Enfermedad de Behcet: un reto diagnóstico en reumatología. Descripción de una serie de casos y revisión de la literatura / Behcet's disease: a diagnostic challenge in rheumatology. Description of a case series and a review of the literature

RESUMEN La enfermedad de Behcet es una entidad clínica autoinflamatoria, de etiología desconocida, generalmente con compromiso sistémico, con un patrón de exacerbación y remisión frecuente que se asocia a retraso en el diagnóstico. El diagnóstico de esta enfermedad es complejo, por esta razón presentamos 4 casos de pacientes con enfermedad de Behcet, que durante el abordaje clínico fueron consideradas otras enfermedades de naturaleza autoinmune. La revisión integrada de la historia clínica, la aparición de úlceras orales y genitales, así como el estudio de tipificación del complejo mayor de histocompatibilidad (HLA) permitieron diagnosticar la enfermedad de Behcet.

ABSTRACT Behcet disease is a rare autoinflammatory disorder of unknown aetiology and is characterised by systemic manifestations with an exacerbation-remission pattern, often associated with diagnostic delay. The diagnostic approach to this disease is complex. A report is given on four cases of patients fulfilling the diagnostic criteria for Behcet disease. Other autoimmune rheumatic diseases were considered in the clinical approach. A meticulous clinical evaluation, taking into consideration relapsing aphthous ulcers in oral mucosa and genitalia, and HLA typing allowed a proper diagnosis of Behcet disease to be made.

Gastrointestinal Symptoms and Elevated Levels of Anti-Saccharomyces cerevisiae Antibodies Are Associated with Higher Disease Activity in Colombian Patients with Spondyloarthritis.

BACKGROUND: Spondyloarthritis (SpA) is a group of articular inflammatory rheumatic diseases that their gastrointestinal manifestations are around 10% of their extra-articular symptoms, supporting that the inflammatory response of the intestinal mucosa could be associated with the clinical status. OBJECTIVES: To investigate the association between gastrointestinal symptoms and autoantibodies and disease activity between SpA patients, healthy subjects (HS), and patients with inflammatory bowel disease (IBD). METHODS: 102 SpA patients, 29 IBD patients, and 117 HS were included. Autoantibodies as ASCA, ANCA, anti-tTG, anti-DGP, ANA, and IgA were measured. The patients were assessed to evaluate clinical and gastrointestinal symptoms. An association analysis was performed using Chi square test and a logistic regression. RESULTS: Significant differences were found for ASCA levels in SpA (28.2%) compared to IBD (14.2%) and HS (6.0%) (p = 0.029), as well as for ANAS in SpA (49.5%) and IBD (37.9%) (p < 0.001) and abdominal pain (p = 0.012) between SpA (54.3%) and IBD (27.5%). Significant associations were found between BASDAI > 4 and gastrointestinal symptoms (p < 0.05) and IgA (p = 0.007). The association for abdominal bloating was maintained (OR: 3.93, CI-95%, 1.14-13.56; p = 0.030). CONCLUSIONS: Gastrointestinal symptoms, ASCA, ANAS, and IgA levels were associated with high disease activity in SpA compared with IBD and HS.

Comparative study of open abdomen treatment: ABThera™ vs. abdominal dressing™.

INTRODUCTION: Negative pressure therapy (NPT) is a widely recognised procedure for the temporary closure of open abdominal wounds. In this study, we compare two NPT products, the V.A.C.® abdominal dressing (AD) system and the new ABThera™ (ABT) system, in terms of the primary closure rates achieved, types of closure, and the associated morbidity. METHODS: We employed a retrospective comparative study of open-abdomen patients treated with NPT using either AD or ABT. The indications for treatment were damage control surgery, abdominal compartment syndrome, or severe abdominal sepsis. RESULTS: The group of patients treated with ABT showed a higher percentage of primary closures (41 vs. 11%) and required fewer days of NPT (17 vs. 26 days) than the AD group. Differences were statistically significant. In addition, only 4% of patients in the ABT group exhibited enteroatmospheric fistulae, compared to 17% in the AD group. CONCLUSIONS: Compared to the AD system, ABT can achieve faster primary closure after open abdomen treatment with only minor complications.

Giant dedifferentiated retroperitoneal liposarcoma.

Liposarcoma tumors only represent 0.1% of all cancers, but they are the more common of retroperitoneal sarcomas. It has a great tendency for local recurrence, mainly the dedifferentiated variety, but its complete resection can provide a 5-year survival of 70%. In this report, we present a case of a giant dedifferentiated retroperitoneal liposarcoma that did not affect any neighboring organ and that was successfully treated by means of complete surgical resection.

Estudio de los valores del factor de necrosis tumoral alfa tisular pancreático en la pancreatitis aguda experimental / Study of tumor necrosis factor-alpha levels in pancreatic tissue in acute experimental pancreatitis

Introducción. En la actualidad, la confirmación de la infección de la necrosis pancreática durante la pancreatitis aguda (PA) en el ser humano parece ser el único aspecto que hace preferible la indicación quirúrgica en estos pacientes. El objetivo del presente estudio es evaluar los valores del factor de necrosis tumoral alfa (TNF- ) tisular pancreático como posible parámetro indicador de formas graves de pancreatitis aguda en la rata Wistar. Material y métodos. Se utilizan 45 ratas Wistar para el estudio. El grupo control (C) está constituido por 4 ratas. Se induce la PA experimental en 41 ratas Wistar mediante la inyección retrógrada ductal de taurocolato sódico al 5 por ciento. Se estiman los valores del TNF- tisular pancreático en la fracción citosoluble del homogeneizado pancreático obtenido tanto en los controles como en las ratas en las que se induce la PA, distribuidas en grupos según el intervalo transcurrido hasta su sacrificio: 1, 3, 12 y 24 h (grupos 1, 3, 12 y 24).Resultados. Los valores del TNF- tisular pancreático son detectables en el páncreas de la rata sana (43,3 ñ 7,7 mg/ml). Con la inducción de la enfermedad se elevan los valores del TNF- con respecto a los controles en los diversos grupos evolutivos (G1 = 101; G3 = 119,3; G12 = 144,2; G24 = 133,9). Existen diferencias estadísticamente significativas de los diversos grupos evolutivos con respecto al grupo control. El test de la t de Student fue significativo para p < 0,05.Conclusiones. Utilizando un modelo experimental de necrosis pancreática de alta agresividad y letalidad demostrada, podemos afirmar que la cuantificación del TNF tisular pancreático es posible y sus valores se elevan en el transcurso de la PA necrohemorrágica experimental. La determinación del TNF- en las ratas sanas con valores significativamente inferiores a los obtenidos durante la evolución de las ratas afectadas de PA permite incorporar la determinación de dicho parámetro bioquímico tisular a los factores de gravedad de la enfermedad (AU)

Outcomes of primary trabeculectomy with the use of adjunctive mitomycin.

OBJECTIVE: To investigate the efficacy and safety of adjunctive mitomycin when used during a primary trabeculectomy within a series of 89 consecutive patients at 1 and 2 years postoperatively. DESIGN: A cohort study of all patients who underwent primary trabeculectomy, performed by one of us (P.F.P.), between April 1, 1991, and December 31, 1994. Patients received topical mitomycin in conjunction with a corneal safety valve incision. A trabeculectomy was considered "successful" if it resulted in an intraocular pressure (IOP) of 21 mm Hg or lower and a 30% or greater reduction in the IOP at and after 1 year of follow-up, with or without medications and without a reoperation for an elevated IOP. Survival analysis was used to calculate success rates. RESULTS: The 1- and 2-year success rates were 85.4% and 77.9%, respectively. The mean IOP was reduced from 26.3 to 11.3 mm Hg at 1 year (n=68) and to 11.9 mm Hg at 2 years (n=56), with 60 (88.2%) of 68 patients off medication at 1 year and 47 (83.9%) of 56 patients off medication at 2 years. Trabeculectomy success rates were significantly lower in black compared with nonblack patients (76.2% vs 87.5% at 1 year, P=.03). Trabeculectomy failure occurred throughout the follow-up period. Endophthalmitis occurred in 2 (2.2%) of the patients, and hypotonia requiring revision occurred in 4 (4.5%) of the patients. CONCLUSIONS: Primary trabeculectomy with the use of intraoperative mitomycin lowered the IOP by 30% or more in 78% (at 2 years) to 86% (at 1 year) of the cases and is associated with a marked reduction in the percentage of patients who require glaucoma medication. Success rates must be evaluated in light of such risks as endophthalmitis and hypotony.

[A descriptive study of hearing in children]. / Estudio descriptivo de la audición en niños.

The authors made an audiological screening of the entire population of the Valle de los Pedroches entering primary education in 1992. The auditory levels of the children were measured and abnormalities were detected. In a total of 440 children, 43 hypoacusic cases were found. The type of hypoacusis was predominanthy conductive (95.4%), serous otitis media, being the most common cause of hypoacusis in infancy. We deduce that screening is useful for detecting this medical problem.

Acute experimental pancreatitis in rat induced by sodium taurocholic acid: objective quantification of pancreatic necrosis.

Retrograde injection of 5% sodium taurocholic acid (TA) in Wistar rat pancreatic duct is followed by acute pancreatitis, resulting in 100% mortality within 36 h. Biochemical determinations show raised levels of amylase in ascites and blood. Necrosis has been measured using seven morphometric characteristics of pathological changes that add precise information on the type and extension of the pancreatic lesion. The percentage of necrotic tissue (by area) seems to be the most objective parameter. Necrosis appears 6 h after TA infusion, being 5.77% in extent after 12 h, 14.9% after 24 h and animals die with an area of 29.5% necrosis. This experimental model seems to one in which physiopathological and therapeutic trials on acute pancreatitis may be tried out.

Foreign body ingestion: management of 167 cases.

We reviewed the management of 167 patients with foreign body ingestion from 1980 to 1986. Two patients (1.1%) refused treatment. Nonoperative management was attempted in 14 (8.4%) patients. Endoscopy was performed on 117 patients with an overall success rate of 85.5% and a complication rate of 1.7%. Surgical treatment was required in 51 (30.0%) patients, 14 of whom had previous unsuccessful endoscopy.

[Primary tonsillar tuberculosis]. / Tuberculosis amigdalar primaria.

The authors depict one case of primary tuberculosis of the tonsil, they point out about its existence actually and they propose a protocol of early diagnosis.

[Comparative study between an easy coagglutination test and traditional cultures for the detection of group A beta-hemolytic streptococci in the oropharynx]. / Estudio comparativo de un fácil test de coaglutinación con los cultivos tradicionales para la detección del estreptococo beta-hemolítico del grupo A en orofaringe.

The authors make a comparative study of the conventional culture media and a commercially available coagglutination test for detection of streptococcus beta-haemolyticus. They draw attention to the simplicity and quickness of the coagglutination test and to their high value of prediction.