Valor pronóstico del cociente lactato/albúmina para la mortalidad en pacientes mayores de 65 años con infección urinaria complicada / Lactate/albumin ratio prognostic value for mortality in patients older than 65 years with complicated urinary tract infection

Antecedentes El cociente lactato/albúmina (LAR) es un biomarcador emergente de sepsis que se ha evaluado para determinar la mortalidad en pacientes con sepsis de distinto foco. Nuestro objetivo es evaluar el valor pronóstico de LAR en pacientes ingresados en el hospital por infecciones urinarias complicadas. Métodos Estudio observacional prospectivo de pacientes mayores de 65 años diagnosticados de ITU. Se calcularon y compararon el área bajo la curva ROC, la sensibilidad y la especificidad para predecir la mortalidad a 30 días para LAR, qSOFA y SOFA. Resultados Se analizaron 341 casos de ITU. La mortalidad a 30 días (20,2 frente a 6,7%, p<0,001) y la mayor estancia hospitalaria (5 [4-8] frente a 4 [3-7], p=0,018) se asociaron con LAR≥0,708. LAR no presenta diferencias estadísticamente significativas en comparación con qSOFA y SOFA para predecir la mortalidad a 30 días (AUROC 0,737 frente a 0,832 y 0,777, respectivamente, p=0,119 y 0,496). La sensibilidad de LAR fue similar a la de qSOFA y SOFA (60,8 frente a 84,4 y 82,2%, respectivamente, p=0,746 y 0,837). Sin embargo, su especificidad fue inferior a la del qSOFA (60,8 frente a 75%, p=0,003), pero similar a la del SOFA (60,8 frente a 57,8%, p=0,787). Conclusiones LAR no presenta diferencias significativas con otras puntuaciones bien establecidas en sepsis, como qSOFA y SOFA, para predecir la mortalidad a 30 días en pacientes con ITU complicada (AU)

Background Lactate to albumin ratio (LAR) is an emerging sepsis biomarker that has been tested for mortality in patients with sepsis of different focus. Our goal is to evaluate the prognostic value of LAR in patients admitted to the hospital due to complicated urinary tract infections. Methods Prospective observational study of patients older than 65 years diagnosed with UTI. Area under the ROC curve, sensibility, and specificity to predict 30-day mortality were calculated for LAR, qSOFA and SOFA. Results Three hundred and forty-one UTI cases were analyzed. Thirty-day mortality (20.2 vs. 6.7%, p<0.001) and longer hospital stay (5 [4–8] vs. 4 [3–7], p=0.018) were associated with LAR≥0.708. LAR has no statistically significant differences compared to qSOFA and SOFA for predicting 30-day mortality (AUROC 0.737 vs. 0.832 and 0.777, respectively, p=0.119 and 0.496). The sensitivity of LAR was similar to the sensitivity of qSOFA and SOFA (60.8 vs. 84.4 and 82.2%, respectively, p=0.746 and 0.837). However, its specificity was lower than the specificity of qSOFA (60.8 vs. 75%, p=0.003), but similar to the specificity of SOFA (60.8 vs. 57.8%, p=0.787). Conclusions LAR has no significant differences with other well-stablished scores in sepsis, such as qSOFA and SOFA, to predict 30-day mortality in patients with complicated UTI (AU)

Evaluation of canine leishmaniosis vaccine CaniLeish® under field conditions in native dog populations from an endemic Mediterranean area-A randomized controlled trial.

Dog vaccination is considered an effective way of reducing Leishmania infantum infection incidence in the canine population, as well as its transmission to humans. However, the use of partially effective vaccines can have the detrimental effect of "masking" vaccinated asymptomatic carriers, capable of harbouring the parasite and transmitting it to naïve individuals. After eight years on the European market, few studies have been released on CaniLeish® vaccine safety and efficacy. The present study, a one-year randomized CaniLeish® vaccine field trial, was performed in a canine leishmaniosis endemic area and included animals selected from a native dog population (n = 168). No severe adverse reactions were observed in vaccinated dogs (n = 85). Cases of active L. infantum infection were detected by serological, molecular and clinical follow-up of dogs. One-year post-vaccination, no differences in number or severity of L. infantum active infections were observed between study groups (n = 4 in each group). Vaccine-induced cellular immunity, assessed through interferon-γ quantification, showed significantly higher levels of this cytokine one-month post-vaccination in the vaccine group (p < 0.001), but no differences were observed after nine months between trial groups (p = 0.078). These results fail to support the reported CaniLeish® efficacy in the prevention of active L. infantum infection in dogs from endemic areas and naturally exposed to the parasite.

Post-mortem microbiology in sudden death: sampling protocols proposed in different clinical settings.

BACKGROUND: Autopsies, including minimally invasive autopsies, are a powerful tool for determination of the cause of death. When a patient dies from an infection, microbiology is crucial to identify the causative organism. Post-mortem microbiology (PMM) aims to detect unexpected infections causing sudden deaths; confirm clinically suspected but unproven infection; evaluate the efficacy of antimicrobial therapy; identify emergent pathogens; and recognize medical errors. Additionally, the analysis of the thanatomicrobiome may help to estimate the post-mortem interval. AIMS: The aim was to provide advice in the collection of PMM samples and to propose sampling guidelines for microbiologists advising autopsy pathologists facing different sudden death scenarios. SOURCES: A multidisciplinary team with experts in various fields of microbiology and autopsies on behalf of the ESGFOR (ESCMID - European Society of Clinical Microbiology and Infectious Diseases - study group of forensic and post-mortem microbiology and in collaboration with the European Society of Pathology) developed this narrative review based on a literature search using MedLine and Scopus electronic databases supplemented with their own expertise. CONTENT: These guidelines address measures to prevent sample contamination in autopsy microbiology; general PMM sampling technique; protocols for PMM sampling in different scenarios and using minimally invasive autopsy; and potential use of the evolving post-mortem microbiome to estimate the post-mortem interval. IMPLICATIONS: Adequate sampling is paramount to identify the causative organism. Meaningful interpretation of PMM results requires careful evaluation in the context of clinical history, macroscopic and histological findings. Networking and closer collaboration among microbiologists and autopsy pathologists is vital to maximize the yield of PMM.

Canine Leishmaniasis Progression is Associated with Vitamin D Deficiency.

The relationship between vitamin D deficiency and the risk of suffering from a plethora of health disorders, ranging from autoimmune processes to infectious diseases has been widely described. Nonetheless, the potential role of vitamin D in visceral leishmaniasis remains uncharacterized. In the Mediterranean basin, where the dog is leishmania's main peri-domestic reservoir, control measures against the canine disease have shown beneficial effects on the incidence of human leishmaniasis. In this study, we measured the vitamin D levels in serum samples from a cohort of 68 healthy and disease dogs from a highly endemic area and we have also studied the relationship of these levels with parasitological and immunological parameters. The sick dogs presented significantly lower (P < 0.001) vitamin D levels (19.6 ng/mL) than their non-infected (31.8 ng/mL) and the asymptomatic counterparts (29.6 ng/mL). In addition, vitamin D deficiency correlated with several parameters linked to leishmaniasis progression. However, there was no correlation between vitamin D levels and the Leishmania-specific cellular immune response. Moreover, both the leishmanin skin test and the IFN-γ levels displayed negative correlations with serological, parasitological and clinical signs. Further studies to determine the functional role of vitamin D on the progression and control of canine leishmaniasis are needed.

How is post-mortem microbiology appraised by pathologists? Results from a practice survey conducted by ESGFOR.

Post-mortem microbiology (PMM) is an important tool in forensic pathology, assisting to determine the cause and manner of death. However, there is a lack of standardisation of PMM sampling. In order to get a better insight into the methods used, the available technical options and developmental needs, ESCMID Study Group for Forensic and Postmortem Microbiology (ESGFOR) members designed a survey aimed at pathologists regarding common practices of PMM in clinical and forensic autopsies. Multiple choice questions were developed based on Cumulative Techniques and Procedures in Clinical Microbiology (Cumitech). The questionnaire was sent to pathologists mainly across Europe and Turkey using SurveyMonkey. The survey had 147 respondents. Although all pathologists were aware of the existence of PMM, 39% (19/49) of the participants were not using it. The three main indications for PMM were: (i) clinical suspicion of an infection not confirmed antemortem (83%), (ii) infectious signs at autopsy (83%) and (iii) as part of a standard protocol for foetal/perinatal or paediatric death (67%). Almost 80% of the participants using PMM stated taking 1-10 samples per case. Of the requested examinations, a general bacteriological culture (96%) and a specific polymerase chain reaction (PCR) assay for a particular infectious agent (34%) were most popular. The most frequent samples were: heart blood (66%), peripheral femoral blood (49%), spleen (64%) and lung (56%). Eighty-nine percent of the participants considered PMM a useful resource when investigating the cause of death. Although there are some common uses, this survey indicates that there is a need for improvement towards standardising sampling procedures in PMM.

Litotricia extracorpórea en pacientes pediátricos / Pediatric Extracorporeal Shock Wave Lithotripsy

Introducción. La Litotricia Extracorpórea por Ondas de Choque (LEOC) constituye el pilar fundamental de la urolitiasis infantil. En este trabajo pretendemos objetivar la tasa de fragmentación y expulsión de cálculos mediante LEOC. Material y Métodos. Revisión retrospectiva de procedimientos de LEOC pediátricos, analizando etiología, clínica, tasa de éxito, factores asociados al mismo y complicaciones. Análisis: SPSS 17.0. Resultados. Se revisaron 90 niños (edad: 8 meses-10 años -mediana 2,9 años) que habían presentado 122 litiasis y precisaron 162 procedimientos de LEOC entre 2003 y 2012. Mediana de seguimiento: 20 meses. Diámetro medio del cálculo: 12,2 mm (rango 4-25 mm). La clínica más habitual fue Infección del Tracto Urinario (ITU) (55,6%, 50 niños). El 3,3% de los cálculos se localizaron en vejiga, el 21,3% en uréteres y el 75,4% en riñón. Se realizó una media de 1,41 LEOC por episodio litiásico. Se consiguió fragmentación y expulsión en el 80,3% (98) de los cálculos. Esta tasa fue mayor en niños menores de 5 años (86,1% vs. 69,8%, p=0,03) y en cálculos asociados a prematuridad y estancia prolongada en UCI (100% vs. 78,4%, p=0,19); y peor en cálculos coraliformes (66% vs. 87,2%, p=0,021), y en los de cistina (30% vs. 84,8%, p< 0,001). Entre los 162 procedimientos, hubo 17 complicaciones (10,4%): (6 ITUs -3,7%-, y 5 ITUs asociadas a calle litiásica -3%-), todas relacionadas con cálculos grandes, coraliformes y/o de estruvita. Conclusión. Los mejores resultados en LEOC se objetivan en los pacientes de menor edad. La LEOC pediátrica es eficaz y segura

Introduction. Extracorporeal Shock Wave lithotripsy (ESWL) is the cornerstone of pediatric urolitiasis management. We evaluated its efficacy and complications in a series of children. Material and Methods. Children who were managed with ESWL between 2003 and 2012 were retrospectively reviewed. We studied etiology, clinical presentation, stonefree ratio and relevant complications. SPSS 17.0 software was used. Results.-90 children aged 0 to 10 years (median 2.9 years) were included in the study; that accounted for 122 stones and 162 ESWL sessions. Mean follow up was 20 months. Mean stone diameter was 12.2 mm. (range 4-25). Most prevalent clinical sign was urinary infection (55.6%, 50 patients). 75.4% of the lithiasis were found in renal pelvis or calices. A mean of 1.42 ESWL sessions per stone was performed. Stonefree status was reached in 80.3% (98) of the lithiasis. This rate was higher in patients below 5 years of age (86.1% vs., 69.8%, p=0.03), and worse in staghorn calculi (66% vs. 87.2%) and cystine ones (30% vs. 84.8%, p< 0.001). We observed 17 complications (10.4% among 162 sessions), 6 UTIs, 6 episodes of fever and 6 episodes of UTI associated with steinstrasse. Almost all complications were associated with bigger size, staghorn calculi and struvite. Discussion. Best results are found in younger patients and small calculi. ESWL is a safe and efficient procedure in pediatric patients

[Pediatric Extracorporeal Shock Wave Lithotripsy]. / Litotricia extracorpórea en pacientes pediátricos.

INTRODUCTION: Extracorporeal Shock Wave lithotripsy (ESWL) is the cornerstone of pediatric urolitiasis management. We evaluated its efficacy and complications in a series of children. MATERIAL AND METHODS: Children who were managed with ESWL between 2003 and 2012 were retrospectively reviewed. We studied etiology, clinical presentation, stonefree ratio and relevant complications. SPSS 17.0 software was used. RESULTS: 90 children aged 0 to 10 years (median 2.9 years) were included in the study; that accounted for 122 stones and 162 ESWL sessions. Mean follow up was 20 months. Mean stone diameter was 12.2 mm. (range 4-25). Most prevalent clinical sign was urinary infection (55.6%, 50 patients). 75.4% of the lithiasis were found in renal pelvis or calices. A mean of 1.42 ESWL sessions per stone was performed. Stonefree status was reached in 80.3% (98) of the lithiasis. This rate was higher in patients below 5 years of age (86.1% vs., 69.8%, p=0.03), and worse in staghorn calculi (66% vs. 87.2%) and cystine ones (30% vs. 84.8%, p<0.001). We observed 17 complications (10.4% among 162 sessions), 6 UTIs, 6 episodes of fever and 6 episodes of UTI associated with steinstrasse. Almost all complications were associated with bigger size, staghorn calculi and struvite. DISCUSSION: Best results are found in younger patients and small calculi. ESWL is a safe and efficient procedure in pediatric patients.

INTRODUCCION: La Litotricia Extracorpórea por Ondas de Choque (LEOC) constituye el pilar fundamental de la urolitiasis infantil. En este trabajo pretendemos objetivar la tasa de fragmentación y expulsión de cálculos mediante LEOC. MATERIAL Y METODOS: Revisión retrospectiva de procedimientos de LEOC pediátricos, analizando etiología, clínica, tasa de éxito, factores asociados al mismo y complicaciones. Análisis: SPSS 17.0. RESULTADOS: Se revisaron 90 niños (edad: 8 meses-10 años -mediana 2,9 años) que habían presentado 122 litiasis y precisaron 162 procedimientos de LEOC entre 2003 y 2012. Mediana de seguimiento: 20 meses. Diámetro medio del cálculo: 12,2 mm (rango 4-25 mm). La clínica más habitual fue Infección del Tracto Urinario (ITU) (55,6%, 50 niños). El 3,3% de los cálculos se localizaron en vejiga, el 21,3% en uréteres y el 75,4% en riñón. Se realizó una media de 1,41 LEOC por episodio litiásico. Se consiguió fragmentación y expulsión en el 80,3% (98) de los cálculos. Esta tasa fue mayor en niños menores de 5 años (86,1% vs. 69,8%, p=0,03) y en cálculos asociados a prematuridad y estancia prolongada en UCI (100% vs. 78,4%, p=0,19); y peor en cálculos coraliformes (66% vs. 87,2%, p=0,021), y en los de cistina (30% vs. 84,8%, p<0,001). Entre los 162 procedimientos, hubo 17 complicaciones (10,4%): (6 ITUs ­3,7%­, y 5 ITUs asociadas a calle litiásica ­3%­), todas relacionadas con cálculos grandes, coraliformes y/o de estruvita. CONCLUSION: Los mejores resultados en LEOC se objetivan en los pacientes de menor edad. La LEOC pediátrica es eficaz y segura.

Esfínter urinario artificial: consideraciones radiológicas sobre sus características morfológicas, ubicación y complicaciones / Artificial urinary sphincter: radiologic considerations about its morphological characteristics, location and complications

La incidencia de incontinencia urinaria en hombres se estima que se encuentra globalmente, en alrededor de un 1-39%. El origen en la mayoría de casos es la realización previa de prostatectomía radical. El EUA es un dispositivo activación manual, cuyo mecanismo impide la pérdida involuntaria de orina y esta indicado en pacientes con incontinencia de esfuerzo moderada a severa con deterioro de la calidad de vida. Las complicaciones pueden ser mecánicas (fallo mecánico, fuga del medio liquido, problemas de llenado del reservorio) y no mecánicas (atrofia o erosión uretral, infección, hematoma, retención aguda de orina, recidiva de la incontinencia, migración). Se realizó una revisión de la literatura, en la que se pretende dar un bosquejo inicial de la valoración del EUA con las diferentes pruebas imagen (AU)

Urinary incontinence in men has a global prevalence of 1-39%. Of those patients, there is a group that develop secondary stress incontinence as an adverse outcome of radical prostatectomy. The artificial urinary sphincter is a mechanical device that allows a urethral occlusion preventing urinary leakage. It is the gold standard treatment for patients that developed stress incontinence after radical prostatectomy. Complications from urinary artificial sphincter are mechanic (mechanical failure, leakage of contrast fluid, problems of reservoir filling) and no mechanic (atrophy or urethral erosion, infection, hematoma, urinary retention, recurrent incontinence, migration). This review show an overview of the artificial urinary sphincter assessment with conventional imaging (AU)

Morphological and biometrical features of Trypanosoma evansi isolates from an outbreak in mainland Spain.

According to several authors, Trypanosoma evansi is a monomorphic trypanosome found exclusively in slender intermediate forms, although additional studies have revealed that many strains present stumpy forms on rare occasions. In a recent T. evansi outbreak in mainland Spain, several atypical forms were observed in blood smear examinations. Molecular procedures were then necessary to confirm the causal agent. Morphological and biometric measures were taken to characterize the different forms of T. evansi. In contrast to published information, the results of this study would indicate that biometrically distinct T. evansi could also be found in the same farm and even in the same animal species. These data could be useful for many trypanosomes endemic areas of the world where molecular methods are not commonly available.

Enhancement of laplacian EEnG from humans by means of an EMD-based method.

Non-invasive recordings of intestinal myoelectrical activity (Electroenterogram, EEnG) are affected by very-low-frequency (VLF) interferences, respiration, ECG and movement artifacts. In order to identify the intestinal pacemaker activity (slow wave), VLF interferences and respiration should be removed from abdominal surface recordings. In this paper a method based on empirical mode decomposition is proposed to identify and cancel such interferences and to enhance external recordings of human EEnG. The study was carried out on 10 recording sessions in which it was acquired 3 surface EEnG signals by means of active laplacian electrodes, together with respiratory and ECG signals. The application of the proposed method permits to increase the signal-to-interference ratio of EEnG signals from - 7.9 ± 3.3 dB to 6.1 ± 2.7 dB. In addition, the method helps to identify the intestinal pacemaker activity from surface EEnG recordings: the dominant frequency of processed signals is 8.6 ± 1.7 cpm which fits the frequency of the intestinal slow wave in the jejunum, whereas the dominant frequency of original signals was 1.6 ± 1.1 cpm which is associated to VLF interferences.

Trypanosoma evansi infection in mainland Spain.

An outbreak of Trypanosoma evansi infection that occurred in mainland Spain is described. The outbreak occurred on an equine and camel farm to which dromedary camels from an infected area of the Canary Islands had recently been introduced. One of these camels developed clinical signs and T. evansi was discovered in a blood smear examination. The herd was evaluated in order to determine the extent of the disease. The results showed that 76% of the camels, 35% of the donkeys and 2% of the horses were affected. The animals were isolated and treated using Cymelarsan((R)) (0.5mg/kg). After treatment, three blood analysis using parasitological methods revealed negative results. This is the first T. evansi outbreak to have occurred in mainland Spain and the second in mainland Europe, both occurring after the introduction of dromedary camels from the Canary Islands.

Bifidez pieloureteral proximal derecha incompleta y triplicidad pieloureteral proximal izquierda incompleta / Right proximal partial bifidus pelvis and ureter and left partial proximal pyeloureteral triplicity

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Little evidence of seasonal variation of natural infection by Leishmania infantum in dogs in Spain.

Leishmania infantum, the etiological agent of canine leishmaniosis in the Mediterranean region, is vectored by Phlebotomus spp sandflies, which are active during the warmer months of the year. In order to determine whether seasonality in transmission induces seasonal changes in the prevalence of infection by L. infantum and of parasite-specific immune response, two groups of dogs, one in February (n=37) and another in October (n=42), were studied. Clinical signs compatible with leishmaniosis, as well as presence of microscopic skin lesions in the muzzle were recorded for all dogs. Assays were also performed for detection of L. infantum parasites in muzzle skin samples (PCR, immunohistochemistry and culture), specific serum antibodies (ELISA), and specific lymphocyte proliferation and interferon-gamma production. Although prevalence of non-specific clinical signs increased significantly after the sandfly season, this was not the case for Leishmania-specific markers: positivity by PCR (24% vs. 21%) or immunohistochemistry (3% vs. 2%) of muzzle skin samples, as well as lymphocyte proliferation (59% vs. 50%) or interferon-gamma production (21% vs. 27%) were similar in February and in October. Only prevalence of positive specific antibody titers increased noticeably in October (8% vs. 20%), although this was not statistically significant. Overall, the sandfly season did not have a marked impact on the prevalence L. infantum infection or parasite-specific immune responses analyzed in this study.

Longitudinal analysis of cytokine gene expression and parasite load in PBMC in Leishmania infantum experimentally infected dogs.

Canine visceral leishmaniasis (CVL) is caused by Leishmania infantum, an intracellular protozoan parasite that causes a severe infectious disease. To evaluate the gene expression profile associated to CVL in vivo, we have measured monthly by real-time PCR over one year the IL-4, IL-10, IL-12, IL-13, IFN-gamma, TGF-beta and TNF-alpha mRNA levels in peripheral blood mononuclear cells in 6 experimentally infected dogs that exhibited different progressions of the illness. While in two dogs no parasite, or a very low number of parasites, was detected and the two dogs did not show any clinico-pathological abnormalities at the end of the study (L dogs), for the remaining dogs high parasite loads were detected and they developed clinical leishmaniasis (H dogs). The L dogs have null expression of both IL-4 and IL-13 for the first 4 months after the infection, whereas an early IL-4 and IL-13 expression occurs in this period of infection in most of the dogs that developed clinical leishmaniasis (H dogs). Furthermore, a higher IFN-gamma expression was associated with the increase of parasite load and clinical status in these dogs. Moreover, the high variability of expression at the pre-infection stage causes us to reject the possibility that the basal levels of these cytokines indicate the prognosis of the subsequent response against infection.

Quiste hidatídico renal / Renal hydatidic cyst

La hidatidosis o equinococosis es una parasitosis zoonótica causada por céstodos del género Ecchinococcus granulosus. La localización más frecuente del quiste hidatídico es el hígado, seguida de la pulmonar. La afectación renal es muy poco frecuente. Presentamos un caso de un varón de 41 años que se realizó un TAC torácico por dificultad respiratoria; en éste se observaba una masa de aspecto sólido. Se comple´to el estudio mediante una ecografía renovesical y un TAC abdominal llegando a las mismas conclusiones. Dada la alta sospecha de tumoración maligna se realizó una nefrectomía radical abierta. El estudio anatomo-patológico informó de quiste hidatídico. La larva de la hidatidosis habita generalmente en el intestino de los perros, el hombre es un huésped intermediario. El quiste hidatídico renal no da clínica específica y a veces como es en nuestro caso se diagnositica de forma incidental a través de pruebas de imagen mostrando diferentes características que pueden ser compatibles con un quiste tanto con un tumor renal. El tratamiento fundamental del quiste hidatídico es la exéresis quirúrgica

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Quistes renales complejos. Diagnóstico diferencial con el cáncer renal: a propósito de dos casos clínicos / Complex renal cysts. Differential diagnosis with renal cancer: two clinical cases

El carcinoma de células renales en un 10% de los casos puede aparecer con un patrón morfológico quístico. Las lesiones quísticas renales pueden dividirse en quistes renales simples, siendo fácilmente diagnosticables por ecografía, y quistes renales complejos, para los cuales existe una clasificación radiológica basada en la TC conocida como clasificación de Bosniak (categorías I,II, IIF, III, IV). Este artículo trata sobre las lesiones quísticas renales de dos casos clínicos. El primero consiste en unquiste complicado Bosniak IV en un varón de 44 años que es tratado con nefrectomía radical (anatomía patológica: carcinoma renal de células claras grado II estadía T1). El segundo, consiste en un quiste simple en mujer de 49 años, tratado con punción-aspiración ecodirigida, con desaparición a los 6 meses. Ante una masa quística renal el principal objetivo de la radiología es diferenciar la masa quirúrgica de la masa no quirúrgica. La ecografía es una prueba realizada habitualmente en nuestro medio por motivos varios y favorece el hallazgo incidental de masas renales de forma precoz. La TX es la prueba más sensible y específica para el diagnóstico de CCR y es la base de la clasificación de Bosniak. Para el estudio densiométrico en la TC se utilizan las Unidades Hunsfield cuyos coeficientes de atenuación a tener en cuenta son: <10 (lesión benigna), 10-15 (lesión sospechosa), >15 (lesión maligna). La RNM se emplea en caso de trombosis venosa, alergia y contraste yodado y alteración de la función renal, siendo sus resultados parecidos a la TC. La actitud a seguir en los quistes renales es la siguiente: Bosniak I no requieren seguimiento; Bosniak II, IIF seguimiento; Bosniak III y IV tratamiento quirúrgico

The carcinoma of renal cells in 10% of the cases can appear with a cystic morphology. The cystic renal lesions can be divided into simple renal systs that you can diagnose with ultrasound, and complex renal cysts, which have a special classification called Bosniak classification (I, II, IIF, III, IV categories). This article is based on two clinical cases of cystic renal mass. The first one is about a Bosniak IV complicated cyst in a 44 years old patient treated with a radical nephrectomy (pathologic anatomy: renal cell carcinoma, II grade, T1 stage). The second consists in a simple cyst in a 49 years old patient, treated with puncture and aspiration of it, which disappears after 6 months. The main objective of radiology with renal cystic mass is to differentiated into surgical and not surgical lesions. The ultrasound is a test realized very often in our locality and helps in finding precocious renal mass. The most sensible and specific proof for the diagnose of RCC is tomography, in which Bosniak Classification is based. Hounsfield units are used to study the densitometric of TC and the important attenuation values are:<10 (benign lesion), 10-15 (suspicious lesion), >15 (malignant lesion). The magnetic nuclear resonance is used in case of venous thrombosis, allergy to iodine contrast and alteration of the renal function; its results are similar to TC. The attitude in the renal cysts is: Bosniak I does not need the following. Bosniak II and IIF needs the following, Bosniak III and IV needs surgical treatment

Effect of highly active anti-retroviral therapy and hepatitis C virus co-infection on serum levels of pro-inflammatory and immunoregulatory cytokines in human immunodeficiency virus-1-infected individuals.

This study aimed to determine the effect of highly active anti-retroviral therapy (HAART) and hepatitis C virus (HCV) co-infection on peripheral levels of interleukin (IL)-2, IL-10, IL-12 (p70), IL-18 and soluble tumour necrosis factor receptor type II (sTNFRII). Serum levels were monitored for a 1-year period in 25 patients infected with human immunodeficiency virus-1 (HIV-1) who were naive for HAART at the initiation of the study, and in four HIV-1-infected long-term non-progressors. Serum levels of both IL-18 and sTNFRII at baseline were significantly higher in HIV-1-infected patients than in controls. Baseline levels of IL-18 and sTNFRII were not significantly different in long-term non-progressors compared with the other patients. HCV co-infected patients had significantly higher levels of IL-18 and sTNFRII at each time-point compared with patients who were not co-infected with HCV. Irrespective of HCV status, response to HAART resulted in a significant decrease in the levels of both IL-18 and sTNFRII, particularly among patients who achieved HIV viral suppression, but the net decrease observed at the end of follow-up was lower in patients co-infected with HCV. No information was obtained from IL-2, IL-10 and IL-12 (p70) measurements. The data suggest that analysis of serum levels of IL-18 and sTNFRII may be a valuable tool for evaluating the response to HAART, and perhaps for assessing the degree of immune restoration achieved by HAART responders. The results also highlight the relevance of considering the HCV infection status of HIV-1-infected patients in order to avoid misinterpretation of IL-18 and sTNFRII measurements.

Masa pelviana en paciente con adenocarcinoma de próstata / Pelvic mass in a patient with prostatic adenocarcinoma

Se presenta el caso de un paciente que tras biopsias prostáticas seriadas, por PSA persistentemente elevado, se diagnostica de ADC de próstata. En el estudio de extensión se detectan metástasis hepáticas y una masa abdominal que tras biopsia percutánea, se diagnostica de GIST

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