Tribocorrosion behavior of beta titanium biomedical alloys in phosphate buffer saline solution.

The tribo-electrochemical behavior of different ß titanium alloys for biomedical applications sintered by powder metallurgy has been investigated. Different mechanical, electrochemical and optical techniques were used to study the influence of the chemical composition, Sn content, and the electrochemical conditions on the tribocorrosion behavior of those alloys Ti30NbxSn alloys (where "x" is the weight percentage of Sn content, 2% and 4%). Sn content increases the active and passive dissolution rate of the titanium alloys, thus increasing the mechanically activated corrosion under tribocorrosion conditions. It also increases the mechanical wear of the alloy. Prevailing electrochemical conditions between -1 and 2V influences the wear accelerated corrosion by increasing it with the applied potential and slightly increases the mechanical wear of Ti30Nb4Sn. Wear accelerated corrosion can be predicted by existing models as a function of electrochemical and mechanical parameters of the titanium alloys.

Electrochemical behavior of near-beta titanium biomedical alloys in phosphate buffer saline solution.

The electrochemical behavior of three different near-ß titanium alloys (composed by Ti, Nb and Sn) obtained by powder metallurgy for biomedical applications has been investigated. Different electrochemical and microscopy techniques were used to study the influence of the chemical composition (Sn content) and the applied potential on the microstructure and the corrosion mechanisms of those titanium alloys. The addition of Sn below 4wt.% to the titanium powder improves the microstructural homogeneity and generates an alloy with high corrosion resistance with low elastic modulus, being more suitable as a biomaterial. When the Sn content is above 4%, the corrosion resistance considerably decreases by increasing the passive dissolution rate; this effect is enhanced with the applied potential.

Incidence of adult form of autoimmune hepatitis in Valencia (Spain).

BACKGROUND AND STUDY AIMS: There is little information on the incidence of autoimmune hepatitis (AIH) because on many occasions the disease can progress asymptomatically, different diagnostic criteria have been proposed during the last 20 years, and many epidemiological studies are based on retrospective clinical series. The aim of this study was to determine the incidence of AIH in the province of Valencia, Spain, during the year 2003. PATIENTS AND METHODS: The Services of Gastroenterology of eight acute-care reference hospitals in the province of Valencia, Spain, covering 1,774,736 inhabitants over 14 years of age, participated in a prospective study. All newly diagnosed patients with AIH between January 1, 2003 and December 31, 2003 were eligible. The diagnosis was based on criteria of the International Autoimmune Hepatitis Group revised in 1999. RESULTS: There were 19 new cases of AIH, 18 females and 1 male [mean (SD) age of 54.3 (11.2) years, range 23-73]. Incidence peaked in the 45-54 year age group. Eighteen cases were classified as AIH type 1 and one case as AIH type 2. The incidence rate of AIH for the year 2003 in people older than 14 years of age was 1.07 new cases per 100,000 inhabitants, with 1.96 cases per 100,000 inhabitants in females and 0.12 cases per 100,000 inhabitants in males. CONCLUSIONS: The 2003 annual incidence of AIH in Valencia, Spain, was similar to that reported in other European countries. AIH occurred more frequently in women and in the 45-54 year age group, type 1 being the most common.

[A clinical study of adult autoimmune hepatitis in Valencia, Spain]. / Estudio clínico de la hepatitis autoinmune del adulto en Valencia.

OBJECTIVE: the clinical phenotype of autoimmune hepatitis (AIH) varies among geographical areas. The aim of this study is to determine the salient features of AIH in adult patients from the province of Valencia, Spain. MATERIAL AND METHODS: eighty-one patients with AIH attended to in eight acute-care hospitals between 1994 and 2003. New patients diagnosed with AIH during year 2003 were evaluated prospectively. Data from patients currently attending follow-up visits and diagnosed before 2003 were collected retrospectively. RESULTS: a total of 94% of patients were females. Forty-three percent were asymptomatic, 27% had acute hepatitis, and 30% had chronic hepatitis. Type 1 AIH was diagnosed in 90% of cases. Type 2 AIH was more frequent in younger patients, and presented with an acute pattern. One third of patients had cirrhosis at onset. Patients with cirrhosis were older than 60 years more frequently. Immunosuppressants were given to 57 patients, with complete or partial remission in 87.7%. There were no significant differences in response to immunosuppression according to presentation pattern or AIH subtype. CONCLUSIONS: AIH in Valencia was predominantly diagnosed in asymptomatic women. Most cases were type 1, and in 25% of patients another autoimmune disease coexisted. At the time of diagnosis one third of patients had cirrhosis, particularly those over 60 years.

Estudio clínico de la hepatitis autoinmune del adulto en Valencia / No disponible

Introducción: existen factores geográficos que influyen en lascaracterísticas de la hepatitis autoinmune (HAI).Objetivo: conocer las características epidemiológicas, clínicasy respuesta al tratamiento de la hepatitis autoinmune en la provinciade Valencia.Material y métodos: se trata de un estudio realizado en ochohospitales de Valencia, recogiendo de forma prospectiva los casosde hepatitis autoinmune diagnosticados en el año 2003 y deforma retrospectiva los diagnosticados entre 1994 y 2002.Resultados: se incluyeron 81 pacientes con HAI, siendo el94% mujeres. La forma de presentación fue: 43% asintomático,27% hepatitis aguda y 30% enfermedad hepática crónica. La mayoría(90%) fueron del tipo 1, mientras que las de tipo 2 fueronmás jóvenes (p = 0,007) y con predominio de hepatitis aguda (p= 0,04). Existía otra enfermedad autoinmune en uno de cada 4casos. Al momento del diagnóstico una tercera parte de los pacientespresentaba cirrosis. La cirrosis se presentó sobre todo enpacientes de más de 60 años (p < 0,01) y sin diferencias según laformas clínica (p = 0,1). El tratamiento se indicó en 57 casos ycon respuesta –completa o parcial– en el 87,7%. No se encontrarondiferencias significativas en la respuesta terapéutica según laforma de presentación ni los tipos de hepatitis autoinmune.Conclusiones: en nuestra zona la hepatitis autoinmune deladulto se presenta sobre todo en mujeres y de manera asintomática.La mayoría es tipo 1 y en el 25% de los casos coexiste otraenfermedad autoinmune. Al diagnóstico la tercera parte presentacirrosis hepática, sobre todo en los que tienen más de 60 años

Objective: the clinical phenotype of autoimmune hepatitis(AIH) varies among geographical areas. The aim of this study is todetermine the salient features of AIH in adult patients from theprovince of Valencia, Spain.Material and methods: eighty-one patients with AIH attendedto in eight acute-care hospitals between 1994 and 2003. Newpatients diagnosed with AIH during year 2003 were evaluatedprospectively. Data from patients currently attending follow-upvisits and diagnosed before 2003 were collected retrospectively.Results: a total of 94% of patients were females. Forty-threepercent were asymptomatic, 27% had acute hepatitis, and 30%had chronic hepatitis. Type 1 AIH was diagnosed in 90% of cases.Type 2 AIH was more frequent in younger patients, and presentedwith an acute pattern. One third of patients had cirrhosisat onset. Patients with cirrhosis were older than 60 years morefrequently. Immunosuppressants were given to 57 patients, withcomplete or partial remission in 87.7%. There were no significantdifferences in response to immunosuppression according to presentationpattern or AIH subtype.Conclusions: AIH in Valencia was predominantly diagnosedin asymptomatic women. Most cases were type 1, and in 25% ofpatients another autoimmune disease coexisted. At the time of diagnosisone third of patients had cirrhosis, particularly those over60 years

[Development of inflammatory bowel disease in a husband and wife]. / Desarrollo de enfermedad inflamatoria intestinal en ambos miembros de un matrimonio.

It is currently thought that chronic inflammatory bowel disease (IBD) may be due to the action of an as-yet unidentified external agent on genetically predisposed individuals. While genetic influence on the development of the disease has been widely studied, very little is known about the possible environmental agents that could influence its development. One example of the influence of environmental agents could be the development of chronic IBD in a husband and wife. We describe the case of a married couple; after more than 30 years of cohabitation, the wife developed fistulizing Crohn's disease and, 7 years later, the husband developed ulcerative proctosigmoiditis. Currently, approximately 70 cases have been described in the international literature but none have been reported in Spain. We discuss the characteristics of our patients compared with those described in published reports and stress the importance of describing these cases for the future identification of a possible external agent.

Cholelithiasic disease and associated factors in a Spanish population.

In order to analyze the factors associated with cholelithiasic disease, 1268 participants of a population sample were studied. On univariate analysis, 11 of the 23 variables included showed a statistically significant association (P < 0.05). Five of these variables, including obesity, triglyceride level, intake of hypolipidemic drugs, and a diet rich in cholesterol and saturated fats in women, and physical exercise in men, remained significantly associated after controlling for age. On multivariate analysis among women, a positive association was found with age (P < 0.001), obesity, and the use of hypolipidemic agents (P < 0.05) and a negative one with a diet rich in cholesterol and saturated fats (P < 0.05). Among men, the same analysis revealed there was a positive association with age (P < 0.001) and triglycerides (P < 0.05) and a negative one with physical exercise (P < 0.05). In conclusion, obesity and the use of hypolipidemic agents in women and triglycerides in men, were positively associated with cholelithiasic disease, independent of age, while negative associations included the intake of cholesterol and saturated fats in women and physical exercise in men.

[The prediction of the endoscopic diagnosis in the dyspepsia patient: the value of the predominating presenting symptom and the initial clinical presumption]. / Predicción del diagnóstico endoscópico en el paciente con dispepsia: valor del síntoma predominante de presentación y de la presunción clínica inicial.

AIM: To assess, in our patient population, whether upper gastrointestinal symptoms can be used to predict the presence of relevant pathology on endoscopy. PATIENTS AND METHODS: In the first retrospective phase, 311 gastroscopies, indicated for dyspeptic symptoms were selected. The gastroscopies were performed by the same endoscopist from April 1998 to March 1999. Patients were divided into four groups according to the main presenting symptom (epigastralgia, epigastralgia with pyrosis, pyrosis with nonspecific symptoms). The positive and negative predictive value, as well as the overall sensitivity and specificity of each group of symptoms for the presentation of a relevant pathology were calculated. In the second, prospective, phase an attempt was made, based on the clinical history taken in the initial consultation, to predict the results of the gastroscopies of 77 dyspeptic patients. There were four possibilities: normal or not relevant, esophagitis, ulcer and neoplasia. The positive predictive value, negative predictive value, sensitivity and specificity of the diagnostic hypothesis were calculated. RESULTS: a) Retrospective phase: the overall positive predictive value of dyspeptic symptoms to predict relevant pathology was 0.38. The highest positive predictive value corresponded to symptoms of pyrosis (0.48). Dividing the patients into groups according to age (older or younger than 45 years) did not improve the predictive value of symptoms. b) Prospective phase: the highest positive predictive value corresponded to "pathology without relevance" (0.7). The prediction of ulcer only gave a positive predictive value of 0.55. CONCLUSION: The main presenting symptom is not a good predictor of whether relevant pathology will be found on gastroscopy. The initial diagnostic hypothesis is not a sufficiently effective tool to accurately detect which patients will most benefit from gastroscopy.

[Prevalence of cholelithiasis in El Real-Gandia]. / Prevalencia de la enfermedad colelitiásica en El Real-Gandia.

The aim of this study was to know the prevalence of cholelithiasis (C) in the El Real-Gandia (Spain) as well as the degree of the response of the population. Health examinations were performed in 1,803 adults from El Real (2,000 inhabitants) and Gandia (54,000 inhabitants) using abdominal echography as the screening technique. Cholelithiasis was defined as the presence of biliary lithiasis (BL) or previous cholecystectomy (PC). Of 1,268 (70.3%) participants in the study, C was found in 126 cases (BL in 102 and P in 24) representing a standardized prevalence of around 15% in women and 5% in men. Cholelithiasis was more frequent in females (13.8%) than in males (5.7%) (p < 0.001) increasing linearly with age (p < 0.005). The proportion of PC was significantly higher in women (23.9%) than in men (5.9%) (p < 0.05) and in Gandia (34.4%) than in El Real (13.8%) (p < 0.02). The prevalence of biliary mud and polyps was of 0.3% and 1.1%, respectively. Working obligations (35.4%) and fear of hospitals (22.4%) were the most frequent causes for no response (NR). Males with more than primary a school education originating from outside the Valencian community (VC) were significantly associated with NR in multivariant analysis.

[Hepatitis B markers at 3 open centers for mentally retarded]. / Marcadores de la hepatitis B en tres centros abiertos para disminuidos psíquicos.

With the aim of investigating the prevalence of hepatitis B virus infection, we studied 161 mentally retarded patients with an age range of 1 to 56, in three open institutions from the Safor Area (Valencia). Some positive serum markers of HBV infection were found in 15 patients (9.3%). The mentally retarded older than 17, presented a prevalence of HBV markers (20.6%), in contrast to those under this age (1.1%) and against the control group (5.1%) (p < 0.001). HBsAg positive markers were found in three cases, representing 4.4% among the older than 17's, against 0.4% of the general population (p < 0.05). There was some positive correlation with personal history of hepatitis (p < 0.01) and severely handicapped patients (p < 0.05) an there was no association with sex, duration of stay and Down's Syndrome. Our results indicate that seropositive B prevalence is similar to the general population in the mentally retarded younger than 17 years old and higher from this age on, which confirms the need for active prophylaxis in the youngest of this collective. Reviewing the Spanish studies we observe a lower prevalence of HBsAg(carriers) and HBV markers in open institutions than in closed institutions.

Hip fracture in the elderly in Spain. Incidence 1977-88 in the province of Salamanca.

We recorded the incidence of fractures of the proximal end of the femur in the province of Salamanca, Spain, 1977-88. Based on age-specific survival estimates, the probability of suffering a hip fracture after 50 years of age in women was 7 percent and in men 2 percent, i.e., substantially lower than in Northern Europe or U.S.A.

[Prevalence of hepatitis B markers in non-hospital health personnel]. / Prevalencia de marcadores de la hepatitis B en el personal sanitario extrahospitalario.

Through a hepatitis B prophylaxis campaign, vaccination and serological study was offered to 316 nonhospital health personnel of the Health Area of Gandia (Valencia). 117 people volunteered (37%); among them, nurses showed the highest participation (45.8%) in comparison with doctors, nursing auxiliaries and non-technical personnel (p less than 0.05). In 22 cases a positive marker could be proved; therefore, total prevalence (18.8%) was significantly higher than that of the control group, which was 6.8% (p less than 0.01). This prevalence is compared with other groups of hospital and nonhospital personnel, and the convenience of new studies and the recommendation of active prophylaxis for this subset of health workers are discussed.

[Reconstructive surgery using a massive prosthesis in loosening of a hip prosthesis]. / Chirurgie de reconstruction par prothèse massive dans le descellement d'endoprothèses de la hanche.

Thirteen cases with loosening of THR treated by a massive prosthesis are reviewed. In previous years, with more conservative surgery, the loss of bone stock was most important. The results after a long follow-up were satisfactory. This was a desperate procedure during a period without a bone-bank. Despite the major problems with failure of this procedure, the author still recommends it in elderly patients who need early mobilization or when the use of a bank-bone is not possible.

Pachydermoperiostosis. A case report.

A case of pachydermoperiostosis observed over a period of 4 years in a man aged 19 is reported. Its clinical features are described; these place it in the "incomplete" group, according to the classification of Touraine et al.. The authors also discuss the diagnostic criteria and the differential diagnosis from Pierre Marie disease, Ribing's syndrome, van Buchem's syndrome and acromegaly.

[Autoimmune hemolytic anemia associated with chronic ulcerative colitis (author's transl)]. / Anemia hemolítica autoinmune asociada a colitis ulcerosa.

A case of autoimmune hemolytic anemia associated with chronic ulcerative colitis in a 28-year-old woman is reported. Immunological studies showed a strongly positive direct Coombs test of IgG type and a non-specific pannagglutinin antibody. This immunological pattern remained for 10 months instead of the medical treatment with corticosteroids and azathioprine. A subtotal colectomy with ileo-rectostomy was performed and the patient experienced a greater clinical improvement, though the total negativity of the immunitary alteration was not obtained. Weak immunological disturbances continued 19 months after the surgical procedure. A short review of the literature is presented and a total of 39 cases of erythorcitic autoimmunization (with or without hemolysis) published up to the present time have been found. Lastly, various etiopathogenic theories in relation to this complication are mentioned.