.1 microg/ml. The proposed method was successfully applied to the determination of inorganic anions in environmental samples and in effluents of a power plant.

Application of programmed-temperature split/splitless injection to the trace analysis of aliphatic hydrocarbons by gas chromatography.

The dependence of the programmed-temperature solvent split sampling technique using a PSS (programmed-split/splitless) injection mode on different variables affecting the introduction of large sample volumes for a mixture of alkanes in capillary GC was evaluated. Apart from the studies found in the literature on different factors such as speed of injection. presence of adsorbent in the liner, internal diameter of the liner, initial and final injector temperature, split flow-rate and initial split time, affecting the chromatographic signal of different compounds, others were studied whose influence has not been considered until now. They include length of the microsyringe needle, adsorbent distribution in the liner, injection volume on analyte discrimination, speed of injector heating, time which the column stays at the initial temperature and time that the injector stays at the final temperature. Once finalised, the study of the PSS injection mode was compared with the conventional mode of gas chromatography splitless injection, and found that the proposed method increases sensitivity in GC trace analysis. Finally, the application of both injection modes in the determination of aliphatic hydrocarbons was tested in an atmospheric particulate sample.

Optimisation of a programmed split-splitless injector in the gas chromatographic-mass spectrometric determination of organochlorine pesticides.

Large-volume injection techniques in gas chromatography are used to compensate for the at times limited detection sensitivity of mass spectrometric detection. In this work a programmed split-splitless injector in solvent split mode was employed to determine organochlorine pesticides in environmental samples. The injection conditions were selected by a Plackett-Burman design followed by a central composite design. The LODs obtained in the optimum conditions were compared with those obtained with splitless-MS and splitless-ECD. Finally, the method was applied to a soil sample.

Development of pressurized liquid extraction and cleanup procedures for determination of organochlorine pesticides in soils.

The scope of this work is the development of a rapid, reliable and sensitive method for the analysis of organochlorine pesticides from soils by pressurized liquid extraction (PLE). The effect of four parameters (temperature, pressure, static time and cell volume) on the extraction efficiency was studied. The great extracting power of the PLE causes the extraction of numerous interfering substances, so a more efficient purification of this extract was necessary. In this work several sorbents have also been assayed to carry out the purification of soil samples: Florisil, silica, alumina, carbon, as well as combinations of them. Finally, the proposed analytical method was validated using a certified reference soil material (CRM804-050) and the results were compared with those obtained by other extraction techniques (Soxhlet and microwave-assisted extraction).

Determination of 21 organochlorine pesticides in tree leaves using solid-phase extraction clean-up cartridges.

A method to determine 21 organochlorine pesticides (OCPs) in tree leaves [chestnut (Castanea sativa), hazel (Corylus avellana), oak (Quercus robur) and walnut tree (Juglans regia)] based on microwave-assisted extraction (MAE) followed by solid-phase extraction (SPE) clean-up is described. After extraction with hexane:acetone (50:50), four different sorbents (Florisil, tandem Florisil + alumina, silica and ENVI-Carb) were assayed for the clean-up step. Pesticides were eluted with 5 mL of hexane:ethyl acetate (80:20) and determined by gas chromatography and electron capture detection (GC-ECD). Carbon was the sorbent, which provided colourless eluates and chromatograms with less interferent compounds. Analytical recoveries obtained were ca. 100% for all the studied pesticides with this sorbent.

Microwave-assisted extraction versus Soxhlet extraction in the analysis of 21 organochlorine pesticides in plants.

A method to determine 21 organochlorine pesticides in vegetation samples using microwave-assisted extraction (MAE) is described and compared with Soxhlet extraction. Samples were extracted with hexane-acetone (1:1, v/v) and the extracts were cleaned using solid-phase extraction with Florisil and alumine as adsorbents. Pesticides were eluted with hexane-ethyl acetate (80:20, v/v) and determined by gas chromatography and electron-capture detection. Recoveries obtained (75.5-132.7% for Soxhlet extraction and 81.5-108.4% for MAE) show that both methods are suitable for the determination of chlorinated pesticides in vegetation samples. The method using microwave energy was applied to grass samples from parks of A Coruña (N.W. Spain) and to vegetation from the contaminated industrial area of Torneiros (Pontevedra, N.W. Spain).