MICA*A4 protects against ulcerative colitis, whereas MICA*A5.1 is associated with abscess formation and age of onset.

Ulcerative colitis (UC) is one of the two major forms of inflammatory bowel disease, the aetiology of which remains unknown. Several studies have demonstrated the genetic basis of disease, identifying more than 130 susceptibility loci. The major histocompatibility complex class I chain-related gene A (MICA) is a useful candidate to be involved in UC pathogenesis, because it could be important in recognizing the integrity of the epithelial cell and its response to stress. The aim of this study was to analyse the relationship between polymorphisms in the transmembrane domain of MICA and susceptibility to develop UC. A total of 340 patients with UC and 636 healthy controls were genotyped for MICA transmembrane polymorphism using a polymerase chain reaction (PCR) combined with fluorescent technology. Different MICA alleles were determined depending on the PCR product size. The allele MICA*A4 was less frequent in patients than in controls (P = 0·003; OR = 0·643), and this protective role is higher when it forms haplotype with B*27 (P = 0·002; OR = 0·294). The haplotype HLA-B*52/MICA*A6 was also associated with UC [P = 0·001; odds ratio (OR) = 2·914]. No other alleles, genotypes or haplotypes were related with UC risk. Moreover, MICA*A5.1 is associated independently with abscesses (P = 0·002; OR = 3·096) and its frequency is lower in patients diagnosed between ages 17 and 40 years (P = 0·007; OR = 0·633), meaning an extreme age on onset. No association with location, extra-intestinal manifestations or need for surgery was found.

[Iris mammillations. Three case reports]. / Mamelones de iris. A propósito de tres casos.

CLINICAL CASES: We report the cases of 3 young patients who were seen in our hospital with the diagnosis of iris mammillations. Two of them were bilateral without familial association. The third child had iris mammillations as part of an ocular melanocytosis. None of them had abnormalities in the posterior segment or the pachymetry. DISCUSSION: The discovery of iris mammillations during an examination requires a long term follow up of these patients due to its association with uveal melanoma. This is required whether it is a casual discovery or in the presence of ocular melanocytosis.

[Sensitization to Lyral]. / Sensibilización al Lyral.

INTRODUCTION: Lyral is a fragrance that is present in many cosmetic products. It has turned into an emergent allergen during the last years. In studies carried out in other European countries, the prevalence of sensitization to Lyral has been found to be 1.9-2.7 %, but it is unknown the prevalence in Spain, as well as the need to include it or not in the standard series of the Spanish Group of Contact Dermatitis (GEIDC). METHODS: We have patch-tested to Lyral all patients with suspicion of contact dermatitis of any origin who attended our Service between April and May-2005. RESULTS: From a total of 170 patients included in our study, 2 of them had a sensitization to Lyral (1.2 %). One of these two patients had an axillae contact dermatitis caused by a deodorant containing Lyral. The other patient was a masseur-woman with a contact dermatitis on both hands, with periods of dissemination to upper extremities and trunk, and who used several cosmetics products for private reasons and during her job. CONCLUSION: Although the sample of this study is quite small, we think that the results allow to suspect that Lyral is one of the main allergens, or even the most important, in causing allergic contact dermatitis to fragrances in our environment. Therefore, we believe that we must raise the inclusion of Lyral in the standard series of GEIDC, either as independent allergen, or including it in a new mixture of fragrances.

Sensibilización al Lyral® / Sensitization to Lyral®

Introducción. El Lyral® es una fragancia presente en múltiples productos cosméticos que en los últimos años se ha convertido en un alérgeno emergente. En estudios realizados en otros países europeos se ha encontrado una prevalencia de sensibilización al Lyral® significativa (1,9-2,7 %), pero se desconoce la importancia de este alérgeno entre la población española, así como la necesidad o no de incluirlo en la batería estándar del Grupo Español de Investigación en Dermatología de Contacto (GEIDC). Métodos. Hemos estudiado mediante la prueba epicutánea la sensibilización al Lyral® en los pacientes que fueron parcheados en nuestro Servicio por sospecha de dermatitis de contacto de cualquier origen entre los meses de abril y junio de 2005. Resultados. De un total de 170 pacientes incluidos en este estudio, 2 presentaban una sensibilización al Lyral® (1,2 %). Uno de estos pacientes sufría un eczema de contacto axilar en relación con un desodorante que contenía esta fragancia. El segundo caso de sensibilización al Lyral® se trataba de una esteticista que manejaba diversos productos cosméticos, tanto en su trabajo como en su vida privada, y que presentaba un eczema de contacto en manos con periodos de diseminación a extremidades superiores y tronco. Conclusión. Si bien la muestra de nuestro estudio es pequeña, creemos que los resultados encontrados permiten sospechar que el Lyral® es una de las principales causas, si no la principal, de los eczemas de contacto alérgicos causados por fragancias en nuestro medio. Por ello, pensamos que nos debemos plantear la inclusión de este alérgeno en la batería estándar del GEIDC, bien de forma independiente, bien formando parte de una nueva mezcla de fragancias

Introduction. Lyral® is a fragrance that is present in many cosmetic products. It has turned into an emergent allergen during the last years. In studies carried out in other European countries, the prevalence of sensitization to Lyral® has been found to be 1,9-2,7 %, but it is unknown the prevalence in Spain, as well as the need to include it or not in the standard series of the Spanish Group of Contact Dermatitis (GEIDC). Methods. We have patch-tested to Lyral® all patients with suspicion of contact dermatitis of any origin who attended our Service between April and May-2005. Results. From a total of 170 patients included in our study, 2 of them had a sensitization to Lyral® (1,2 %). One of these two patients had an axillae contact dermatitis caused by a deodorant containing Lyral®. The other patient was a masseur-woman with a contact dermatitis on both hands, with periods of dissemination to upper extremities and trunk, and who used several cosmetics products for private reasons and during her job. Conclusion. Although the sample of this study is quite small, we think that the results allow to suspect that Lyral® is one of the main allergens, or even the most important, in causing allergic contact dermatitis to fragrances in our environment. Therefore, we believe that we must raise the inclusion of Lyral® in the standard series of GEIDC, either as independent allergen, or including it in a new mixture of fragrances

Eosinophilic gastroenteritis: our recent experience: one-year experience of atypical onset of an uncommon disease.

Eosinophilic gastroenteritis is an unusual entity that is rarely found in daily clinical practise. Its aetiology is unknown and diagnosis can be made microscopically with evidence of massive eosinophilic infiltration in patients with chronic gastrointestinal symptoms, excluding entities that may cause such findings (parasitic infestation, medical therapy, inflammatory bowel disease, and so on). Allergic processes are usually associated and these normally respond well to steroids. We present our last year's experience of four women with eosinophilic gastroenteritis with an extraordinary atypical clinical onset. Two of the women presented with an acute abdomen and two with isolated colonic involvement. The management of acute abdomen avoiding surgery and a complete response with azathioprine are the outstanding variables that make our recent cases of special interest. Demographic variables were similar to others reported from our medium, with the exception of a higher incidence of women. Our cases suggest the wide spectrum of clinical presentations and show the high suspicion index needed for a diagnosis that is made by pathologists.

[The treatment of incipient diabetic nephropathy (2nd of 2 parts)]. / Consideraciones sobre el tratamiento de la nefropatía diabética incipiente (segunda de dos partes).

Besides diabetic patients are controlled with glycosylated hemoglobins not exceeding 7% and the normalization of blood pressure with some hypotensive drugs, it has been noted the important role of protein restriction in diet in order to retard nephropathy progression. For some years, various aldose reductase inhibitors (ARIs) have been used, which avoid the accumulation of sorbitol in tissues as well as complications. Platelet antiaggregants are also used for the treatment of diabetic nephropathy, but at a lower level.

[Considerations on the treatment of incipient diabetic nephropathy (lst of 2 parts)]. / Consideraciones sobre tratamiento de la nefropatía diabética incipiente (Primera de dos partes).

Diabetic nephropathy is the third cause of renal failure after pyelonephritis and glomerulonephritis. Lately, many efforts have been made for the early identification (on the silent stage) of patients with a high risk of developing this disease. On these initial stages, therapeutic attitude has changed very much, emphasizing nowadays the importance of glucose levels control, avoiding maintained conditions of hyperglycemia and maintaining blood pressure within the limits, by using the therapeutic store available, basically calcium antagonists and angiotensin-converting enzyme inhibitors.