Parameters and functional analysis of the deep epaxial muscles in the thoracic, lumbar and sacral regions of the equine spine.

The epaxial muscles produce intervertebral rotation in the transverse, vertical and axial axes. These muscles also counteract the movements induced by gravitational and inertial forces and movements produced by antagonistic muscles and the intrinsic muscles of the pelvic limb. Their fascicles are innervated by the dorsal branch of the spinal nerve, which corresponds to the metamere of its cranial insertion in the spinous process. The structure allows the function of the muscles to be predicted: those with long and parallel fibres have a shortening function, whereas the muscles with short and oblique fibres have an antigravity action. In the horse, the multifidus muscle of the thoracolumbar region extends in multiple segments of two to eight vertebral motion segments (VMS). Functionally, the multifidus muscle is considered a spine stabiliser, maintaining VMS neutrality during spine rotations. However, there is evidence of the structural and functional heterogeneity of the equine thoracolumbar multifidus muscle, depending on the VMS considered, related to the complex control of the required neuromuscular activity. Osteoarticular lesions of the spine have been directly related to asymmetries of the multifidus muscle. The lateral (LDSM) and medial (MDSM) dorsal sacrocaudal muscles may be included in the multifidus complex, the function of which is also unclear in the lumbosacral region. The functional parameters of maximum force (Fmax ), maximum velocity of contraction (Vmax ) and joint moment (M) of the multifidus muscles inserted in the 4th, 9th, 12th and 17th thoracic and 3rd and 4th lumbar vertebrae of six horses were studied postmortem (for example: 4MT4 indicates the multifidus muscle that crosses four metameres with cranial insertion in the T4 vertebra). Furthermore, the structural and functional characteristics of LDSM and MDSM were determined. Data were analysed by analysis of variance (anova) in a randomised complete block design (P ≤ 0.05). For some muscles, the ordering of Vmax values was almost opposite to that of Fmax values, generally indicating antigravity or dynamic functions, depending on the muscle and VMS. The muscles 3MT12, 3ML3 and 4ML4 exhibited high Fmax and low Vmax values, indicating a stabilising action. The very long 7MT4 and 8MT4 multifidus had low Fmax and high Vmax values, suggesting a shortening action. However, some functional characteristics of interest did not fall within these general observations, also indicating a dual action. In summary, the results of the analysis of various structural and functional parameters confirm the structural and functional heterogeneity of the equine thoracolumbar multifidus complex, depending on the VMS, regardless of the number of metameres crossing each fascicle. To clarify the functions of the equine multifidus muscle complex, this study aimed to assess its functional parameters in thoracolumbar VMSs with different movement characteristics and in the MDSM and LDSM muscles, hypothesising that the functional parameters vary significantly when the VMS is considered.

Structural and functional characteristics of the thoracolumbar multifidus muscle in horses.

The multifidus muscle fascicles of horses attach to vertebral spinous processes after crossing between one to six metameres. The fascicles within one or two metameres are difficult to distinguish in horses. A vertebral motion segment is anatomically formed by two adjacent vertebrae and the interposed soft tissue structures, and excessive mobility of a vertebral motion segment frequently causes osteoarthropathies in sport horses. The importance of the equine multifidus muscle as a vertebral motion segment stabilizer has been demonstrated; however, there is scant documentation of the structure and function of this muscle. By studying six sport horses postmortem, the normalized muscle fibre lengths of the the multifidus muscle attached to the thoracic (T)4, T9, T12, T17 and lumbar (L)3 vertebral motion segments were determined and the relative areas occupied by fibre types I, IIA and IIX were measured in the same muscles after immunohistochemical typying. The values for the normalized muscle fibre lengths and the relative areas were analysed as completely randomized blocks using an anova (P ≤ 0.05). The vertebral motion segments of the T4 vertebra include multifidus bundles extending between two and eight metameres; the vertebral motion segments of the T9, T12, T17 and L3 vertebrae contain fascicles extending between two and four metameres The muscle fibres with high normalized lengths that insert into the T4 (three and eight metameres) vertebral motion segment tend to have smaller physiological cross-sectional areas, indicating their diminished capacity to generate isometric force. In contrast, the significantly decreased normalized muscle fibre lengths and the increased physiological cross-sectional areas of the fascicles of three metameres with insertions on T9, T17, T12, L3 and the fascicles of four metameres with insertions on L3 increase their capacities to generate isometric muscle force and neutralize excessive movements of the vertebral segments with great mobility. There were no significant differences in the values of relative areas occupied by fibre types I, IIA and IIX. In considering the relative areas occupied by the fibre types in the multifidus muscle fascicles attached to each vertebral motion segment examined, the relative area occupied by the type I fibres was found to be significantly higher in the T4 vertebral motion segment than in the other segments. It can be concluded that the equine multifidus muscle in horses is an immunohistochemically homogeneous muscle with various architectural designs that have functional significance according to the vertebral motion segments considered. The results obtained in this study can serve as a basis for future research aimed at understanding the posture and dynamics of the equine spine.

[The way we were. On the centenary of the first Spanish Congress of Paediatrics in Palma de Mallorca (1914-2014)]. / Tal como éramos. En el centenario del Primer Congreso Español de Pediatría de Palma de Mallorca (1914-2014).

Between the 19th and 25th April 1914, the First Spanish Congress of Paediatrics was held in Palma de Mallorca under the slogan "Protect the Children". The specialty had broken away a few years earlier from its secular connection with Obstetrics and Gynaecology, both in its teaching aspect as well as regarding healthcare. With the newly created Chairs in Childhood Diseases, in a way this Congress meant the coming-of age and debut int society of paediatrics in our country. Prof. Martínez Vargas, a university professor in Barcelona, was the Chairman, and soul of the congress. There was a need to face a very high rate of infant mortality. The Congress responded to that social and sanitary/health demand with the participation of over three hundred pediatricians, including foreign representatives from Belgium, France, Russia and Latin America. The activities were divided into four sections: Childcare, Child Medicine, Surgery and Health, and accredited lecturers gave master classes on the most pressing issues of child pathology of the time. One hundred years on, what we are today is the fruit gathered by those who preceded us. Some were brilliant figures in paediatrics and others, the majority, anonymous paediatricians. They dedicated their lives, their science and their best smile to child care. The way we were and the way we are. With legitimate pride and satisfaction, it is an honour for the Group on the History of Paediatrics and AEP Documentation to celebrate this centennial commemoration in the framework of the Annals of Paediatrics.

Bibliografía española de algunos síndromes malformativos. Las primeras descripciones / Malformation syndromes in the spanish literature: The first descriptions

Introducción: Los síndromes malformativos o dismórficos son entidades que se definen por la asociación característica de un conjunto de malformaciones mayores y menores que, generalmente, tienen un origen genético. Hemos investigado las primeras descripciones españolas de un amplio número de entidades sindrómicas. Material y métodos: Se partió de la definición que aparece en un tratado clásico sobre el tema. Entre los 60 síndromes escogidos, se estudiaron, al menos, 2 artículos de cada entidad entre los publicados en España y el primero en el tiempo que figura en el Índice Médico Español. Para los años previos a 1970, se amplió la búsqueda en PubMed. Resultados: Se han reunido 64 artículos que corresponden a 58 síndromes. Cuatro artículos se escribieron durante la primera mitad del siglo XX . En la década de los setenta aparecieron casi la mitad de los trabajos (n = 30). Los trabajos se publicaron en 10 revistas pediátricas españolas, en 9 españolas no pediátricas, en 3 pediátricas no españolas y en 2 no pediátricas y no españolas. Las revistas con más artículos publicados fueron Anales de Pediatría y Revista Española de Pediatría. Los hospitales que firmaron artículos con más frecuencia fueron La Paz de Madrid y el Clínico de Barcelona. El resto de los trabajos se escribieron en 30 hospitales pediátricos españoles más y en 2 extranjeros. El número de autores se fue incrementando con el paso del tiempo. Conclusiones: Aunque con posibles limitaciones, hemos localizado las que pueden ser las primeras descripciones de 58 síndromes, entre los 60 escogidos inicialmente (AU)

Introduction: Malformation or dysmorphic syndromes are conditions that are defined by the combination of a set of major and minor malformations that generally have a genetic origin. We investigated the early Spanish descriptions of a large number of sydromes. Material and methods: We started the study from the definition in a classic treatise on the subject. Among the 60 selected syndromes studied, at least two articles of each syndrome among those published in Spain and for the first time were listed in the Spanish Medical Index. For years prior to 1970, it expanded The search was expanded to PubMed, for the years before1970.Results: We collected 64 articles that referred to 58 syndromes. Four articles were written during the first half of the twentieth century. Almost half of the works (n = 30) appeared in the 1970’s. The papers were published in ten Spanish pediatric, nine Spanish non pediatric, three pediatric non-Spanish and two non-Spanish non-pediatric Journals. The Journals with the most articles published were Anales de Pediatría y Revista Española de Pediatría. The hospitals where the articles originate more often were Hospital La Paz, Madrid and Hospital Clinic, Barcelona. The rest of the works were written in 30 pediatric hospitals and two more in non-Spanish hospitals. The number of authors increased with the passage of time. Conclusions: Although there were potential limitations, we have identified what may be the first descriptions of 58 syndromes, among the 60 chosen initially (AU)

Unidad Diagnóstica y pronóstica del microrna-21 en el cáncer colorrectal / Diagnostic and prognostic utility of serum microrna-21 in colorectal cancer

INTRODUCCIÓN. Los microRNAs son estructuras moleculares de 20-22 nucleótidos con actividad post-transcripional que están implicados en la carcinogénesis mediante una regulación genética post-transcripcional. Presentamos un estudio prospectivo donde se determina la expresión sérica de microRNA-21 en pacientes con diagnóstico de adenocarcinoma de colon. MATERIAL Y MÉTODOS. Estudio de cohorte prospectivo de al menos 100 pacientes con diagnóstico de adenocarcinoma de colon, y de al menos 60 pacientes con apendicitis aguda como grupo control. Se realizó el análisis de microRNA-21 sérico mediante PCR de las muestras sanguíneas de los pacientes obtenidas de forma preoperatoria. RESULTADOS. La comparación de la expresión del microRNA-21 sérico fue mayor en los pacientes con cáncer colorrectal que en los pacientes del grupo control, siendo el área bajo la curva de 0,603. En el análisis univariante, la expresión del miR- 21 se relaciona de forma estadísticamente significativa con la recidiva local (p=0,025) y con la mortalidad (p=0,029). En el análisis multivariante también se puso de manifiesto que las expresiones mayores (sobreexpresiones) de miR-21 se relacionaban con una reducción del riesgo derecidiva del 51%, mientras que dicha sobreexpresión se relacionaba con una reducción de mortalidad del 50%. CONCLUSIONES. La expresión del microRNA-21 sérico podría ser considerado como un potencial marcador diagnóstico para el cáncer colorrectal. La expresión sérica del microRNA-21 se correlaciona con la recidiva y mortalidad en el cáncer colorrectal. Nuestros resultados sugieren que el miR-21 sérico es un prometedor marcador diagnóstico y pronóstico, y pone de manifiesto su potencial utilidad clínica en el cáncer colorrectal (AU)

BACKGROUND. MicroRNAs (miRNAs) are small, noncoding RNAs that are involved in carcinogenesis through postranscriptional gene regulatory activity. Few studies have focused on the detection of miR-21 in serum rather than in tissue. The currentstudy aimed to measure serum miR-21 expression levels and to evaluate their association with the outcome of colorectal cancer (CRC). METHODS. Blood samples were collected from almost 100 CRC patients undergoing surgery with curative intent, and almost 60 control patients. The expression levels of miR-21 were measured using a quantitative reverse transcription polymerase chain reaction (qRT-PCR). RESULTS. Serum microRNA-21 expression was higher in colorectal cancer patients than in control patients, with a ROC curve of 0.603. A univariate analysis revealed that lower expression levels of serum miR-21 were associated with higher local recurrence (p=0.025) and mortality (p=0.029). A logistic regression analysis demonstrated that the relative overexpression of miR-21 (expression >1) was associated with a 51% reduction in the risk of recurrence. A Cox regression analysis identified that a relative increase in miR-21 expression (>1) was associated with a 50% reduction in the risk of mortality. CONCLUSIONS. Serum microRNA-21 expression could be considered as a potential diagnostic marker for colorectal cancer. The expression level of serum miR-21 correlates with the recurrence and mortality of CRC patients. Our results suggest that circulating serum miR-21 is a promising diagnostic and prognostic tumour marker, and they highlight the potential clinical utility of miR-21 in colorectal cancer (AU)

[Serum microRNA-21 usefulness in inflammatory pathology of the colon]. / Utilidad de la determinación sérica de microRNA-21 en la enfermedad inflamatoria del colon.

BACKGROUND: MicroRNAs are 20-22 nucleotide molecular structures with post-transcriptional activity that are involved in the immune response, as well as in the inflammatory pathways of different cells and tissues. AIMS: We present herein a prospective study in which serum microRNA-21 expression was determined in patients diagnosed with acute appendicitis as a model of bowel inflammation. MATERIAL AND METHODS: A prospective cohort study of patients diagnosed with acute appendicitis was conducted. Serum microRNA-21 was analyzed through the PCR of blood samples taken from the patients prior to surgery. MicroRNA-21 values were compared with the analytic variables (leukocytes, hemoglobin, hematocrit, platelets, prothrombin activity, glucose, urea, and creatinine) and the anatomopathologic variables (normal appendix, phlegmonous, gangrenous, and perforated acute appendicitis). RESULTS: A total of 60 patients with acute appendicitis diagnosis were consecutively included in the study from June to October 2009. Sixty-six percent of the patients were men (40 men and 20 women), with a mean age of 26.2±14.8 years. The mean absolute level of microRNA-21 was 24.8±0.93, whereas the mean microRNA-21 gene expression was 1.04±0.28. No correlation between the analytic and anatomopathologic parameters evaluated was observed (P=.47). CONCLUSIONS: It is necessary to continue to search for the most appropriate microRNAs, so that their determination in serum can lead to greater precision in establishing the diagnosis and outcome of inflammatory disorders of the bowel.

[Malformation syndromes in the spanish literature: The first descriptions]. / Bibliografía española de algunos síndromes malformativos. Las primeras descripciones.

INTRODUCTION: Malformation or dysmorphic syndromes are conditions that are defined by the combination of a set of major and minor malformations that generally have a genetic origin. We investigated the early Spanish descriptions of a large number of sydromes. MATERIAL AND METHODS: We started the study from the definition in a classic treatise on the subject. Among the 60 selected syndromes studied, at least two articles of each syndrome among those published in Spain and for the first time were listed in the Spanish Medical Index. For years prior to 1970, it expanded The search was expanded to PubMed, for the years before 1970. RESULTS: We collected 64 articles that referred to 58 syndromes. Four articles were written during the first half of the twentieth century. Almost half of the works (n=30) appeared in the 1970's. The papers were published in ten Spanish pediatric, nine Spanish non-pediatric, three pediatric non-Spanish and two non-Spanish non-pediatric Journals. The Journals with the most articles published were Anales de Pediatría y Revista Española de Pediatría. The hospitals where the articles originate more often were Hospital La Paz, Madrid and Hospital Clinic, Barcelona. The rest of the works were written in 30 pediatric hospitals and two more in non-Spanish hospitals. The number of authors increased with the passage of time. CONCLUSIONS: Although there were potential limitations, we have identified what may be the first descriptions of 58 syndromes, among the 60 chosen initially.

Adaptive functional specialisation of architectural design and fibre type characteristics in agonist shoulder flexor muscles of the llama, Lama glama.

Like other camelids, llamas (Lama glama) have the natural ability to pace (moving ipsilateral limbs in near synchronicity). But unlike the Old World camelids (bactrian and dromedary camels), they are well adapted for pacing at slower or moderate speeds in high-altitude habitats, having been described as good climbers and used as pack animals for centuries. In order to gain insight into skeletal muscle design and to ascertain its relationship with the llama's characteristic locomotor behaviour, this study examined the correspondence between architecture and fibre types in two agonist muscles involved in shoulder flexion (M. teres major - TM and M. deltoideus, pars scapularis - DS and pars acromialis - DA). Architectural properties were found to be correlated with fibre-type characteristics both in DS (long fibres, low pinnation angle, fast-glycolytic fibre phenotype with abundant IIB fibres, small fibre size, reduced number of capillaries per fibre and low oxidative capacity) and in DA (short fibres, high pinnation angle, slow-oxidative fibre phenotype with numerous type I fibres, very sparse IIB fibres, and larger fibre size, abundant capillaries and high oxidative capacity). This correlation suggests a clear division of labour within the M. deltoideus of the llama, DS being involved in rapid flexion of the shoulder joint during the swing phase of the gait, and DA in joint stabilisation during the stance phase. However, the architectural design of the TM muscle (longer fibres and lower fibre pinnation angle) was not strictly matched with its fibre-type characteristics (very similar to those of the postural DA muscle). This unusual design suggests a dual function of the TM muscle both in active flexion of the shoulder and in passive support of the limb during the stance phase, pulling the forelimb to the trunk. This functional specialisation seems to be well suited to a quadruped species that needs to increase ipsilateral stability of the limb during the support phase of the pacing gait. Compared with other species, llama skeletal muscles are well suited for greater force generation combined with higher fatigue resistance during exercise. These characteristics are interpreted as being of high adaptive value, given the llama's habitat and its use as a pack animal.

Carcinogénesis del cáncer colorrectal / Colorectal cancer carcinogenesis

El cáncer colorrectal representó en el año 2008 el tercer tumor más diagnosticado en España, siendo la segunda neoplasia que causó más fallecimientos. El conocimiento del proceso carcinogenético de este tipo de enfermedad permitirá el descubrimiento de nuevas terapéuticas que conlleven menores tasas de incidencia y mortalidad. El continuo avance en la enfermedad tumoral hace que esta revisión sea una puesta al día en el conocimiento de la carcinogénesis del cáncer colorrectal (AU)

In 2008, colorectal cancer represented the third most commonly diagnosed tumor in Spain, and the second tumor that caused ore deaths. Knowledge of the carcinogenetic process of this disease will allow the discovery of new therapies involving lower rates of incidence and mortality. The continuous progress in tumor disease makes this review an update on the knowledge of colorectal cancer carcinogenesis (AU)

Biological behavior due to cell proliferation markers of gastrointestinal stromal tumors.

BACKGROUND/AIMS: The mitotic index and tumor size are currently the main prognostic indicators of gastrointestinal stromal tumors (GIST). The purpose of this study is to investigate the expression of different immunohistochemical markers and their relation to mortality and relapse, and especially concerning high-risk tumors. METHODOLOGY: We did a retrospective study of 68 patients who underwent surgery from 1997 to 2007 with a diagnostic of gastrointestinal stromal tumor. RESULTS: The median follow-up period was 29 months. Relapse and mortality rates were 35.3% (24 cases) and 41.2% (28 cases), respectively. The mitotic index was related to p53 and the cellular proliferation index -Ki67- (p = 0.006 and p = 0.003, respectively). Considering both high and intermediate-risk neoplasms, a significant relation to Ki67 was obtained (p = 0.008). Relapse was related to the mitotic index (p = 0.032) and Ki67 (p = 0.024). Concerning mortality, statistically significant results were obtained with necrosis variables (p = 0.02), mitotic index (p = 0.013), p53 (p = 0.024) and Ki67 (p = 0.033). CONCLUSIONS: Ki67 could be considered a prognostic marker for both relapse and mortality. Concerning high risk GIST, the usefulness the p53 protein and Ki67 nuclear antigen markers was also evident concerning relapse and mortality.

[Manual single infusion of combined remifentanil and propofol for anesthesia during laparoscopic gynecology procedures: a case series]. / Infusión manual única de remifentanil y propofol para anestesia en cirugía laparoscópica ginecológica: serie de casos.

OBJECTIVE: To describe a single manual infusion technique for total intravenous anesthesia with remifentanil and propofol. MATERIAL AND METHODS: Descriptive study of a series of 30 women classified as ASA 1 or 2 who received total intravenous anesthesia by means of a single manual infusion of a combination of remifentanil and propofol for laparoscopic gynecology procedures. The patients received 5 microg of remifentanil plus 2 mg of propofol per milliliter of normal saline solution. The rate of infusion was established according to remifentanil requirements and modified in accordance with the bispectral (BIS) index. RESULTS: Sufficient hemodynamic stability was maintained in all patients, with BIS values between 40 and 60. The average time until awakening was 5.2 minutes after the anesthetic infusion had been halted. CONCLUSIONS: Total intravenous anesthesia by means of a single manual infusion of remifentanil and propofol provided appropriate anesthetic and surgical conditions, with rapid, predictable awakening.

[Quality indicators in bariatric surgery: weight loss valoration]. / Indicadores de calidad en cirugía bariátrica: Valoración de la pérdida de peso.

The medical management of MO may be effective in the short and intermediate terms, although it usually fails then leading to surgical management. Our goal is to assess Capella's surgical technique by means of quality indicators including weight loss. The present work has been performed with surgical MO patients at the 12 de Octubre University Hospital during 2000-2001, and registering the follow-up checkups for the period 2000-2001/2003-2004. We reviewed the clinical charts of 23 patients. The average Body Mass Index (BMI) was 52.24 +/- 10.07 kg/m(2), (range, 41-74.41). When compiling the statistical results, we observed statistically significant post-surgical decreases with no differences whether the PEIMCP outcome was excellent (>or= 65%), fair (= 50-65%) or failure (or= 60 kg/m(2).

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

Objetivo: Conocer los cambios epidemiológicos y de abordaje diagnóstico y terapéutico de la infección urinaria neonatal en los últimos años. Pacientes y métodos: Estudio descriptivo retrospectivo de las infecciones del tracto urinario (ITU) en pacientes ingresados durante11 años en nuestra unidad neonatal. Se realiza una comparación temporal, por grupo de microorganismos y por resultados en cistouretrografía miccional seriada (CUMS). Resultados: Se estudiaron 106 casos (5 casos por cada 1.000 recién nacidos vivos [RNV]). Los microorganismos más frecuentemente aislados fueron Escherichia coli (81,1 %), Enterococcusfaecalis (6,6 %) y Enterobacter cloacae (4,7 %). La gentamicina tuvo una sensibilidad global del 93,2%, seguida de la cefotaxima con el 91,3 % y de la amoxicilina-ácido clavulánico con el 89,5 %. No encontramos diferencias temporales por microorganismos ni por sensibilidades. Hemos encontrado diferencias en la proteína Creactiva (PCR), en la nitrituria y en la leucocituria en las ITU causadas por E. coli frente a no causadas por este microorganismo, así como en los patrones de sensibilidad antibiótica, ya que las infecciones por microorganismos que no eran E. coli eran más resistentes. No se encontraron diferencias por microorganismos en pacientes con CUMS normal y patológica. Encontramos alteraciones en la ecografía y en la CUMS en el 35,2 y en el 21,4 % de la serie, respectivamente. Conclusiones: La ITU es un problema frecuente en nuestro medio. E. coli es el microorganismo más frecuentemente aislado. En las ITU no causadas por E. coli se produce una mayor resistencia a los tratamientos habituales, aunque en ellas no se detectan más datos patológicos en las pruebas de imagen. No encontramos aumento alguno de resistencias antibióticas a lo largo del estudio (AU)

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 unitover 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 Escherichiacoli (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 UTI shave 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 (AU)

Características epidemiológicas del lactante con primer episodio sibilante ¿podemos identificar al niño con riesgo de episodio grave y/o de recidiva? / Epidemiological characteristics of first wheezy episodes: can we identify children at risk of serious episode and/or relapse?

Introducción: los episodios sibilantes bronquiales son una de las patologías más frecuentes en la época del lactante. Pacientes y métodos: se diseñó un estudio prospectivo observacional con el objetivo de determinar los factores de riesgo de mala evolución y de reingreso de los episodios sibilantes en los lactantes. Se incluyeron, durante 12 meses, a todos los niños menores de 2 años ingresados en nuestro Hospital por un primer episodio sibilante. En los pacientes en que se realizó analítica sanguínea se determinaron los valores de troponina I. Se realizó una comparación por grupos, virus sincitial respiratorio (VSR) positivo frente a VSR negativo y mayores de 6 meses frente a menores y se estableció un período de observación de reingreso. Resultados: los pacientes pertenecientes al grupo VSR positivo presentaron una puntuación en la escala de Wood-Downes modificada por Ferres en el peor momento de evolución superior a la de los VSR negativos (7,2 vs 5,9; p<0,01). Los pacientes con troponina I elevada (≥0,1 ng/ml) presentaron también mayor media en esta escala, aunque estos hallazgos no adquirieron significación estadística. En el grupo de pacientes que reingresaron encontramos mayor porcentaje de niñas, padres fumadores y una estancia hospitalaria prolongada en el primer ingreso, adquiriendo todos estos resultados significación estadística. Conclusiones: la infección por VSR y la troponina I elevada pueden jugar un papel como factores predictivos de gravedad. Se relacionan con el reingreso el sexo femenino, padres fumadores y primer episodio con estancia hospitalaria prolongada (AU)

Introduction: wheezing is a common problem in infancy. Patients and methods: a prospective observational study was designed to determine risk factors for a poor outcome and readmission among infants admitted for a wheezing episode. Infants younger than 2 years admitted in a 12 month period for a first wheezing episode were included. Troponine I values were measured in some infants who had a blood sample. A comparison among groups, Respiratory Syncytial Virus (RSV)- positive versus RSV- negative, and younger than six months of age versus 6 months or older() were performed and an observation period was established. Results: scores in the Wood-Downes scale modified by Ferres were higher among the RSV + children (7,2 vs 5,9; p<0,01). Patients with elevated troponine I values (≥0,1 ng/ml) showed higher average scores but this finding did not reach statistical significance. In the group of patients who were readmission there was more female, parental smoking, and a longer length- of stay in their first admission, this results reach statistical significance. Conclusions: RSV positive and high troponine I levels may play be related to more severe disease. Female gender, parental smoking and a long length of stay in their first episode are related to a higher risk of readmission (AU)

[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.

¿Es posible cambiar el paradigma reflujocéntrico? / Is it possible to change the reflux-centred paradigm?

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[Epidemiological study of juvenile idiopathic arthtitis in the last sixteen years in Asturias (Spain)]. / Estudio epidemiológico de artritis idiopática juvenil en el Principado de Asturias: presentación de la casuística en los últimos dieciséis años.

INTRODUCTION: Juvenile idiopathic arthritis (JIA) is one of the most common chronic diseases in children. The results of several epidemiologic studies have shown surprisingly wide variety in the incidence (0.8 to 22.6 per 100,000 children) and prevalence (7 to 400 per 100,000) of this disease. MATERIAL AND METHODS: We performed a retrospective epidemiological study to identify all patients born after 1989 and resident in Asturias who were diagnosed with JIA using the criteria of the International League of Associations for Rheumatology (ILAR) criteria. RESULTS: Data were obtained from 60 patients (23 boys and 37 girls). The mean age of symptom onset was 5.6 years, with onset of spondyloarthropathies occurring most frequently in the oldest group. An incidence rate of 2.5/10(5) (3.5 at the present time) and a prevalence rate of 51.4/10(5) children and adolescents aged less than 16 years old were calculated. In 50% of patients, JIA started with inflammation in one of the knees. The most frequent form of onset was persistent oligoarticular arthritis (41.7%), followed by spondyloarthropathies (11.7%), conditions that did not meet the criteria for any category (11.7%), polyarticular arthritis (11.7%), systemic disease (10%), psoriatic arthritis (6.7%), and extended oligoarticular arthritis (6.7%). Chronic anterior uveitis was found in 5 patients (pauciarticular group in all 5 patients). Methotrexate was used in 25 children with good response and no relevant adverse events were observed. Only 10% of our patients are currently in the active phase of arthritis. CONCLUSION: An incidence rate of 3.5/10(5) and a prevalence rate of 51.4/10(5) children and adolescents aged less than 16 years old in Asturias were calculated (taking into account the possible bias of our study). The most frequent form of onset was persistent oligoarticular arthritis and the most commonly involved joints were the knees.

Estudio epidemiológico de artritis idiopática juvenil en el Principado de Asturias: presentación de la casuística en los últimos dieciséis años / Epidemiological study of juvenile idiopathic arthtitis in the last sixteen years in Asturias (Spain)

Introducción La artritis idiopática juvenil (AIJ) es una de las enfermedades crónicas más frecuentes en niños. Resulta sorprendente la gran variedad de cifras que manejan los diferentes estudios publicados en cuanto a su incidencia (0,8-22,6/10 5 < de 16 años) y prevalencia (7-400/10 5 jóvenes). Material y métodos Se realiza un estudio epidemiológico retrospectivo de la enfermedad para identificar a todos los enfermos nacidos a partir de 1989, residentes en el Principado de Asturias y diagnosticados de AIJ según los criterios acordados por la Liga Internacional de Asociaciones para la Reumatología (ILAR). Resultados Se obtuvieron datos de un total de 60 pacientes, 23 varones y 37 mujeres. La edad media para el inicio de la enfermedad fue de 5,6 años, siendo las espondiloartropatías las de mayor edad al inicio de la sintomatología. La tasa media de incidencia para todo el período de estudio resultó ser de 2,5/10 5 < 16 años (3,5 en el momento actual). La prevalencia según estos datos sería de 51,4/10 5. En el 50 % de los pacientes la enfermedad se inició como inflamación en una de sus rodillas. En cuanto a la distribución por subgrupos, la mayoría se clasificó como oligoarticular persistente (41,7 %), seguida por las espondiloartropatías (11,7 %), no clasificables (11,7 %), poliarticular (11,7 %), sistémica (10 %), artritis psoriásica (6,7 %) y forma oligoarticular extendida (6,7 %). Se detectaron 5 casos de uveítis anterior crónica (forma oligoarticular en todos los casos). El metotrexato fue empleado en 25 niños, con buena eficacia terapéutica y sin ningún efecto adverso importante. Sólo el 10 % de nuestros pacientes se encuentra actualmente en fase activa de la enfermedad. Conclusiones La incidencia anual de AIJ en Asturias en el momento actual, y con la salvedad de los posibles sesgos de nuestro estudio, es de 3,5/10 5 < 16 años, con una prevalencia de 51,4/10 5 menores de dicha edad. Predomina la forma oligoarticular persistente siendo la rodilla la articulación más frecuentemente afectada

Introduction Juvenile idiopathic arthritis (JIA) is one of the most common chronic diseases in children. The results of several epidemiologic studies have shown surprisingly wide variety in the incidence (0.8 to 22.6 per 100000 children) and prevalence (7 to 400 per 100000) of this disease. Material and methods We performed a retrospective epidemiological study to identify all patients born after 1989 and resident in Asturias who were diagnosed with JIA using the criteria of the International League of Associations for Rheumatology (ILAR) criteria. Results Data were obtained from 60 patients (23 boys and 37 girls). The mean age of symptom onset was 5.6 years, with onset of spondyloarthropathies occurring most frequently in the oldest group. An incidence rate of 2.5/10 5 (3.5 at the present time) and a prevalence rate of 51.4/10 5 children and adolescents aged less than 16 years old were calculated. In 50 % of patients, JIA started with inflammation in one of the knees. The most frequent form of onset was persistent oligoarticular arthritis (41.7 %), followed by spondyloarthropathies (11.7 %), conditions that did not meet the criteria for any category (11.7 %), polyarticular arthritis (11.7 %), systemic disease (10 %), psoriatic arthritis (6.7 %), and extended oligoarticular arthritis (6.7 %). Chronic anterior uveitis was found in 5 patients (pauciarticular group in all 5 patients). Methotrexate was used in 25 children with good response and no relevant adverse events were observed. Only 10 % of our patients are currently in the active phase of arthritis. Conclusion An incidence rate of 3.5/10 5 and a prevalence rate of 51.4/10 5 children and adolescents aged less than 16 years old in Asturias were calculated (taking into account the possible bias of our study). The most frequent form of onset was persistent oligoarticular arthritis and the most commonly involved joints were the knees

Leiomiosarcoma de la vulva / Leiomyosarcoma of the vulva

Se presenta un caso de leiomiosarcoma de la vulva (LMS-V), tumor maligno de frecuencia excepcional; según la extensa revisión bibliográfica efectuada, el aquí recogido tendría el número 47 de los publicados. El seguimiento comprende más de 5 años y la evolución ha sido favorable. Se analizan la apariencia clínica de benignidad, los criterios histológicos para su caracterización y gradación histológicas y los tratamientos empleados, de los cuales el tratamiento quirúrgico primario con suficiente margen de seguridad parece ser el más eficaz para conseguir una evolución favorable (AU)