Prevalencia del aneurisma de aorta abdominal en varones de 65-80 años de una población rural / Prevalence of abdominal aortic aneurysm in a rural population of 65-80 year-old males

Introducción. La prevalencia del aneurisma de aorta abdominal (AAA) es del 3,5-4% en varones mayores de 65 años. Se desconoce si esa prevalencia es extrapolable a una población rural, resultante de las mediciones ecográficas realizadas por médicos de familia. Objetivo. Estimar la prevalencia de AAA en una población rural de varones con edades de 65 a 80 años, mediante ecografía abdominal realizada por médicos de familia e identificar su asociación con diferentes FRV. Sujetos y método. Estudio transversal. Se incluyeron varones de 65 a 80 años (n = 320), de una población rural de la provincia de Ciudad Real. La variable dependiente, presencia o no de AAA, se consideró como un diámetro mayor o igual a 3 cms a la exploración ecográfica. Variables explicativas: índice tobillo/brazo (ITB), índice de masa corporal (IMC), antecedentes de hipertensión arterial (HTA), diabetes mellitus (DM), dislipemia (DLP), cardiopatía isquémica, accidentes cerebrovaculares, tabaquismo. Se realizó un análisis bivariante, multivariante, de prevalencias y además un estudio de concordancia entre observadores. Resultados. La prevalencia de AAA fue 3,3% con un IC95%: 1,1-5,5%. La DM y la DLP presentó una asociación significativa e independiente con el AAA (OR 5,19; IC95% 1,42-18,95). La concordancia entre observadores fue muy alta (CCI 0,96 (IC95% 0,91-0,98). Conclusiones. La prevalencia obtenida es similar a la encontrada en la literatura. Debido al diseño transversal del estudio, tanto FRV como la HTA o la EAP no presentan asociación con el AAA. Se podría crear un programa de detección precoz desde Atención Primaria por médicos de familia para el AAA (AU)

Introduction. The prevalence of aortic aneurysm (AAA) is reported to be 3.55%-4% in men over 65. But it is not known if this prevalence, resulting from ultrasound measurements made by Family Physicians, can be extrapolated to a rural population. Objective. To estimate the prevalence of AAA in a rural population of males aged 65-80 years, using abdominal ultrasound by family physicians, and to identify its association with different cardiovascular risk factors. Subjects and method. A cross sectional study was conducted that included males of 65-80 years (n = 320) in a rural population of the province of Ciudad Real, Spain. The dependent variable was the presence or not of AAA using ultrasound measurements of the aorta. Those with a diameter greater than or equal to 3 cm were considered positive. Explanatory variables were measured; ankle/brachial index (ABI), body mass index (BMI), medical history of high blood pressure (hypertension), diabetes mellitus (DM), dyslipidaemia (DLP), ischemic heart disease, cerebrovascular accidents (CVA), and smoking habits. A bivariate and multivariate analysis of the prevalences was performed, as well as a study of the agreement between observers. Results. The prevalence of AAA in the population was 3.3% (95% CI: 1.1-5.5%. DM and DLP were significantly associated with AAA. The agreement between observers was 0.96 (95% CI; 0.91-0.98). The high prevalence of different cardiovascular risk factors (CVRF) was particularly noteworthy. Conclusions. The prevalence of AAA in 65-80 year-old males in a rural population is similar to that found in the literature. Due to the cross-sectional nature of the study, CVRFs such as hypertension or CVA were not associated with the AAA. A screening program for the early detection of AAA could be introduced into Primary Health Care by family physicians (AU)

[Prevalence of abdominal aortic aneurysm in a rural population of 65-80 year-old males]. / Prevalencia del aneurisma de aorta abdominal en varones de 65-80 años de una población rural.

INTRODUCTION: The prevalence of aortic aneurysm (AAA) is reported to be 3.55%-4% in men over 65. But it is not known if this prevalence, resulting from ultrasound measurements made by Family Physicians, can be extrapolated to a rural population. OBJECTIVE: To estimate the prevalence of AAA in a rural population of males aged 65-80 years, using abdominal ultrasound by family physicians, and to identify its association with different cardiovascular risk factors. SUBJECTS AND METHOD: A cross sectional study was conducted that included males of 65-80 years (n=320) in a rural population of the province of Ciudad Real, Spain. The dependent variable was the presence or not of AAA using ultrasound measurements of the aorta. Those with a diameter greater than or equal to 3cm were considered positive. Explanatory variables were measured; ankle/brachial index (ABI), body mass index (BMI), medical history of high blood pressure (hypertension), diabetes mellitus (DM), dyslipidaemia (DLP), ischemic heart disease, cerebrovascular accidents (CVA), and smoking habits. A bivariate and multivariate analysis of the prevalences was performed, as well as a study of the agreement between observers. RESULTS: The prevalence of AAA in the population was 3.3% (95% CI: 1.1-5.5%. DM and DLP were significantly associated with AAA. The agreement between observers was 0.96 (95% CI; 0.91-0.98). The high prevalence of different cardiovascular risk factors (CVRF) was particularly noteworthy. CONCLUSIONS: The prevalence of AAA in 65-80 year-old males in a rural population is similar to that found in the literature. Due to the cross-sectional nature of the study, CVRFs such as hypertension or CVA were not associated with the AAA. A screening program for the early detection of AAA could be introduced into Primary Health Care by family physicians.

Diffuse leptomeningeal seeding from benign choroid plexus papilloma.

Choroid plexus papillomas (CPP) are rare intracranial tumours with a favourable long-term outcome after surgical excision. Although they are histologically benign, local recurrences may occasionally occur, but leptomeningeal dissemination is exceptional. We report an unusual example of a fourth ventricle choroid plexus papilloma with diffuse leptomeningeal seeding. Neither the initial tumour nor the recurrence showed malignant histological features. Treatment with systemic and intrathecal chemotherapy was ineffective in this patient. We review the literature concerning leptomeningeal dissemination of benign choroid plexus papillomas.

[Chordoid glioma of the III ventricle. Case report and revision of the literature]. / Glioma cordoide del III ventrículo. Nuevo caso y revisión de la literatura.

Chordoid glioma of the third ventricle is an infrequent brain tumour that was described for the first time by Brat et al. in 1998; since then, only 39 cases have been reported. We present a new case of chordoid glioma of the third ventricle in a 51-year-old-man that was treated with total surgical removal, with a good initial postoperative evolution. Sudden death, most likely due to a massive pulmonary embolism, occurred in the third postoperative day. We present the histological characteristics of the tumour and review the literature regarding this entity.

Glioma cordoide del III ventrículo. Nuevo caso y revisión de la literatura / No disponible

El glioma cordoide del tercer ventrículo es una entidadtumoral muy infrecuente descrita por primeravez en 1998 por Brat y colaboradores; desde entoncesse han descrito en la literatura tan sólo 39 casos. Presentamosun nuevo caso de glioma cordoide del tercerventrículo en un paciente varón de 51 años, que fuetratado mediante resección quirúrgica completa, conbuena evolución en el postoperatorio inmediato, peroque falleció súbitamente tres días después de la intervenciónpor un probable embolismo pulmonar. Presentamoslas características histológicas del tumor yrealizamos una revisión de la literatura

Chordoid glioma of the third ventricle is an infrequentbrain tumour that was described for the firsttime by Brat et al. in 1998; since then, only 39 caseshave been reported. We present a new case of chordoidglioma of the third ventricle in a 51-year-old-man thatwas treated with total surgical removal, with a good initialpostoperative evolution. Sudden death, most likelydue to a massive pulmonary embolism, occurred in thethird postoperative day. We present the histologicalcharacteristics of the tumour and review the literatureregarding this entity

Inhibition of human leukemia in an animal model with human antibodies directed against vascular endothelial growth factor receptor 2. Correlation between antibody affinity and biological activity.

Vascular endothelial growth factor (VEGF) and its receptors (VEGFR) have been implicated in promoting solid tumor growth and metastasis via stimulating tumor-associated angiogenesis. We recently showed that certain 'liquid' tumors such as leukemia not only produce VEGF, but also express functional VEGFR, resulting in an autocrine loop for tumor growth and propagation. A chimeric anti-VEGFR2 (or kinase insert domain-containing receptor, KDR) antibody, IMC-1C11, was shown to be able to inhibit VEGF-induced proliferation of human leukemia cells in vitro, and to prolong survival of nonobese diabetic-severe combined immune deficient (NOD-SCID) mice inoculated with human leukemia cells. Here we produced two fully human anti-KDR antibodies (IgG1), IMC-2C6 and IMC-1121, from Fab fragments originally isolated from a large antibody phage display library. These antibodies bind specifically to KDR with high affinities: 50 and 200 pM for IMC-1121 and IMC-2C6, respectively, as compared to 270 pM for IMC-1C11. Like IMC-1C11, both human antibodies block VEGF/KDR interaction with an IC(50) of approximately 1 nM, but IMC-1121 is a more potent inhibitor to VEGF-stimulated proliferation of human endothelial cells. These anti-KDR antibodies strongly inhibited VEGF-induced migration of human leukemia cells in vitro, and when administered in vivo, significantly prolonged survival of NOD-SCID mice inoculated with human leukemia cells. It is noteworthy that the mice treated with antibody of the highest affinity, IMC-1121, survived the longest period of time, followed by mice treated with IMC-2C6 and IMC-1C11. Taken together, our data suggest that anti-KDR antibodies may have broad applications in the treatment of both solid tumors and leukemia. It further underscores the efforts to identify antibodies of high affinity for enhanced antiangiogenic and antitumor activities.

Enfermedad de Rendu-Osler-Weber. Fístulas arteriovenosas / Rendu-Osler-Weber syndrome. Pulmonary arteriovenous fistulas. A report of three cases

La telangiectasia hemorrágica heredofamiliar (THH) o síndrome de Rendu-Osler-Weber es un trastorno sistémico infrecuente asociado con malformaciones vasculares pulmonares (MPAV). Aunque el diagnóstico clínico puede fundamentarse en las manifestaciones cutaneomucosas, de vías aéreas altas o en los múltiples episodios de sangrado, la presencia de un compromiso pulmonar suele cursar inaparente y definir el pronóstico. Se presentan tres pacientes con una THH y con MPAV en los que la medición del shunt con O2 al 100 per cent, la ecocardiografía con contraste y la tomografía helicoidal sustentan el enfoque diagnóstico no invasor. En uno de los pacientes, la arteriografía confirmó la sospecha de MPAV única. Recibió emboloterapia quirúrgica con un coil y se obtuvo definida mejoría clínica y funcional (AU)

Alopecia aguda asociada a empiema por actinomices / Acute alopecia associated to empyema caused by actinomyces

No disponible

[Rendu-Osler-Weber syndrome. Pulmonary arteriovenous fistulas. A report of three cases]. / Enfermedad de Rendu-Osler-Weber. Fístulas arteriovenosas.

Hereditary hemorrhagic telangiectasia (HHT), or Rendu-Osler-Weber syndrome, is a rare disorder that is closely linked to the development of pulmonary arteriovenous malformations (PAVM). Diagnosis can be based on clinical signs such as upper respiratory tract changes or recurrent hemorrhagic events. Nevertheless, pulmonary involvement, a prognostic factor, may remain undetected. In the three HTT cases with PAVM we report, the following diagnostic information was obtained non-invasively: shunt fraction measurements (breathing 100% oxygen), echocardiographic contrast studies, and three-dimensional helical computed tomographs. Arteriography demonstrated a single PAVM in one case and the patient underwent successful coil embolization, with clinical and functional improvement.

Evidence of increased endothelial cell turnover in brain arteriovenous malformations.

OBJECTIVE: We hypothesized that human brain arteriovenous malformations (BAVMs) are nonstatic vascular lesions with active angiogenesis or vascular remodeling. To test this hypothesis, we assessed endothelial cell turnover in BAVMs. METHODS: We identified nonresting endothelial cells by use of immunohistochemistry for the Ki-67 antigen. From archived paraffin blocks, we selected BAVM vessels without intravascular thrombosis or embolic material in areas nonadjacent to the nidus edge. For controls, we used 50- to 100-microm diameter cortical vessels from temporal lobe cortex removed for epilepsy treatment. The Ki-67 index was calculated as a percentage of Ki-67-positive endothelial cells. The data were analyzed by the nonparametric Mann-Whitney test and reported as mean +/- standard deviation. RESULTS: Thirty-seven specimens that met the above criteria were selected. There were 26 +/- 15 vessels counted in each BAVM specimen versus 18 +/- 5 in each control cortex (n = 5). The mean Ki-67 index was higher for BAVM vessels than control cortical vessels (0.7 +/- 0.6 versus 0.1 +/- 0.2%; P = 0.005), which represented an approximately seven-fold increase in the number of nonresting endothelial cells. In the BAVM group, there was a trend for younger patients to have a wider variation and higher Ki-67 index than older patients; no trend was evident in the control group. CONCLUSION: Compared with control vessels, BAVM vessels have higher endothelial cell turnover, which suggests the presence of active angiogenesis or vascular remodeling in BAVMs.

[Bronchiolitis obliterans in a patient previously working as a printer in a textile factory]. / Bronquiolitis obliterante en un paciente trabajador de estampación en una fábrica textil.

We report the case of a 24-year-old man with a diagnosis of bronchiolitis obliterans, a rare clinical condition; the similarity to Ardystil syndrome was striking. Relevant occupational history included work in a textile air-brushing factory. Also noteworthy were lesions observed by CT scan in the form of cystic formations measuring less than 1 cm, a finding not previously described in the context of bronchiolitis obliterans. The patient improved immediately after starting corticoid treatment although scans failed to improve over several months of follow-up.

Abnormal pattern of Tie-2 and vascular endothelial growth factor receptor expression in human cerebral arteriovenous malformations.

OBJECTIVE: Human cerebral arteriovenous malformations (AVMs) are speculated to result from abnormal angiogenesis. Vascular endothelial growth factor receptors (VEGF-Rs) and Tie-2 play critical roles in vasculogenesis and angiogenesis. We hypothesized that the abnormal vascular phenotype of AVMs may be associated with abnormal expression of VEGF-Rs and Tie-2. METHODS: We measured the expression of Tie-2, VEGF-R1, and VEGF-R2 in AVMs and normal brain tissue, using immunoblotting. To assess active vascular remodeling, we also measured endothelial nitric oxide synthase expression. CD31 expression was used to control for endothelial cell mass for Tie-2, VEGF-Rs, and endothelial nitric oxide synthase. Immunoblotting data were presented as relative expression, using normal brain tissue values as 100%. RESULTS: CD31 was expressed to similar degrees in AVMs and normal brain tissue (99+/-29% versus 100+/-20%, mean +/- standard error, P = 0.98). Tie-2 expression was markedly decreased in all AVMs, compared with normal brain tissue (16+/-9% versus 100+/-37%, P = 0.04). VEGF-R1 expression was decreased in four of five AVMs, but the difference between the mean values was not significant (35+/-8% versus 100+/-42%, P = 0.14). VEGF-R2 expression was decreased in all AVMs, compared with normal brain tissue (28+/-6% versus 100+/-29%, P = 0.03). There was no difference in endothelial nitric oxide synthase expression between AVMs and normal brain tissue (106+/-42% versus 100+/-25%, P = 0.91). CONCLUSION: AVM vessels exhibited abnormal expression of Tie-2 and VEGF-Rs, both of which may contribute to the pathogenesis of AVMs.

Bronquiolitis obliterante en un paciente trabajador de estampación en una fábrica textil / Bronchiolitis obliterans in a textile printing worker

Presentamos el caso de un varón de 24 años de edad diagnosticado de bronquiolitis obliterante, entidad clinicopatológica infrecuente. Llama la atención la similitud con el síndrome de Ardystil. Entre los antecedentes profesionales se encuentra haber trabajado en una empresa de aerografía textil. También son destacables las lesiones radiológicas por tomografía axial computarizada, consistentes en formaciones quísticas de menos de 1 cm, no descritas con anterioridad en relación con la bronquiolitis obliterante. Diagnosticado el paciente, se inicia tratamiento con corticoides, con mejoría clínica inmediata, pero no radiológica, tras varios meses de seguimiento (AU)

[Testicular epidermoid cysts. Report of 2 cases]. / Quistes epidermoides testiculares. A propósito de dos observaciones.

Testicular epidermoid cysts are benign tumours which account for less than 1% of all testicular tumours. Their uncertain histogenesis, difficult pre-operative diagnosis and controversial therapeutic approach are at the base of this paper. Report on two patients, 20- and 21-year old, with testicular epidermoid cysts treated by inguinal radical orchiectomy and tumorectomy, respectively. Literature review focused on the diagnostic and therapeutic aspects. Emphasis on the relevance of ultrasound for pre-operative diagnosis. We also advocate for a conservative management if their presence is suspected or in the presence of negative tumoral markers.

[Laryngeal paraganglioma]. / Paraganglioma laríngeo.

A case of laryngeal paraganglioma in a 65-year-old male was treated by supraglotic laryngectomy. This controversial tumor is analyzed and guidelines are given for its clinical and histological (immunohistochemical) diagnosis and treatment.

[Inhaled corticosteroids and asthma education]. / Corticoides inhalados y educacíon para el asma.

UNLABELLED: Thirty asthmatic patients were evaluated to assess the association of therapy with inhalatory corticosteroids and an educational program, EDUCASMA. Spirometric evaluation with Flow-Volume loop (MEDICAL GRAPHIC CPF-S), ambulatory FEP (mini WRIGHT meters) was performed. In regard of initial symptoms patients were qualified as moderate or severe. After two weeks of a screening period, they were randomized into 2 groups: a) beclomethasone; b) budesonide; respective doses in according to the initial status. During the study period (8 wks) they visited the medical Staff six or more times. In each visit the patients received clinical evaluation (i.e. clinical scoring), spirometry (i.e. FEV1), and FEP ambulatory revision. FEP x (mean), FEP delta, FEV1, and clinical scores values were matched at the start and at the end of the follow-up period. Non-parametric statistics were applied (Wilcoxon test) and significative changes were defined (p < 0.05). CONCLUSIONS: 1) inhalatory corticosteroids therapy associated with a previous educational program could achieve early improvements of clinical scores; 2) in moderate asthma ambulatory FEP showed objective changes both in beclomethasone and budesonide treatments. It appears to indicate increasing changes very close to the clinical improvement; 3) the short period of our observation and the inflammatory condition of airways in severe asthma, could be explained as probable factors for the minor differences in the FEV1 evaluation; 4) no differences between budesonide and beclomethasone treatment were found.

Metastatic endometrial adenocarcinoma to the skin of a toe.

A 55-year-old woman had a history of prolonged vaginal bleeding. Dilatation and curettage confirmed poorly differentiated endometrial adenocarcinoma. After hysterectomy, salpingo-oophorectomy, and 5,040 cGy of postoperative irradiation, lung metastases developed, which temporarily responded to chemotherapy that included adriamycin and cisplatin. Metastatic lesions developed later in the left acetabulum and the hallux. The latter, clinically reminiscent of pyogenic granuloma, affected only skin. The poorly differentiated toe metastasis duplicated areas of the primary endometrial adenocarcinoma and was immunohistochemically similar to it. While appearing quite rarely, and generally late in the disease, pedal skin lesions may represent metastases from known or occult visceral cancers.

[Malignant otitis externa with disfunction of the temporomandibular articulation]. / Otitis externa maligna con disfunción de la articulación temporomandibular.

Here we present a case of a female patient 70 years old stricken with diabetes mellitud 40 years of evolution with manifestations of malignant external otitis accompanied by disfunction of the temporomandibular articulation. Here we will show the clinical characteristics and the diagnosis in our patient likewise its treatment. We will expound the most important aspects of the entity at this present time.