Experimental model for reproduction of canine visceral leishmaniosis by Leishmania infantum.

In this report an experimental model of Leishmania infantum (L. infantum) infection in dogs is described. The data presented are derived from an overall and comparative analysis of the clinical outcomes of three groups of dogs intravenously infected with 500,000 promastigotes on different dates (2003, 2006 and 2008). The parasites used for challenge were isolated from a dog having a patent form of leishmaniosis, classified as MCAN/ES/1996/BCN150 zymodeme MON-1. Late-log-phase promastigote forms derived from cultured amastigotes obtained from the spleen of the heavily infected hamsters were used for infection. Only one single infective dose was administered to each dog. After challenge, the animals were monitored for 12 months. To analyze the disease outcome, several biopathological, immunological and parasitological end-points were considered. The analysis of the infected dogs indicated that the development of the clinical disease was very similar in the three experimental challenges, as shown by the immune response, the parasite load and the clinical and histopathological lesions detected at necropsy. A high similarity was also observed between the disease development after the experimental challenge and the one reported to occur in endemic natural infection areas, as various degrees of susceptibility to the disease and even resistance were observed in the experimentally infected animals. We believe that this challenge model faithfully reproduces and mimics the course of a natural infection and that it could be used as a suitable tool for analyzing the efficacy of anti-Leishmania drugs and vaccines.

The chimerical multi-component Q protein from Leishmania in the absence of adjuvant protects dogs against an experimental Leishmania infantum infection.

The protective potential against Leishmania infection of the Leishmania chimerical Q protein administered as a single (Q) or double dose (Q+Q) without adjuvant was analyzed in a double-blind placebo controlled experiment in dogs. During vaccination the protein induced an intense early anti-Q response but no reactivity against total Leishmania infantum proteins was detected. Several end-points were taken into consideration. In the vaccinated animals the amount and intensity of clinical symptoms was lower than in the control group. Pathological signs of disease were observed in liver, kidney and spleen of all dogs from the control group in contrast to the normal appearance of the organs of the vaccinated animals. Vaccination was able to induce parasite clearance in most dogs. Only 1/7 dog was parasite DNA positive in skin in the Q group in contrast to 6/7 dogs in control and 4/7 in Q+Q. Significant anti-SLA clearance was observed in the vaccinated animals at the end of the study. Differences between control and vaccinated animals were also observed at the biochemical level, DTH and nitrite oxide production.

[Gender bias in women with myocardial infarction: ten years after]. / Desigualdad de esfuerzo terapéutico en mujeres con infarto agudo de miocardio: 10 años después.

OBJECTIVE: Previous studies show that the women with acute myocardial infarction (AMI) receive less fibrinolitic treatment than the men. The objective of this study is to analyze if it exists any difference in fibrinolysis related to gender and to compare the results with those obtained 10 years ago. DESIGN: Retrospective descriptive study that compare patients with AMI of less than 24 hours of evolution of studies Analysis of Delay in Acute Infarct of Myocardium (ARIAM) in 2003-2004 and Project of Analysis Epidemiologist of Critical Patient (PAEEC) of 1992-1993. SETTING: ICUs from 86 hospitals in Spain that participated in the PAEEC study and 120 ICUs in the ARIAM. PATIENTS: We compared data of 9,981 patients including in study ARIAM in 2003-2004 with 1,668 of the PAEEC of 1992-1993. RESULTS: Women were less likely to receive thrombolytic therapy than men (odds ratio= 0.82, p < 0.01), after adjusting for age, origin, size of the hospital and antecedents. The probability of fibrynolisis is lower in elderly, patients referred from the general ward, in hospitals of more than 1,000 beds and patients with arterial hypertension, stroke, diabetes or peripheral vascular disease. The probability of fibrinólisis is higher when patient is transferred from another hospital (followed by those of Emergencies Room), in the hospitals by less than 300 beds (followed by those of 300-1,000) and when history of prior ischemic heart disease exists. Comparing the two periods, has increased the frequency of fibrynolisis in both genders, although the increment has been greater in the women. CONCLUSIONS: The women with AMI continue receiving less fibrynolisis, although exists an increase in the number of treatments superior to register in the men.

Descripción de los aspectos generales del manejo del síndrome coronario agudo en España durante el año 2002 / Description of general aspects of the management of acute coronary syndrome in Spain during the year 2002

Objetivo. Describir los aspectos más relevantes en el manejo inicial del paciente con síndrome coronario agudo (SCA) durante el año 2002. Diseño y ámbito. Estudio observacional prospectivo. Participaron 84 hospitales. Pacientes, variables y resultados. Se han seleccionado los 12.743 casos incluidos en el registro ARIAM desde el 1 de enero al 31 de diciembre de 2002. Las variables analizadas se agrupan en 4 apartados: características generales, diagnóstico de infarto agudo de miocardio (IAM), atención prehospitalaria y tratamiento fibrinolítico. Ingresaron 6.879 pacientes con diagnóstico de IAM, incrementándose este diagnóstico en un 16,8% al alta. La mortalidad en Unidad de Cuidados Intensivos (UCI) para los pacientes con IAM ha sido del 8,4%. Cinco mil trescientos sesenta y ocho (47%) casos llegaron al hospital a través del sistema sanitario prehospitalario con una mediana de retraso desde el inicio de los síntomas de 155 minutos. El 59% de los IAM ST elevado recibieron tratamiento fibrinolítico. El 6,7% de las fibrinolisis se realizaron en la primera hora y el 31,1% en las dos primeras horas. De los pacientes con menos de tres criterios de reperfusión sólo se realizó angioplastia de rescate en 144 casos (7%). Conclusiones. El descenso de mortalidad del IAM respecto a años previos puede estar en relación con la aplicación de los nuevos criterios diagnósticos. La atención prehospitalaria comporta mayor retraso a su llegada al hospital pero aporta un acceso más precoz acceso a las medidas básicas de atención. Los porcentajes de fibrinolisis en las dos primeras horas y de angioplastias de rescate son bajos respecto a otras series

Objective. A description of the most relevant aspects in the initial management of the patient with acute coronary syndrome (ACS) during the year 2002. Design and scope. Prospective observational study. Eighty-four participating hospitals. Patients, variables and results. The 12,743 cases included in the ARIAM registry from January 1 to December 31, 2002 were selected. The variables analyzed have been grouped into 4 sections: general characteristics, acute myocardial infarction (AMI) diagnosis, prehospital care and fibrinolytic treatment. A total of 6,879 patients were admitted with the diagnosis of AMI, this diagnosis increasing by 16.8% on discharge. Mortality in the Intensive Care Unit (ICU) for patients with AMI was 8.4%. The number of cases that reached the hospital through the prehospital health care system was 5,368 (47%) with a median delay from onset of the symptoms of 155 minutes. A 59% of the elevated ST AMI received fibrinolytic treatment. A 6.7% of the fibrinolysis were performed in the first hour and 31.1% in the first 2 hours. Rescue angioplasty was only done in 144 cases (7%) of the patients with less than three reperfusion criteria. Conclusions. Decrease in AMI mortality regarding previous years may be related with the application of new diagnostic criteria. Prehospital care entails greater delay of arrival to the hospital but supplies earlier access to the basic care measures. The percentage of fibrinolysis in the first 2 hours and rescue angioplasties are low regarding other series

Variabilidad en el manejo del infarto agudo de miocardio en el registro ARIAM en el año 2002 / Variability in the management of acute myocardial infarction in the ARIAM registry in the year 2002

Objetivo. Analizar las diferencias en el manejo del infarto agudo de miocardio (IAM) entre las distintas comunidades autónomas de los hospitales participantes en el registro ARIAM durante el año 2002. Diseño. Registro multicéntrico nacional de base hospitalaria de pacientes ingresados en Unidades de Cuidados Intensivos Cardiológicos (UCIC) por sospecha de síndrome coronario agudo. Ámbito. UCIC de 80 hospitales españoles de 14 comunidades autónomas. Pacientes o participantes. Se incluyen todos los pacientes del registro ARIAM del año 2002 cuyo motivo de ingreso hospitalario es IAM de menos de 24 horas de evolución. Intervenciones. Ninguna Variables de interés principales. Se registraron variables demográficas, antecedentes, clínicas, retrasos y lugar de actuación inicial, uso de técnicas diagnósticas y terapéuticas, tiempos de estancia y morbimortalidad. Se agruparon los casos por áreas geográficas que corresponden a las diferentes comunidades autónomas de España. Se analizaron las diferencias mediante el uso del coeficiente de variación (CV). Resultados. Se incluyeron 6.820 pacientes. Las características basales fueron similares, salvo para la presencia de diabetes como factor de riesgo (CV: 21%). Los CV excesivos correspondieron al modo de acceso al sistema sanitario (061: 29%), lugar de realización de la fibrinolisis (extrahospitalaria: 155%, urgencias: 120%), tipo de fibrinolítico (rTPA: 78%), retrasos intrahospitalarios (puerta-aguja: 24% y puerta-balón: 39%), uso de angioplastia coronaria transluminal percutánea (ACTP) primaria (122%), realización de coronariografía (75%) y tratamiento con anti-IIb/IIIa (34%). La mortalidad en UCIC global fue del 8,0%, con un CV de 16%. Conclusiones. Existen diferencias en el manejo del IAM entre las distintas comunidades autónomas estudiadas, especialmente en lo concerniente a la atención prehospitalaria y el uso de las técnicas de revascularización. Sin embargo, en la población estudiada, no se traducen en diferencias significativas respecto al resultado a corto plazo

Objective. Analyze the differences in the management of acute myocardial infarction (AMI) between the different regional communities of the hospitals participating in the ARIAM registry during the year 2002. Design. Hospital based multicenter, national registry of patients admitted to cardiology intensive care units (CICU) due to suspicion of acute coronary syndrome. Scope. CICU of 80 Spanish hospitals in 14 regional communities. Patients or participants. All the patients from the ARIAM registry in the 2002 whose cause of hospitalization is AMI of less than 24 hours evolution are included. Interventions. None. Variables of principal interest. Demographic variable, background, symptoms, delays and site of initial action, use of diagnostic and therapeutic techniques, stay time and morbidity-mortality were recorded. The cases were grouped by geographic areas that correspond to the different regional communities of Spain. Differences were analyzed with the variation coefficient (VC).Results. A total of 6,820 patients were included. Basal characteristics were similar, except for the presence of diabetes as risk factor (VC: 21%). Excessive variation coefficients corresponded to way of access to health care system (061: 29%), site fibrinolysis was done (community: 155%, emergency service: 120%), fibrinolytic type (rTPA: 78%), interhospital delays (door-to-needle: 24% and door-to-balloon: 39%), use of primary percutaneous transluminal coronary angioplasty (PTCA) (122%), conduction of coronariography (75%) and treatment with anti-IIb/IIIa (34%). Global mortality in the CICU was 8.0%, with a 16% VC. Conclusions. There are differences in the management of AMI between the different regional communities studied, especially in that regarding prehospital care and the use of revascularization techniques. However, no significant differences are found in the study population regarding short term result

La gastrostomía endoscópica percutánea. Realidad en la práctica nutricional clínica intra y extrahospitalaria / Percutaneous endoscopic gastrostomy. Reality in the intra- and extra-community clinical nutritional practice

Objetivo. El objetivo de este trabajo ha sido revisar nuestra experiencia durante 8 años de la utilización de la gastrostomía endoscópica percutánea (GEP) y su aplicación en nutrición enteral domiciliaria (NED). Material y métodos. Estudiamos 207 pacientes (56 mujeres y 151 hombres) a los que se le ha realizado GEP desde 1994 al 2002 inclusive, al requerir nutrición enteral de forma prolongada (> 4 semanas). En aquellos casos en los que se programó NED los pacientes/familiares fueron adiestrados en las técnicas y cuidados de la GEP y de la NE, y el control se hizo a través de la consulta externa de Nutrición. Resultados. El tiempo medio de duración de la GEP fue de 640 días y 175 pacientes (84,6%) necesitaron la GEP más de 60 días, mientras que 135 la requirieron más de 6 meses. El aporte calórico medio fue de 1.730 ± 288 Kcal/día; el modo de administración fue mediante infusión intermitente por gravedad en 162 casos y por infusión continua a través de bomba volumétrica en 45 pacientes. En dos pacientes con hiperémesis gravídica se realizó gastroyeyunostomía endoscópica percutánea (GYEP) en el tercer y cuarto mes de embarazo, terminándose con éxito la gestación mediante parto por vía vaginal. La realización de la GEP facilitó el alta hospitalaria y la programación de la NED en 195 pacientes (94%). Las complicaciones más frecuentes fueron la infección de la gastrostomía, que ocurrió en 41 pacientes, y la aparición de granuloma en la ostomía en 34 casos. Sólo hubo un paciente que falleció en relación directa con una peritonitis tras la GEP. Conclusión. De nuestro trabajo se infieren las ventajas de la GEP como técnica de nutrición enteral, permitiendo la instauración de un programa de NED con escasa incidencia de complicaciones y muy baja mortalidad

Background. This study aimed to review our experience during 8 years in the use of percutaneous endoscopic gastrostomy (PEG) and its application in home enteral nutrition (HEN). Material. We studied 207 patients (56 women and 151 men) who had undergone a PEG from the beginning of 1994 to the end of 2002 as they needed prolonged enteral nutrition (> 4 weeks). In those cases in which home enteral nutrition was programmed, the patients/relatives were trained in the techniques and care of the PEG and EN, and the control was done through the nutrition out-patient clinic. Results. Mean duration time of the PEG was 640 days and 175 patients (84.6%) needed PEG for more than 60 days and 135 for more than 6 months. Mean calorie supply was 1,730 ± 288 Kcal/day. Administration mode was by intermittent infusion due to seriousness in 162 cases and continuous infusion through volemetric pump in 45 patients. In 2 patients with hyperemesis gravidarum, percutaneous endoscopic gastrojejunostomy (PEGJ) was done in the 3rd and 4th month of pregnancy, the pregnancy finishing successfully by vaginal delivery. Performance of PEG facilitated hospital discharge and programming of home enteral nutrition in 195 patients (94%). The most frequent complications were gastrostomy infection that occurred in 41 patients and the appearance of granuloma in the ostomy in 34 cases. Only one patient died in direct relationship due to peritonitis after PEG. Conclusion. Our study includes the advantages of PEG as an enteral nutrition technique, permitting the establishment of a home enteral nutrition program with limited incidence of complications and very low mortalityBackground. This study aimed to review our experience during 8 years in the use of percutaneous endoscopic gastrostomy (PEG) and its application in home enteral nutrition (HEN). Material. We studied 207 patients (56 women and 151 men) who had undergone a PEG from the beginning of 1994 to the end of 2002 as they needed prolonged enteral nutrition (> 4 weeks). In those cases in which home enteral nutrition was programmed, the patients/relatives were trained in the techniques and care of the PEG and EN, and the control was done through the nutrition out-patient clinic. Results. Mean duration time of the PEG was 640 days and 175 patients (84.6%) needed PEG for more than 60 days and 135 for more than 6 months. Mean calorie supply was 1,730 ± 288 Kcal/day. Administration mode was by intermittent infusion due to seriousness in 162 cases and continuous infusion through volemetric pump in 45 patients. In 2 patients with hyperemesis gravidarum, percutaneous endoscopic gastrojejunostomy (PEGJ) was done in the 3rd and 4th month of pregnancy, the pregnancy finishing successfully by vaginal delivery. Performance of PEG facilitated hospital discharge and programming of home enteral nutrition in 195 patients (94%). The most frequent complications were gastrostomy infection that occurred in 41 patients and the appearance of granuloma in the ostomy in 34 cases. Only one patient died in direct relationship due to peritonitis after PEG. Conclusion. Our study includes the advantages of PEG as an enteral nutrition technique, permitting the establishment of a home enteral nutrition program with limited incidence of complications and very low mortalityBackground. This study aimed to review our experience during 8 years in the use of percutaneous endoscopic gastrostomy (PEG) and its application in home enteral nutrition (HEN). Material. We studied 207 patients (56 women and 151 men) who had undergone a PEG from the beginning of 1994 to the end of 2002 as they needed prolonged enteral nutrition (> 4 weeks). In those cases in which home enteral nutrition was programmed, the patients/relatives were trained in the techniques and care of the PEG and EN, and the control was done through the nutrition out-patient clinic. Results. Mean duration time of the PEG was 640 days and 175 patients (84.6%) needed PEG for more than 60 days and 135 for more than 6 months. Mean calorie supply was 1,730 ± 288 Kcal/day. Administration mode was by intermittent infusion due to seriousness in 162 cases and continuous infusion through volemetric pump in 45 patients. In 2 patients with hyperemesis gravidarum, percutaneous endoscopic gastrojejunostomy (PEGJ) was done in the 3rd and 4th month of pregnancy, the pregnancy finishing successfully by vaginal delivery. Performance of PEG facilitated hospital discharge and programming of home enteral nutrition in 195 patients (94%). The most frequent complications were gastrostomy infection that occurred in 41 patients and the appearance of granuloma in the ostomy in 34 cases. Only one patient died in direct relationship due to peritonitis after PEG. Conclusion. Our study includes the advantages of PEG as an enteral nutrition technique, permitting the establishment of a home enteral nutrition program with limited incidence of complications and very low mortality

Aplasia medular inducida por antitiroideos de síntesis / Aplastic anemia induced by antithyroid drugs

No disponible

[Home enteral nutrition. Annual report 1999. NADYA-SENPE Group]. / Nutrición enteral domiciliaria. Informe anual 1999. Grupo NADYA-SENPE.

GOAL: During 1999, as in previous years, the NADYA-SENPE Group has maintained an annual register of patients with Artificial Nutrition at Home in order to keep up to date our available knowledge of this therapy. The present paper analyzes the results of the sixth National Register of patients under treatment with Enteral Nutrition at Home corresponding to 1999, produced with the co-operation of twenty-three centres in the Spanish national health network. MATERIAL AND METHODS: The data were collected through a closed questionnaire included on our web site (www.nadya-senpe.com). Apart from epidemiological information, the form includes the indication that led to the prescription of nutrition, nutritional treatment, access path, complications and admissions to hospital, follow-up of the treatment, patients' quality of life and progress. All of the data are processed by the co-ordinating team. The Nutrition Unit at La Paz Teaching Hospital in Madrid has acted as the group co-ordinator. RESULTS: During 1999, a total of 2,262 patients at the twenty-three collaborating centres followed treatment with Home Enteral Nutrition (NED in its Spanish acronym). The mean age was 63.6 (19.67 years (males: 57.6%; females: 42.3%). The mean time with nutritional treatment is 5.89 (4.25 months. The neurological alterations (37.5%) and neoplasias (36.8%) were the most frequent indications for NED. Most patients used oral administration (50.7%), the use of artificial routes is less frequent, with 5NG being used on 27.9% and PEG on 12.7%. The polymeric formulas are the ones most commonly used (87.7%). The number of complications recorded amounted to 1,403 episodes, representing 0.62 complications per patient per year, of which 40.8% were gastro-intestinal (0.26 complications per patient per year) and 18.7% were mechanical complications, with only 9 recorded cases of bronchoaspiration. It was necessary to admit patients to hospital on 836 occasions (0.38 admissions per patient), albeit generally for causes not associated with nutrition (86.1%). At year-end, 51.4% of patients continued to receive nutritional support. CONCLUSIONS: Enteral nutrition at home is a safe technique whose use is growing in Spain. It requires the existence of appropriately equipped nutrition teams as well as the collaboration of the Primary Health Care services and the suitable training of patients and relatives. It is essential to progress more deeply into the development and application of clinical routes that provide a clear and concise methodology covering all nutrition-related aspects. In itself, nutrition is a therapeutic alternative regardless of whether access is obtained through a natural or an artificial route. It is necessary for the persons responsible for health-care administration to realize that the appropriate nutrition of patients leads to an improvement in their general health, a shorter course for their illness and, therefore, a reduction in costs.

Nutrición enteral domiciliaria. informe anual 1999. Grupo NADYA-SENPE / Enteral nutrition at home. annual report 1999. NADYA-SENPE group

Objetivo: Durante 1999, como en años anteriores, el Grupo NADYA-SENPE ha realizado el registro anual de pacientes con Nutrición Artificial Domiciliaria, con el objetivo de mantener actualizados los conocimientos que sobre esta terapéutica tenemos. En el presente trabajo analizamos los resultados del sexto Registro Nacional de pacientes en tratamiento con Nutrición Enteral Domiciliaria correspondiente al año 1999, en el que han colaborado veintitrés centros de la red sanitaria nacional.Material y Métodos: La información se ha recogido en un cuestionario cerrado incluido en nuestra pagina web (www.nadya-senpe.com). El formulario incluye, además de los datos epidemiológicos, la indicación que motivó la nutrición, tratamiento nutricional, vía de acceso, complicaciones y hospitalizaciones, seguimiento del tratamiento, calidad de vida y evolución de los pacientes. La información total es procesada por el equipo coordinador. La Unidad de Nutrición del Hospital Universitario La Paz de Madrid, ha actuado como coordinador del grupo.Resultados: Durante el año 1999 han seguido tratamiento con Nutrición Enteral Domiciliaria (NED) 2262 pacientes en los veintitrés centros colaboradores. La edad media ha sido de 63,6 ñ 19,67 (H: 57,6 por ciento; M: 42,3 por ciento). El tiempo medio con tratamiento nutricional es de 5,89 ñ 4,25 meses. Las alteraciones neurológicas (37,5 por ciento) y las neoplasias (36,8 por ciento) han sido las indicaciones de NED más frecuentes. La mayoría de los pacientes utilizan la vía oral (50,7 por ciento), la utilización de vías artificiales es menos frecuente, la SNG es utilizada en el 27,9 por ciento y la PEG en un 12,7 por ciento. Las formulas polimericas son las mas empleadas (87,7 por ciento). Se contabilizaron 1403 episodios de complicaciones, lo que representa 0,62 complicac./paciente/año, el 40,8 por ciento gastrointestinales (0,26 complicaciones/paciente/año), el 18,7 por ciento complicaciones mecánicas, solo se contabilizaron 9 casos de broncoaspiración. En 836 ocasiones (0,38 hospitaliz./paciente) fue necesario hospitalizar al paciente, aunque debido generalmente a causas no asociadas con la nutrición (86,1 por ciento).Al finalizar el año el 51,4 por ciento de los pacientes continuaban con el soporte nutricional Conclusiones: La nutrición enteral domiciliaria es una técnica segura en pleno desarrollo en nuestro país.Requiere la existencia de equipos de nutrición adecuadamente dotados así como la colaboración de los servicios de atención primaria y la adecuada formación de familiares y pacientes. Es indispensable profundizar en el desarrollo y aplicación de vías clínicas que contemplen una metodología clara y concisa que abarque todos los aspectos relativos a la nutrición. La nutrición es, en si misma, una alternativa terapéutica independientemente de si el acceso se realiza por una vía natural o artificial. Es necesario que los responsables administrativos se den cuenta de que una nutrición adecuada de los pacientes redunda en una mejoría de su estado general, un tiempo de evolución mas corto y, por lo tanto, en una disminución de los costes (AU)

Goal: During 1999, as in previous years, the NADYA-SENPE Group has maintained an annual register of patients with Artificial Nutrition at Home in order to keep up to date our available knowledge of this therapy. The present paper analyzes the results of the sixth National Register of patients under treatment with Enteral Nutrition at Home corresponding to 1999, produced with the co-operation of twenty-three centres in the Spanish national health network. Material and Methods: The data were collected through a closed questionnaire included on our web site (www.nadya-senpe.com). Apart from epidemiological information, the form includes the indication that led to the prescription of nutrition, nutritional treatment, access path, complications and admissions to hospital, follow-up of the treatment, patients’ quality of life and progress. All of the data are processed by the coordinating team. The Nutrition Unit at La Paz Teaching Hospital in Madrid has acted as the group co-ordinator. Results: During 1999, a total of 2,262 patients at the twenty-three collaborating centres followed treatment with Home Enteral Nutrition (NED in its Spanish acronym). The mean age was 63.6 ( 19.67 years (males: 57.6%; females: 42.3%). The mean time with nutritional treatment is 5.89 ( 4.25 months. The neurological alterations (37.5%) and neoplasias (36.8%) were the most frequent indications for NED. Most patients used oral administration (50.7%), the use of artificial routes is less frequent, with 5NG being used on 27.9% and PEG on 12.7%. The polymeric formulas are the ones most commonly used (87.7%). The number of complications recorded amounted to 1,403 episodes, representing 0.62 complications per patient per year, of which 40.8% were gastro-intestinal (0.26 complications per patient per year) and 18.7% were mechanical complications, with only 9 recorded cases of bronchoaspiration. It was necessary to admit patients to hospital on 836 occasions (0.38 admissions per patient), albeit generally for causes not associated with nutrition (86.1%). At year-end, 51.4% of patients continued to receive nutritional support Conclusions: Enteral nutrition at home is a safe technique whose use is growing in Spain. It requires the existence of appropriately equipped nutrition teams as well as the collaboration of the Primary Health Care services and the suitable training of patients and relatives. It is essential to progress more deeply into the development and application of clinical routes that provide a clear and concise methodology covering all nutrition-related aspects. In itself, nutrition is a therapeutic alternative regardless of whether access is obtained through a natural or an artificial route. It is necessary for the persons responsible for health-care administration to realize that the appropriate nutrition of patients leads to an improvement in their general health, a shorter course for their illness and, therefore, a reduction in costs (AU)

[Treatment of stenosis in uretero-intestinal anastomosis]. / Tratamiento de las estenosis en las anastomosis uretero-intestinales.

UNLABELLED: We report our experience in the treatment of uretero-enteric anastomotic strictures. Our incidence in this complication is 3.8% in orthotopic bladder substitution and 8.3% in ileal conduict. MATERIAL AND METHODS: We have treated this complication in 6 patients with orthotopic bladder substitution and 4 with ileal conduict. We tried to perform a dilatation with a high pressure balloon and to place a Double-J catheter. RESULTS: In 4 cases we could not introduce the guidewire through the stricture because there was a total stop. In the others 6 cases, one is doing well without Double-J, another one did not tolerate the catheter and we performed an open surgical reanastomosis, 2 kept the catheters until their death due to metastases and the other two continue alive with their catheter periodically replaced. CONCLUSIONS: The direct uretero-enteric anastomoses present less stenoses risk. Endourological techniques should be the first option in treatment of these patients.

Tratamiento de las estenosis en las anastomosis uretero-intestinales / Treatment of uretero-enteric anastomotic strictures

Presentamos nuestra experiencia en el tratamiento de las estenosis en las anastomosis uretero-intestinales. Nuestra incidencia en esta complicación en las sustituciones vesicales ortotópicas es del 3,8 por ciento, y en las ileostomías cutáneas del 8,3 por ciento. MATERIAL Y MÉTODOS: Hemos tratado esta complicación a 6 pacientes con plastia de sustitución vesical ortotópica y 4 con ileostomía cutánea. Intentamos realizar una dilatación de la estenosis con balón de alta presión y dejar una sonda doble J. RESULTADOS: En 4 casos no logramos cateterizar la estenosis por existir un stop completo. De los otros 6 pacientes uno está bien sin doble J, otro no toleró la sonda y tuvimos que realizar una reanastomosis abierta, 2 mantuvieron la sonda hasta su fallecimiento por metástasis y otros 2 viven actualmente con sonda y cambios periódicos. CONCLUSIONES: Las anastomosis directas del uréter en el intestino tienen menos riesgo de estenosis. Las técnicas endourológicas deben ser la primera opción en el tratamiento de estos pacientes (AU)

[Optimization of the conditions for RAPD-PCR of Candida spp. and Cryptococcus spp]. / Optimización de las condiciones RAPD-PCR en Candida spp. y Cryptococcus spp.

In this study, we determined the optimal RAPD amplification conditions to obtain genetic molecular markers for the rapid and accurate identification of Cryptococcus spp. and Candida spp. The following parameters are modified: template DNA, DNA polymerase, magnesium cloride and primer concentration; denaturation, annealing and extension time, temperature of annealing and thermal cycles. After the optimization, reliable and reproducible RAPD patterns are obtained.

[Penile incarceration with metal rings]. / Incarceración peneana por anillos metálicos.

Contribution of a case report of penial incarceration following placement of three thick metal rings and its resolution. Literature review.

[Orthotopic substitutive cystoplasty in women. Technical modifications in anterior exenteration: results in 9 cases]. / Plastia de sustitución vesical ortotópica en la mujer. Modificaciones técnicas en la exenteración anterior: resultado en 9 casos.

OBJECTIVE: The results obtained in 9 female patients who underwent bladder substitution after a modified anterior pelvic exenteration are presented. METHODS: From 1994 to 1999, 9 women underwent bladder substitution after a modified anterior pelvic exenteration that preserved the two distal thirds of the urethra, the pubourethral ligaments and endo-pelvic fascia and limited laterovaginal dissection to preserve the innervation of the striated sphincter for continence. RESULTS: The bladder capacity was 332.9 +/- 35.6 ml and urinary flow was 17.7 +/- 2.9 ml/sec. Seven patients are completely continent and two patients have stress incontinence grade II. None of the patients had difficulty with bladder emptying. Fistula (one case) and diarrhea (one case) were the most important complications. CONCLUSIONS: Our approach is based on a better understanding of the anatomical mechanisms of female continence and the viability of the remaining urethra from the oncologic perspective. This technique achieves a high level of patient satisfaction and quality of life.

Incarceración peneana por anillos metálicos / Penial incarceration by metal rings

Presentamos un caso de incarceración peneana, tras la colocación de tres gruesos anillos metálicos y su resolución, así como una revisión de la literatura (AU)

Genetic variability in the Iberian imperial eagle (Aquila adalberti) demonstrated by RAPD analysis.

RAPD analysis was used to estimate the genetic diversity in an Iberian imperial eagle (Aquila adalberti) population, one of the most threatened bird species in the world. Forty-five of 60 arbitrarily designed primers amplified 614 loci in 25 individual eagles, 59.7% of which were polymorphic. In contrast to the traditional allozyme analysis performed in a previous study, the RAPD method has revealed a high level of heterozygosity in this species (H = 0.267+/-0.008). The genetic distances estimated between 25 eagles can serve to establish more adequate mating in order to preserve genetic variability. Conservation efforts being carried out in Spain in this species might be successful based on the results obtained in the present work.

[Laparoscopic approach of Dielt's syndrome]. / Tratamiento laparoscópico del síndrome de Dielt.

Dielt's syndrome is generally known as nephritic colic due to the dilation of the urinary tract that results from a renal ptosis. In spite of renal ptosis being a commonly seen occurrence, sometimes it can be the cause of a serious painful clinical manifestation. This paper presents one case successfully treated through laparoscopic nephropexy. It also includes a discussion on the various diagnostic and therapeutical techniques.

[Tuberculosis and renal cancer]. / Tuberculosis y cáncer renal.

The association of tuberculosis and renal adenocarcinoma is very uncommon. In general, the condition presents clinically, radiologically and biologically, as a tuberculosis while the diagnosis of renal carcinoma came as a pathoanatomical finding following nephrectomy. We contribute one case report of tuberculosis and renal adenocarcinoma in association that initially presented with tumoral signs and symptoms in a 34-year-old female patient. The patient, with no previous background, was later diagnosed TBC. A review is made on the pathogenesis, epidemiology and pathoanatomical diagnosis of tuberculosis. It is hypothesized that the tuberculosis damage may be a reactivation secondary to a renal tumour.

[Primary abscess of the psoas. Report of a case]. / Absceso primario de psoas. A propósito de un caso.

Psoas abscess is an uncommon condition at the present time. The initial anodyne signs and symptoms make diagnosis difficult. It can be diagnosed and rated as primary when the origin is not found, or secondary when a focus for infection spreading is detected. Drainage either percutaneously or by open surgery, and antibiotic therapy are the choice treatment, achieving an important survival rate. This paper presents a new case of psoas abscess, including a revision of the diagnosis and treatment of this condition.

Rapid and easy method to extract and preserve DNA from Cryptococcus neoformans and other pathogenic yeasts.

The mucopolysaccharide capsule of Cryptococcus neoformans and other pathogenic yeasts prevent the extraction of DNA from these important zoonotic agents. We report that the use of a lysis buffer containing a high concentration of urea is an easy, efficient and time-saving technique to obtain high yields of good-quality DNA for molecular diagnosis. The use of urea also prevents the degradation of DNA during storage of samples at room temperature for up to 6 months.