Role of chemerin in the control of glucose homeostasis.

Chemerin is an adipokine produced by the white adipose tissue and other tissues, which plays various roles in the pathogenesis of inflammatory and metabolic diseases in multiple organs. The present review aims at gathering scientific evidence reported in the last ten years, concerning the relationship of chemerin with alterations of glycaemic control, such as insulin resistance, type 2 diabetes and gestational diabetes in humans. Although the vast majority of the studies have shown a positive correlation between the chemerin level and a bad glycaemic control, a general consensus has not been reached. The reported results come from case-control and observational longitudinal studies, thereby limiting their interpretation. In fact, it cannot be stated whether insulin resistance and diabetes lead to an increase in chemerin levels or, on the contrary, if high levels of chemerin contribute to an impaired glycaemic control. Elevated levels of circulating chemerin are also associated with gestational diabetes mellitus. Chemerin gene polymorphisms could be proposed as mediators of glucose-related diseases. Nevertheless, to date very little is known about their implication in glucose metabolism. With regard to the mechanisms of action, chemerin impairs insulin cascade signaling by acting on several proteins of this cascade and by inducing inflammation.

Brote epidémico de intoxicación alimentaria por cannabinoides / Epidemic outbreak of cannabinoid food poisoning

La marihuana es la sustancia ilícita de mayor consumo a nivel mundial. En los últimos años se han descrito casos de intoxicación por cannabinoides por vía oral, siendo su presentación habitualmente accidental. Se presenta un brote epidémico de intoxicación por cannabinoides debido a ingesta alimentaria en un establecimiento público de Barcelona. Ninguno de los afectados presentó signos de gravedad a su llegada al servicio de urgencias hospitalario. Las principales alteraciones clínicas fueron hipertensión, taquicardia, debilidad e inestabilidad cefálica. La determinación de tóxicos en orina fue positiva en todos los casos. La mayoría de los casos no requirió tratamiento farmacológico. La evolución de los pacientes fue correcta, siendo dados de alta tras unas horas de observación

Marijuana is the most consumed illicit substance worldwide. Some involuntary oral cannabinoid intoxications has been reported in recent years. An epidemic outbreak of cannabinoid intoxication due to the consumption of adulterated food in a public establishment in Barcelona is presented. None of patients showed severity signs at presentation. Hypertension, tachycardia, sickness and instability were the most frequent clinical findings. Urine drug test was positive in all cases. Patient evolution was satisfactory and all they were discharged after several hours of observation. Most cases needed no pharmacological treatment

Extra-pulmonary tuberculosis: differential aspects and role of 16S-rRNA in urine.

BACKGROUND: Early diagnosis of extra-pulmonary tuberculosis (EPTB) is important for successful treatment. METHODS: All cases of EPTB diagnosed at Ramon y Cajal Hospital, Madrid, Spain, from 1997 to 2008 were analysed and compared with pulmonary tuberculosis (PTB) patients to identify differential parameters that could serve to predict the presence of EPTB at initial presentation. Different microbiological techniques were analysed, including amplification of 16S-rRNA in urine. RESULTS: During the study period, 814 cases of TB were diagnosed at our centre; 330 (40.5%) were EPTB. Concomitant PTB was detected in 45% of EPTB cases. The main clinical forms of EPTB were lymphadenitis (86, 26%), miliary TB (60, 18%), and multifocal TB (43, 13%). Variables independently associated with EPTB were human immunodeficiency virus (HIV) infection (OR 3.6, 95%CI 2.4-5.4), older age (>60 years) (OR 3.7, 95%CI 2.5-5.6) and mortality (OR 2.9, 95%CI 1.3-6.3). 16S-rRNA in urine was performed in 82 EPTB patients (25%), among whom a positive result was obtained in 70%; in the PTB group, a positive result was found in 5 of 28 patients (18%) (P <0.001). CONCLUSIONS: HIV infection and older age appear to be the main risk factors associated with EPTB. In this study, mortality was significantly higher in patients with EPTB. A positive 16S-rRNA test result in urine is a useful marker of EPTB.

[Inverted urothelial papilloma: our clinical experience]. / Papiloma invertido urotelial: nuestra experiencia clínica.

UNLABELLED: A study of inverted urothelial papilloma in our area. METHODS: A study was conducted of inverted urothelial papillomas diagnosed at our center from January 1994 to December 2007. This was a retrospective and prospective study with a descriptive statistical analysis: urological history, reason for consultation, diagnostic methods, tumor focality, follow-up method, prognosis, and recurrence. SPSS software version 13 was used for statistical analysis. RESULTS: Fourteen inverted papillomas were diagnosed in the study period in patients with a median age of 59 years. The presenting complaint was hematuria in 7 patients (50%), followed by low back pain in 2 patients (14.28%), and irritative syndrome in 1 patient (7.14%). The tumor was incidentally diagnosed in 4 patients (28.5%). A single relapse/recurrence occurred in a low-grade tumor during the follow-up period. CONCLUSIONS: Prognosis, recurrence, and malignant potential of this tumor are unclear, and controversy exists in the literature on this subject. Thus, although we think this is a benign tumor, we advise follow-up as if it were a low-grade urothelial tumor.

Papiloma invertido urotelial: nuestra experiencia clínica / Inverted urothelial papilloma: Our clinical experience

Estudio de los papilomas invertidos uroteliales en nuestra área. Material y métodos: Realizamos un estudio de los papilomas invertidos uroteliales diagnosticados en nuestro centro entre enero de 1994 y diciembre de 2007. Se realizó un estudio retrospectivo y prospectivo con análisis estadístico descriptivo: antecedentes urológicos, motivo de consulta, método diagnóstico, focalidad tumoral, método de seguimiento, pronóstico y recurrencia. Se realizó un estudio estadístico con el software SPSS versión 13. Resultados: En el período de estudio se han diagnosticado 14 papilomas invertidos, con una mediana de 59 años. El motivo de consulta fue hematuria en 7 enfermos (50%), seguido de dolor lumbar en 2 enfermos (14,28%) y de síndrome irritativo en 1 enfermo (7,14%), fue diagnosticado en 4 enfermos (28,5%) de manera incidental. Durante el período de seguimiento sólo se produjo una recidiva/recurrencia en un tumor de bajo grado. Conclusiones: El pronóstico, la recurrencia y el potencial de malignización de este tumor no están claros, existiendo controversias en la literatura médica mundial, hecho por el cual aunque desde nuestro punto de vista su naturaleza es benigna, aconsejamos un seguimiento como si se tratase de un tumor urotelial de bajo grado (AU)

A study of inverted urothelial papilloma in our area. Methods: A study was conducted of inverted urothelial papillomas diagnosed at our center from January 1994 to December 2007. This was a retrospective and prospective study with a descriptive statistical analysis: urological history, reason for consultation, diagnostic methods, tumor focality, follow-up method, prognosis, and recurrence. SPSS software version 13 was used for statistical analysis. Results: Fourteen inverted papillomas were diagnosed in the study period in patients with a median age of 59 years. The presenting complaint was hematuria in 7 patients (50%), followed by low back pain in 2 patients (14.28%), and irritative syndrome in 1 patient (7.14%). The tumor was incidentally diagnosed in 4 patients (28.5%). A single relapse/recurrence occurred in a low-grade tumor during the follow-up period. Conclusions: Prognosis, recurrence, and malignant potential of this tumor are unclear, and controversy exists in the literature on this subject. Thus, although we think this is a benign tumor, we advise follow-up as if it were a low-grade urothelial tumor (AU)

In vitro activity of linezolid against Mycobacterium tuberculosis complex, including multidrug-resistant Mycobacterium bovis isolates.

The activity of linezolid was studied against 55 Mycobacterium tuberculosis (42 susceptible, 3 isoniazid resistant and 10 isoniazid and rifampicin resistant), one Mycobacterium bovis and two multidrug-resistant M. bovis isolates using the standard 7H10 agar proportion and the ESP Culture System II methods. Both methods displayed similar MIC(90) values (minimum inhibitory concentrations for 90% of the organisms) of 0.5mg/L; however, the former method yielded slightly lower MIC(50) values (MICs for 50% of the organisms) (0.25mg/L) compared with the latter method (0.5mg/L). No differences were observed between susceptible and resistant isolates, including multidrug-resistant M. bovis isolates, with a MIC range of 0.12-0.5mg/L. The potential role of linezolid in tuberculosis patients requires further in vivo evaluation.

[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.

Anestesia urgente de la extremidad inferior mediante bloqueo combinado ciático y femoral / Emergency lower limb anaesthesia by combined sciatic-femoral nerve block

No disponible

Retención aguda de orina, “RAO“, como presentación de quiste de uraco / Urachal cyst presentated as acute urinary retention

El quiste de uraco esta presente aproximadamente en el 2% de los adultos, siendo su diagnostico difícil y secundario a las manifestaciones de su complicaciones. Presentamos un caso inusual de retención aguda de orina en un quiste de uraco, que debutó como dolor hipogástrico y anuria (AU)

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 (AU)

[Renal synchronous tumor: association of renal adenocarcinoma and transitional tumor of renal pelvis, in the same kidney, an exceptional discovery]. / Tumor sincrónico renal: asociación de adenocarcinoma renal y tumor transicional de pelvis renal, en el mismo riñón, un hallazgo excepcional.

The renal cell tumour supposes 1% of the adult's tumors, while the transitional carcinoma has an incidence of 7%. The simultaneous appearance of a carcinoma of renal cells, and a transitional tumour of pelvis in the same kidney, they suppose an exceptional fact not existing but of 30 cases published in the world, presenting an approximate incidence of 0.14% of the pathology renal tumoral. We present a new case of this unusual association that supposes the 4 case indexed in the literature in Spanish.

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

Introducción: El sistema TVT (Tension-free Vaginal Tape) es la técnica quirúrgica de elección en los últimos años de la incontinencia urinaria de esfuerzo femenina (IUE), dada la facilidad de la técnica, buenos resultados clínicos y escasas complicaciones. Material y métodos: Desde Abril de 1999 a Marzo 2004 se han implantado en nuestro servicio 100 sistemas TVT con revisión de los resultados a los 6 meses, y un seguimiento medio de 10,36 meses (R: 1-54 meses), con una pérdida de seguimiento en el 11% de los casos. Todas las mujeres estudiadas presentaban incontinencia de esfuerzo, siendo la edad media de 56,5 años (30-80). Un 12% habían sido intervenidas previamente de IUE. Presentan cirugía previa del suelo pélvico 21 pacientes. En un 17% de los casos se realizó TVT asociado a otra técnica quirúrgica: 15% cistorrafia anterior, 1% corrección de rectocele, 1% cirugía compleja del suelo pélvico que incluye TVT, corrección de cistocele e histerectomía. Resultados: Obtenemos un 65% de éxitos (comprobación objetiva de la ausencia de escape por parte del médico y referencia subjetiva de la paciente), un 17% de mejoría (disminución clara de escapes por parte de la paciente y mejoría subjetiva) y un 7% de fracaso de la técnica. El porcentaje global de aparición de urgencia de novo posquirúrgica es del 9%. Existieron un 12% de complicaciones; 3 casos(3%) de perforación vesical, 2 de ellos intraoperatorios y 1 diferida junto con infección de la herida quirúrgica; 3 episodios (3%) de residuos altos en el postoperatorio inmediato, resueltos con autosondajes, y un caso de RAO (1%) dado de alta con cistostomía suprapúbica; un caso (1%) de peritonitis química tras retirada de talla vesical resuelta con tratamiento conservador; dos casos (2%) de extrusión vaginal de la bandeleta, con sección de la porción de malla exteriorizada en ambos casos; un (1%) paciente presenta hematoma hipogástrico que se resuelve con medidas conservadoras; un 1 % de los pacientes (1 caso) presentó molestias pélvicas subcrónicas con resolución espontánea. Conclusiones: Consideramos el sistema TVT una técnica quirúrgica eficaz en el tratamiento de la incontinencia urinaria femenina de esfuerzo. Es una técnica sencilla, con baja estancia hospitalaria y escasas complicaciones (AU)

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 (AU)

[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.

Tumor sincrónico renal: asociación de adenocarcinoma renal y tumor transicional de pelvis renal, en el mismo riñón, un hallazgo excepcional / Renal synchronous tumor: association of renal adenocarcinoma and transitional tumor of renal pelvis, in the same kidney, an exceptional discovery

El tumor de células renales supone el 1% de los tumores del adulto, mientras que el carcinoma transicional tiene una incidencia del 7%. La aparición simultánea de un carcinoma de células renales, y un tumor transicional de pelvis en el mismo riñón, suponen un hecho excepcional no existiendo más de 30 casos publicados en el mundo, presentando una incidencia aproximada del 0,14% de la patología tumoral renal. Presentamos un nuevo caso de esta inusual asociación que supone el 4caso referenciado en la literatura en español (AU)

The renal cell tumour supposes 1% of the adult’s tumors, while the transitional carcinoma has an incidence of 7%. The simultaneous appearance of a carcinoma of renal cells, and a transitional tumour of pelvis in the same kidney, they suppose an exceptional fact not existing but of 30 cases published in the world, presenting an approximate incidence of 0.14% of the pathology renal tumoral. We present a new case of this unusual association that supposes the 4 case indexed in the literature in Spanish (AU)

[Benign retroperitoneal schwannoma. Incidental diagnostic in patient with hematuria of the percusionist]. / Schwannoma retroperitoneal benigno. Diagnostico incidental en paciente con hematuria del percusionista.

The incidence of retroperitoneal primitive tumour varies from the 0.3 to 3%. The sarcomas suppose the group but it frequents of retroperitoneal tumour, being the Schwannoma an unusual tumour with an incidence from 1% to 50% of the retroperitoneal primary tumours. The schwannoma also denominated neurinoma or neurolenoma, it is a derived tumour of the cells of Schwann of the outlying nerves. It is characterized by their clinical and radiological inespecify, being the diagnose pathological, with intense positive inmunohistoquimics to the protein S-100. The election treatment is the surgical remove, with wide margins; not being described cases of malignización neither of metastasis at distance, but if the recurrence existence at probably secondary local level to incomplete resection.