In vivo efficiency of antimicrobial inorganic bone grafts in osteomyelitis treatments.

The purpose of the present work was to evaluate in vivo different antimicrobial therapies to eradicate osteomyelitis created in the femoral head of New Zealand rabbits. Five phosphate-based cements were evaluated: calcium phosphate cements (CPC) and calcium phosphate foams (CPF), both in their pristine form and loaded with doxycycline hyclate, and an intrinsic antimicrobial magnesium phosphate cement (MPC; not loaded with an antibiotic). The cements were implanted in a bone previously infected with Staphylococcus aureus to discern the effects of the type of antibiotic administration (systemic vs. local), porosity (microporosity, i.e. <5 µm vs. macroporosity, i.e. >5 µm) and type of antimicrobial mechanism (release of antibiotic vs. intrinsic antimicrobial activity) on the improvement of the health state of the infected animals. A new method was developed, with a more comprehensive composite score that integrates 5 parameters of bone infection, 4 parameters of bone structural integrity and 4 parameters of bone regeneration. This method was used to evaluate the health state of the infected animals, both before and after osteomyelitis treatment. The results showed that the composite score allows to discern statistically significant differences between treatments that individual evaluations were not able to identify. Despite none of the therapies completely eradicated the infection, it was observed that macroporous materials (CPF and CPFd, the latter loaded with doxycycline hyclate) and intrinsic antimicrobial MPC allowed a better containment of the osteomyelitis. This study provides novel insights to understand the effect of different antimicrobial therapies in vivo, and a promising comprehensive methodology to evaluate the health state of the animals was developed. We expect that the implementation of such methodology could improve the criteria to select a proper antimicrobial therapy.

Sindrome de Marshall- Smith en mujer adulta: nuevos retos en anticoncepción / Marshall-Smith syndrome in an adult woman: new challenges in contraception

Se presenta el caso de una mujer de 38 años con Síndrome de Marshall-Smith. Se trata de una enfermedad rara de etiología desconocida, cuyas características incluyen anomalías craneofaciales, maduración ósea acelerada, alteraciones en el desarrollo neurológico y en las vías respiratorias con compromiso de la vía aérea y escasa supervivencia a largo plazo debido a problemas respiratorios. Sin embargo, los avances en el soporte respiratorio han permitido que algunos pacientes lleguen a la etapa adulta. Nuestra paciente, sin retraso intelectual ni psicomotor, solicita método anticonceptivo. Los pacientes con enfermedades raras necesitan ser atendidos con especial dedicación intentando reducir al mínimo la transmisión genética de dichas entidades, y mejorando al máximo su calidad de vida. Se ofrece un método anticonceptivo reversible de larga duración, sin riesgos para la evolución de su patología respiratoria, y atendiendo a los criterios medicos de elegibilidad de método anticonceptivo de la OMS, se indica la utilización de un implante subdérmico de etonogestrel. Con un perfil de seguridad y farmacocinética equivalente a los métodos de solo gestágeno y mayor comodidad.

A 38-year-old female patient with a history of Marshall-Smith syndrome is reported. It is a rare congenital disorder of unknown aetiology, which features include craneo facial dysmorphism, accelerated bone maturation, neurodevelopmental abnormalities, and upper and lower airways compromise. Long term survival is a problem due to respiratory complications, but it has decreased since airway support has improved, and that allows survival into adulthood. Our patient has neither intelectual nor psychomotor delay, so she asks for contraception method. As a rare genetic condition it needs to be attended with special consideration in order to reduce the disorder's transmission and to increase the life's quality of patients. A secure contraception method should be offered with no risk at all, attending to medical elegibility criteria for contraception use. We considered progestogen-only options and the patient's choice was etonogestrel subcutaneous implant.

Vulvitis de Zoon: caso clínico / Zoon vulvitis: clinical case

Se presenta un caso de una paciente de 84 años con vulvitis de Zoon. Se trata de una dermatosis vulvar de etiología incierta, muy poco frecuente, que ocasiona sintomatología inespecífica de prurito y escozor vulvar de larga evolución, acompañados de una o varias lesiones focales circunscritas y eritematosas de difícil diagnóstico clínico. Se insiste en la necesidad de realización de biopsia vulvar para obtención de un diagnóstico histológico de certeza. Se comentan las opciones terapéuticas actuales descritas en la literatura aunque no existe un tratamiento de elección.

An 84 year old female patient with Zoons vulvitis case is reported. It is a rare vulvar dermatosis of unknown etiology, with unspecific symptoms such as pruritus and vulvar stinging, both developed over a long period of time, accompanied with focal erythematous injuries. As a clinical diagnosis remains difficult, it is essential that a biopsy is obtained for accurate histological diagnosis. Despite different therapeutic options available, there is no consensus on a standardized treatment.

Mielinólisis pontina y extrapontina secundaria a fluctuaciones en la glucemia / Pontine and extrapontine myelinolysis secondary to glycemic fluctuati

No disponible

Tratamiento médico del aborto espontáneo del primer trimestre / Medical treatment of spontaneous abortion in the first trimester

Objetivos: Evaluar la eficacia del tratamiento médico con misoprostol en el aborto espontáneo del primer trimestre de la gestación. En segundo plano, conocer la incidencia de efectos secundarios y complicaciones e identificar las causas que puedan motivar el fracaso del tratamiento médico. Establecer el grado de aceptabilidad y satisfacción de las pacientes. Realizar un estudio coste/eficacia. Sujetos y métodos: Estudio longitudinal, observacional, prospectivo, descriptivo y analítico. Se evaluó a 680 pacientes con diagnóstico de aborto espontáneo del primer trimestre en el periodo comprendido entre junio de 2009 y diciembre de 2011 en el Hospital Clínico San Carlos, elaborándose un protocolo para la administración del tratamiento médico con misoprostol para aquellas pacientes que lo aceptaban, frente al tratamiento quirúrgico clásico. Resultados: El éxito del tratamiento médico fue del 81,85%. Eficaz en el 89,21% de los abortos consumados incompletos, en el 79,52% de los abortos diferidos y en el 78,46% de las gestaciones anembrionadas. Hubo efectos secundarios menores en el 33,59% de las pacientes, declarándose satisfechas el 84,99% de las pacientes. Con respecto al estudio de costes, se produjo un ahorro por paciente de 960,54 Euros. Conclusiones: El éxito del tratamiento médico en nuestro estudio fue elevado, siendo eficaz aproximadamente en 8 de cada 10 pacientes. El misoprostol es altamente aceptado por las pacientes, declarándose la mayoría satisfechas. La incidencia de efectos secundarios menores es baja, y fueron bien tolerados, por lo que su presencia no parece que limite la aplicación de dicho tratamiento. Su utilización contribuye a reducir los costes sanitarios

Objectives: To evaluate the efficacy of medical treatment with misoprostol in spontaneous abortion in the first trimester; to determine the incidence of adverse effects and complications and identify causes that may lead to the failure of medical treatment; to identify the acceptability of the treatment, patient acceptance and patient satisfaction; and to perform a cost-effectiveness analysis. Subjects and methods: A longitudinal, observational, prospective, descriptive and analytic study was performed in 680 patients diagnosed with spontaneous abortion in the first trimester between June 2009 and December 2011 at the Hospital Clínico San Carlos. A protocol was developed for medical treatment with misoprostol administration for patients who accepted to undergo this treatment rather than classical surgery. Results: The success of medical treatment was 81.85%. The treatment was effective in 89.21% of incomplete abortions, in 79.52% of missed abortions, and in 78.46% of anembrionic pregnancies. Minor adverse effects occurred in 33.59% of the patients, and 84.99% of the patients reported they were satisfied. Medical treatment produced a cost saving of 960.54 Euros per patient. Conclusions: The success of medical treatment in our study was high, with misoprostol administration being effective in approximately 8 out of 10 patients. Misoprostol is highly accepted by patients and most reported that they were satisfied. The incidence of minor adverse effects was low, and these effects were well tolerated; consequently, their presence does not seem to restrict the application of this treatment. Misoprostol use helps to reduce healthcare costs

Paucisymptomatic infectious prostatitis as a cause of fever without an apparent origin. A series of 19 patients.

According to the literature, prostatitis is a rare cause of prolonged fever without an apparent origin. However, this syndrome can be easily diagnosed using specific tests, either two-glass pre- and post-prostatic massage or the Meares-Stamey four-glass test. A retrospective study over a 5-year period (between August 1st 2006 and July 31st 2011) was performed. All patients who met the criteria for microbiological prostatitis were included and assigned to one of two groups, either a study group [paucisymptomatic infectious prostatitis (PIP)] or a control group [classic infectious prostatitis (CIP)]. Epidemiological, clinical, microbiological, and treatment-related variables were collected. A comparative study between both groups was performed. Thirty-nine patients were diagnosed with prostatitis. The main risk factors were unprotected anal intercourse, human immunodeficiency virus (HIV) infection, recent travel, and recurrent urinary tract infections. The most significant differences between the PIP (19 patients) and CIP (20 patients) groups were higher frequency of elevated inflammatory markers, higher frequency of monomicrobial etiology, and longer treatment. In monomicrobial prostatitis, the most common causative agents were coagulase-negative Staphylococcus spp., Escherichia coli, and Corynebacterium glucuronolyticum. According to the findings of this study, we believe that prostatitis should be included as a possible diagnosis in a man who complains of prolonged fever without an apparent origin and having at least one of the following risk factors: unprotected anal intercourse, HIV infection, recent travel, and recurrent urinary tract infections.

On-farm measurement of electrical conductivity for the estimation of ammonium nitrogen concentration in pig slurry.

Pig (Sus scrofa domesticus) slurry (PS) is commonly applied as fertilizer to agricultural fields. Knowledge of PS nitrogen content is essential for good management, but PS nitrogen content is highly variable, not only between farms but also within a farm. Laboratory analysis of animal slurries is often expensive and impractical for routine farmer use. Therefore, when slurry is spread on land, its fertilizer value is generally unknown, resulting in the risk of pollution. In this work, two rapid and suitable for field use methods for determining PS ammonium N (NH(4)+-N) concentration (Quantofix and conductimetry) are evaluated. The electrical conductivity of a dilution 1 PS:9 distilled water had better results than Quantofix, did not need reagents, and gave a direct value of NH(4)+-N concentrations (range, 1.0-7.6 kg NH(4)+-N m(-3)). The conductimetry method allows the use of alternative waters with EC <1.9 dS m(-1) for dilution. This method is being introduced to farmers in northeast Spain to improve PS management and has been well received due to its low cost and ease of use.

Outbreak of cryptosporidiosis in a child day-care centre in Gipuzkoa, Spain, October to December 2011.

From October to December 2011, an outbreak of 26 cases of cryptosporidiosis occurred in a day-care centre in Gipuzkoa, Spain. The infection spread from person to person and affected 24 children under two years of age (attack rate: 38%) and two caregivers. Cryptosporidium oocysts were observed in 10 of 15 samples. During 2010, only four cases of cryptosporidium were detected in Gipuzkoa, and 27 overall in Spain.

Púrpura de Schönlein-Henoch / Henoch-Schönlein purpura

La púrpura de Schönlein-Henoch (PSH) es una vasculitis leucocitoclástica de mecanismo inmunológico con afectación de vaso pequeño. Afecta a niños en el 90% de los casos, principalmente varones. Las 4 características clínicas fundamentales son la erupción purpúrica, dolor abdominal, artralgias y afectación renal. La PSH es generalmente autolimitada en el 94% de los niños y en el 89% de los adultos. El tratamiento es básicamente sintomático para la afectación articular y el dolor abdominal. El interés del caso radica en la poca frecuencia de esta patología en adultos, aunque puede ser de mayor gravedad dado que hay un mayor riesgo de afectación renal crónica (AU)

Henoch-Schönlein purpura (HSP) is an immune mechanism leukocytoclastic vasculitis with small vessel involvement. It affects children, mainly males, in 90% of cases.. The four main clinical features include purpura rash, abdominal pain, arthralgia and renal involvement. HSP is usually self-limiting in 94% of children and 89% of adults. Treatment is basically symptomatic for joint involvement and abdominal pain. The interest in this case lies in the rarity of this disease in adults, which may be more serious since there is an increased risk of chronic renal impairment (AU)

Supervivencia y resultado funcional a largo plazo de prótesis de rodilla no cementadas / Uncemented knee arthroplasty: supervivorship and long-term functional outcome

Objetivo: Analizar la supervivencia a largo plazo y el resultado funcional de un modelo de prótesis de rodilla no cementada. Material y método: Realizamos un estudio prospectivo observacional de pacientes operados entre los años 1989 y 1996 con el modelo Low Contact Stress Mobile-Bearing Total Knee Replacement(R) (Depuy, Warsaw, IN, EE. UU.). Las variables estudiadas fueron edad, sexo, tiempo de seguimiento, puntuación del Knee Society Score (KSS), supervivencia del implante y motivos de la revisión. Un total de 96 artroplastias de 127 completaron el seguimiento. La media de edad fue de 79 años. La media de seguimiento fue de 14,5 años. Once prótesis se reintervinieron (6 por aflojamiento aséptico de implantes y 5 por problemas de componentes móviles). Se obtuvieron curvas de supervivencia al considerado el tiempo de seguimiento, el tiempo desde la cirugía primaria hasta la reintervención y el episodio «recambio por aflojamiento de componente metálico» y «necesidad de reintervención». Resultados: Las curvas de supervivencia arrojaron una supervivencia del 96,45% a los 9 años y del 92,78% a los 12 años, y se consideró la «necesidad de reintervención» como punto final. Al considerar la necesidad de recambio de componentes metálicos, la supervivencia a los 14 años y medio fue del 93,75%. La puntuación media del KSS funcional fue de 89,2. Conclusión: En nuestra experiencia y con el modelo protésico utilizado, las prótesis totales de rodilla no cementadas proporcionan un resultado clínico y funcional excelente, valorado por el KSS, y una supervivencia del 93,75% a los 14 años y medio al considerar la supervivencia del implante metálico (AU)

Purpose: To analyze the long term survivorship and functional results of a model of uncemented knee prosthesis. Materials and methods: We carried out a prospective observational study of patients implanted between 1989 and 1996 with the Low Contact Stress Mobile-Bearing Total Knee Replacement (Depuy, Warsaw, IN, EEUU). Variables studied included: age, gender, follow-up, Knee Society Score, implant survivorship and reasons for revision. A total of 96 arthroplasties out of 127 reached the end of follow-up Mean age was 79 years. Mean follow-up was 14 years. Eleven prostheses were revised (6 following aseptic loosening and 5 because of problems with the mobile bearings). Survivorship curves were obtained considering length of follow-up, time elapsed between the primary and the revision surgery and the “revision following loosening of a metal component” and “need for revision” events. Results: When "need for revision" was considered as the endpoint, survivorship curves revealed a survivorship rate of 96.45% at 9 years and 92.78% at 12 years. When the endpoint was the "need to revise metal components" 14.5-year survivorship was 93.75%. Mean Knee Society Score was 89.2 points. Conclusion: The use of the uncemented LCS knee has resulted in excellent clinical and functional results as measured by the Knee Society Score, as well as 93.75% survivorship at 14 years and a half, considering the survivorship of the metal implant (AU)

[Patient with bilateral lung nodes like metastasis. Late silicosis]. / Paciente con nódulos pulmonares sugerentes de metástasis. Silicosis, presentación tardía.

We present a 72-year-old patient that he has admitted to analize a large amount and bilateral lung nodes in a incidentally thorax x-ray. It is carried out a lung node biopsy, with a result of silicoanthacosis.

Paciente con nódulos pulmonares sugerentes de metástasis. Silicosis, presentación tardía / Patient with bilateral lung nodes like metastasis. Late silicosis

Presentamos a un paciente de 72 años que ingresa para estudio de nódulos pulmonares múltiples y bilaterales en radiografía de tórax realizada de forma casual. Se realiza biopsia de nódulo pulmonar con el resultado anatomopatológico de silicoantracosis (AU)

We present a 72-year-old patient that he has admitted to analize a large amount and bilateral lung nodes in a incidentally thorax x-ray. It is carried out a lung node biopsy, with a result of silicoanthacosis (AU)

Chronic intestinal pseudo-obstruction: a diagnosis to be considered.

Chronic intestinal pseudoobstruction (CIPO) is a rare entity characterized by recurrent clinical episodes of intestinal obstruction in which no mechanical cause is identified. There are multiple causes for this syndrome but two main groups can be distinguished: a) secondary to a systemic non-gastrointestinal disease; and b) primary or idiopathic originated from alterations in the components of the intestinal wall. The latter forms are the most uncommon and their diagnosis is generally difficult. In the present article, we describe nine patients with CIPO that were diagnosed in our center over the last six years. Four of them were diagnosed with primary or idiopathic form of CIPO and another four were clearly secondary to a systemic disease. The ninth case, which was initially diagnosed as secondary, is probably also a primary form of the disease. The number of patients diagnosed in our center, even thought small, makes us to hypothesize that the prevalence of CIPO is probably greater than is generally believed and that the reasons of its rarity are the incomplete understanding of its physiopathology and the difficulties to achieve a correct diagnosis.

Chronic intestinal pseudo-obstruction: a diagnosis to be considered

Chronic intestinal pseudoobstruction (CIPO) is a rare entitycharacterized by recurrent clinical episodes of intestinal obstructionin which no mechanical cause is identified. There are multiplecauses for this syndrome but two main groups can be distinguished:a) secondary to a systemic non-gastrointestinal disease;and b) primary or idiopathic originated from alterations in thecomponents of the intestinal wall. The latter forms are the mostuncommon and their diagnosis is generally difficult. In the presentarticle, we describe nine patients with CIPO that were diagnosedin our center over the last six years. Four of them were diagnosedwith primary or idiopathic form of CIPO and another four wereclearly secondary to a systemic disease. The ninth case, whichwas initially diagnosed as secondary, is probably also a primaryform of the disease. The number of patients diagnosed in our center,even thought small, makes us to hypothesize that the prevalenceof CIPO is probably greater than is generally believed andthat the reasons of its rarity are the incomplete understanding ofits physiopathology and the difficulties to achieve a correct diagnosis(AU)