Differential effect of appendectomy and tonsillectomy on anti-Kudoa sp. antibodies in patients with MALTectomy.

We found an association between tonsillectomized patients and subsequent appendicitis. We also observed that MALTectomy significantly decreased secretory IgA levels in serum of patients, being this decrease more pronounced when both operations (tonsillectomy and appendectomy) had been performed. The elevated humoral responses detected previously by us in BALB/c mice immunized with Kudoa sp. pseudocyst extracts and the high IgG1 and IgE levels induced by the oral administration of Kudoa sp. pseudocysts to BALB/c mice showed the possible immunopathological effects in man from the ingestion of Kudoa sp. infected fish. We use the ELISA method to investigate the possible relationship between MALTectomy (tonsillectomy and appendectomy) and specific antibody levels to Kudoa sp. Both anti-Kudoa sp. specific antibody levels and the number of patients that recognized Kudoa sp. antigens were greater in tonsillectomy patients when compared to the control and the other studied groups (appendectomized and appendectomized+tonsillectomies patients). Tonsillectomy was associated to a switch in the class of immunoglobulins involved in these responses and these responses may be abrogated by appendectomy. Tonsils and appendix may respond in different ways to Kudoa sp. antigens and these different reactions may be involved in some immunopathological reactions.

Anisakis simplex and Kudoa sp.: evaluation of specific antibodies in appendectomized patients.

High prevalence and intensity of infection with anisakid larvae has been reported in commercially important fish in Spain. Likewise, Kudoa-infected fish have lately been detected in both fresh and frozen fish. In the present study the possible relation between appendectomy and specific antibodies to these fish parasites was investigated. One hundred and sixty patients were enrolled in this study. They were divided into two groups of eighty patients each and matched for sex and age: Group 1 (appendectomized) and Group 2 (control group). Total immunoglobulins (Ig's), IgG, IgM, IgA and IgE against Anisakis simplex or Kudoa sp. antigens were analysed by ELISA. The mean values of the specific antibodies were lower in the appendectomy group, although significant differences were not observed in the case of IgG, IgA and IgE anti-A. simplex and IgE anti-Kudoa sp. In summary, appendectomy significantly decreased serum specific immunoglobulin levels against these food borne parasite antigens. This decrease was detectable from three months to three years post-appendectomy. It is necessary to study the influence of the surgical removal of other important parts of the GALT on these anti-parasite humoral immune responses.

Ginecomastia bilateral y tratamiento con omeprazol / Bilateral bynecomastia and treatment with omeprazolel

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Association between tonsillectomy, adenoidectomy, and appendicitis.

INTRODUCTION: Tonsillectomy, with or without adenoidectomy, is one of the most frequent surgical procedures generally performed, especially in young patients. Several studies suggest that there is a relationship between tonsillectomy and altered MALT immune system. OBJECTIVE: To examine the possible association between tonsillectomy or adenoidectomy and the risk of subsequent appendicitis. MATERIAL AND METHOD: A cross-sectional study was performed in 650 patients admitted to the emergency department of a general hospital in Valencia, Spain. Previous history of tonsillectomy and/or adenoidectomy was related to a history of appendectomy. A descriptive study and an analysis of the relationship between previous operations and appendicitis was performed. A multivariable analysis controlled for age and sex was also performed, including the possible interaction of the gender variable. The independent effect of each of the procedures (tonsillectomy, adenoidectomy) was tested. RESULTS: The 25.5% of patients had undergone tonsillectomy and 11.5% adenoidectomy; 17.5% had had an appendectomy. On average, women were operated on more frequently than men. In the bivariate analysis, both tonsillectomy and adenoidectomy were significantly associated with subsequent appendectomy. In the multivariate analysis, this association was only maintained for tonsillectomy (OR: 3.23; 95% CI: 2.11-4.94). A stratified analysis controlling for sex showed a modification of this effect, with a higher association in women (OR: 5.20; 95% CI: 2.91-9.28) than in men (OR: 1.74; 95% CI: 0.90-3.39). CONCLUSIONS: A clear association has been found, especially in women, between previous tonsillectomy and subsequent acute appendicitis. Due to a lack of data on acute appendicitis there should be further studies to explain the findings of this study, as this could be the first described risk factor of acute appendicitis.

Asociación entre amigdalectomía, adenoidectomía y apendicitis / Association between tonsillectomy, adenoidectomy, and appendicitis

Introduction: tonsillectomy, with or without adenoidectomy,is one of the most frequent surgical procedures generally performed,especially in young patients. Several studies suggest thatthere is a relationship between tonsillectomy and altered MALTimmune system.Objective: to examine the possible association between tonsillectomyor adenoidectomy and the risk of subsequent appendicitis.Material and method: a cross-sectional study was performedin 650 patients admitted to the emergency department of a generalhospital in Valencia, Spain. Previous history of tonsillectomyand/or adenoidectomy was related to a history of appendectomy.A descriptive study and an analysis of the relationship betweenprevious operations and appendicitis was performed. A multivariableanalysis controlled for age and sex was also performed, includingthe possible interaction of the gender variable. The independenteffect of each of the procedures (tonsillectomy,adenoidectomy) was tested.Results: the 25.5% of patients had undergone tonsillectomyand 11.5% adenoidectomy; 17.5% had had an appendectomy.On average, women were operated on more frequently than men.In the bivariate analysis, both tonsillectomy and adenoidectomywere significantly associated with subsequent appendectomy. Inthe multivariate analysis, this association was only maintained fortonsillectomy (OR: 3.23; 95% CI: 2.11-4.94). A stratified analysiscontrolling for sex showed a modification of this effect, with ahigher association in women (OR: 5.20; 95% CI: 2.91-9.28) thanin men (OR: 1.74; 95% CI: 0.90-3.39).Conclusions: a clear association has been found, especially inwomen, between previous tonsillectomy and subsequent acute appendicitis.Due to a lack of data on acute appendicitis there shouldbe further studies to explain the findings of this study, as this couldbe the first described risk factor of acute appendicitis

[Mesenteric panniculitis with retroperitoneal involvement resolved after treatment with intravenous cyclophosphamide pulses]. / Paniculitis mesentérica con afectación retroperitoneal resuelta tras tratamiento con pulsos de ciclofosfamida endovenosa.

Mesenteric panniculitis is an inflammatory process of the adipose tissue of the mesentery. It produces a thickening of the mesentery of the small bowel or colon and can occasionally involve the retroperitoneum. It is characterized by an infiltration of lipid-laden macrophages and associated with variable degrees of inflammation and fibrosis. Several treatments have been used, including colchicine, dapsone, corticosteroids associated or not with immunosuppressants, but there are no prospective controlled studies to define appropriate treatment: moreover, there are cases of regression without specific therapy. We present the case of a patient with mesenteric panniculitis affecting the colon and retroperitoneal space including the right ureter and iliac vein. Immunosuppressive treatment with monthly intravenous pulse cyclophosphamide and oral corticosteroids, resulted in the disappearance of the abdominal mass without relapse during ten months of monitoring.

Paniculitis mesentérica con afectación retroperitoneal resuelta tras tratamiento con pulsos de ciclofosfamida endovenosa / Mesenteric panniculitis with retroperitoneal involve ment resolved after treatment with intravenous cyclophosphamide pulses

La paniculitis mesentérica es un proceso inflamatorio del tejido graso mesentérico. Cursa con un engrosamiento del mesenterio del intestino delgado o colon y puede afectar en ocasiones al retroperitoneo. Se caracteriza por una infiltración de macrófagos cargados de grasa y asociados a un grado variable de inflamación y fibrosis. En el tratamiento se ha empleado colchicina, dapsona, corticoides asociados o no a inmunosupresores, pero no hay estudios controlados prospectivos que definan el tratamiento adecuado. Además hay casos de regresión sin terapéutica específica. Presentamos el caso de una paciente con paniculitis mesentérica con afectación del colon y espacio retroperitoneal englobando el uréter y la vena ilíaca derechos. El tratamiento médico inmunosupresor con ciclofosfamida en pulsos mensuales endovenosos y corticoides orales, consiguió la desaparición de la masa abdominal sin recaída durante diez meses de seguimiento (AU)

Background: The most commonly used measures of association in cross-sectional studies are the odds ratio (OR) and the prevalence ratio (PR). Some cross-sectional epidemiologic studies describe their results as OR but use the definition of PR. The main aim of this study was to describe and compare different calculation methods for PR described in literature using two situations (prevalence < 20% and prevalence > 20%). Material and methods: A literature search was carried out to determine the most commonly used techniques for estimating the PR. The four most frequent methods were: 1) obtaining the OR using non-conditional logistic regression but using the correct definition; 2) using Breslow-Cox regression; 3) using a generalized linear model with logarithmic transformation and binomial family, and 4) using the conversion formula from OR into PR. The models found were replicated for both situations (prevalence less than 20% and greater than 20%) using real data from the 1994 Catalan Health Interview Survey. Results: When prevalence was low, no substantial differences were observed in either the estimators or standard errors obtained using the four procedures. When prevalence was high, differences were found between estimators and confidence intervals although all the measures maintained statistical significance. Conclusion: All the methods have advantages and disadvantages. Individual researchers should decide which technique is the most appropriate for their data and should be consistent when using an estimator and interpreting it (AU)

Actitud a seguir en el caso de accidente biológico / Steps to follow in case of a biological accident

La transmisión del virus de la inmunodeficiencia humana (VIH), el virus de la hepatitis B (VHB) o el virus de la hepatitis C (VHC), desde un paciente portador a un trabajador sanitario, puede ocurrir a través de pinchazos accidentales con agujas o heridas con instrumentos cortantes. Aunque poco frecuente, la trascendencia médica y legal que una exposición ocupacional puede tener para el personal sanitario es importante. Dado el riesgo de transmisión de enfermedades infecto-contagiosas de elevada morbimortalidad, y la necesidad de tener perfectamente establecida una secuencia de actuación, hacen que estas recomendaciones de profilaxis postexposición deban ser conocidas y estar al alcance de todos los profesionales sanitarios que realicen una labor asistencial. Con este fin realizamos esta revisión y puesta al día de la "actitud a seguir en caso de accidente biológico", primando la practicidad de aplicación dentro de la amplitud que un tema tan interesante conlleva. (AU)

[Alien hand syndrome in Creutzfeldt-Jakob disease]. / Síndrome de la mano alienígena en la enfermedad de Creutzfeldt-Jakob.

Alien hand syndrome is defined by uncontrolable actions of the arm and hand that seem to have a purpose. It is usually associated with acute focal lesions after a stroke or surgery of the corpus callosum. It has been described in chronic dementiating diseases such as cortico-basal degeneration, Alzheimer's disease, orthochromatic leukodystrophy and Marchiafava-Bignami disease. We now report a patient with Creutzfeldt-Jakob disease and alien hand syndrome, which appeared after the cognitive alterations and had characteristics of the frontal type of alien hand affecting the dominant upper limb. In the three cases described previously in the literature the alien hand affected the non-dominant hand and the abnormal movement appeared before dementia was clinically obvious. The non specific nature and poorly localising sign of alien hand is remarked. Alien hand should be added the list of features of Creutzfeldt-Jakob disease.

Síndrome de la mano alienígena en la enfermedad de Creutzfeldt-jakob / Alien hand syndrome in CreutzfeldtJakob disease

El síndrome de la mano alienígena se caracteriza por acciones incontroladas del brazo y la mano que parecen tener un propósito. La extrañeza que causa al sujeto esa extremidad y sus acciones define a este síndrome. Se asocia habitualmente a lesiones focales agudas tras ictus y a tumores o cirugía sobre el cuerpo calloso. También se ha descrito en enfermedades crónicas demenciantes como la degeneración corticobasal, la enfermedad de Alzheimer, la leucodistrofia ortocromática y la enfermedad de Marchiafava-Bignami. Describimos el caso de un paciente con enfermedad de Creutzfeldt-Jakob y síndrome de la mano alienígena que aparece con posterioridad a la alteración cognitiva y que reúne características de mano alienígena en su variante frontal con afección de mano dominante. En los tres casos previamente descritos en la bibliografía la afección fue de la mano no dominante y este movimiento anormal precedió al deterioro cognitivo. Se señala la inespecifidad de este síndrome en cuanto a etiología y valor localizador. Sugerimos que la mano alienígena debe considerarse como una de las posibles manifestaciones de la enfermedad de Creutzfeldt-Jakob (AU)