[Diagnostic agreement of primary care and minor surgery in a basic health area]. / Concordancia diagnóstica entre atención primaria y cirugía menor en una zona básica de salud.

AIM: Minor Surgery (MS) is an ever-increasing programmed activity in Primary Health Care Centres (PHC). The aim of this study is to establish the clinical and histopathology diagnostic agreement between PHC and MS and evaluating the efficacy of this activity. METHODS AND MATERIALS: A retrospective, observational, and reliability study was performed. A total of 234 patient specimens were sent to Histopathology between January 2014 and December 2018 in basic health area of San Benito-La Laguna, Santa Cruz de Tenerife. Of these, 203 specimens met criteria, with 31 being excluded due to death or absence of diagnosis. Sociodemographic and diagnostic variables were analysed, and 10 possible diagnoses were grouped into 3 categories according to their nature. Cohen kappa coefficient was used as the main evaluation measure. RESULTS: The majority of specimens were obtained from women (51.2%), and the mean age was 52.82±17.82 years. The most frequently referred lesion was the epidermoid cyst (20.2-21.67%). A clinical-pathological agreement of 60% was obtained in Minor Surgery, with a specificity of 98.3% and a sensitivity of 61.9%. In Primary Care agreement was 36.1%, with a specificity of 98.4% and a sensitivity of 42.8%. Infectious lesions represented the largest concordance difference obtained, with 27% less in Primary Care compared to Minor Surgery. CONCLUSIONS: Minor Surgery is an effective support in the initial diagnosis of lesions referred for evaluation at Primary Care. However, it is necessary to implement improvements in diagnostic efficacy of Primary Care.

The androgen receptor expression and its activity have different relationships with prognosis in hepatocellular carcinoma.

The role of the Androgen Receptor (AR) expression and its activity in the prognosis of hepatocellular carcinoma (HCC) remains inconclusive. The aim of this study is to analyze the role of the AR expression and its activity as prognostic biomarkers in HCC. Three-hundred and thirty-seven patients from The Cancer Genome Atlas (TCGA) (107 females; 59.42 years [SD = 13.0]) were included. To infer AR activity, the expression-profile of previously validated androgen responsive genes (ARGs) was included. AR activity was shown by the AR-Score-21 (21 ARGs) and AR-Score-13 (13 ARGs) that were computed based on the expression of the selected ARGs. Those ARGs whose expression was significantly different between histological grades were used for computing two new AR-Scores. HCC patients with higher AR expression showed a higher median overall survival (OS). AR-Score 21 and AR-Score-13 did not show any association with prognosis. Six of the 21 ARGs of the AR-Score-21 and 7 of the 13 ARGs of the AR-Score-13 showed a significant different expression profile among histological grades. Based on these differences, another two AR-Scores were computed (AR-Score-6 and AR-Score-7). They showed the relative increase of upregulated to downregulated ARGs in high-grade HCC. Higher AR activity inferred by these AR-Scores was associated with worse outcomes. The expression of AR is associated with a better prognosis in HCC. However, the activity of the AR seems to be qualitatively different among histological grades. The AR activity inferred by the shifted ARGs is associated with a worse prognosis in HCC patients.

[Comparison of the effectiveness of two different pharmacologic approaches to prevent intraoperative floppy iris syndrome]. / Comparación de la efectividad de dos estrategias farmacológicas para la prevención del síndrome de iris flácido intraquirúrgico.

OBJECTIVE: To compare the effectiveness of two strategies to prevent the appearance of intraoperative floppy iris syndrome (IFIS) in patients exposed to a-blockers. METHODS: We compared retrospectively the presence and severity of the appearance of IFIS in 29 patients subjected to cataract surgery, establishing two groups of 12 patients (22 eyes) and 17 patients (33 eyes). The strategy applied to group one consisted of suspending the exposure to a-blockers for at least one week prior to the intervention, the topical application of 1% atropine three times a day for two days before the intervention and the use of intracameral lidocaine. The strategy for group two consisted of suspending use of the drug for at least one week before the intervention and the intracameral application at the beginning of surgery of a solution of physiological serum, adrenaline and lidocaine. RESULTS: Six patients from group one showed no evidence of IFIS, 2 exhibited bilateral mild symptoms, 2 bilateral moderate and 2 unilateral severe symptoms of IFIS. In total, 45.5% eyes suffered from IFIS. In group two, only 3 eyes (9.1%) from 2 patients exhibited mild symptoms. Statistical analysis showed a significant difference between both groups (p=0.002). If only those exhibiting moderate and severe symptoms are taken into account the result was highly statistically significant (p=0.0002). CONCLUSION: The study shows a greater statistical effectiveness of the strategy applied to group two compared to the strategy applied to group one (Arch Soc Esp Oftalmol 2009; 84: 549-556).

Perfil del niño y adolescente asmático en Atención Primaria / Profile of asthmatic children and adolescents in Primary Care

Aunque el asma bronquial es la enfermedad crónica pediátrica más prevalente, son pocos los estudios basados en la historia clínica de Atención Primaria (AP). En este sentido, conocer sus características clínicas ayudará a conocer la verdadera magnitud que el asma representa en AP. Material y métodos: Estudio transversal de prevalencia de asma diagnosticado en niños adscritos a cuatro cupos de pediatría de AP de Cantabria (2478 niños de 6 a 15 años) con descripción del perfil clínico, epidemiológico y alérgico de los niños asmáticos (295 niños) encontrados a partir de los datos de sus historias clínicas hasta septiembre de 2008. Resultados: La prevalencia de asma diagnosticada fue del 11,90% (295 niños) con variaciones desde un 14,4% hasta el 7,4% dependiendo del cupo estudiado. La prevalencia de asma activo con crisis de asma en el último año fue del 8,3% (206 niños). El 59% de los asmáticos fueron varones. Como antecedentes familiares destacaban la presencia de asma en alguno de los padres en el 30,5%, de rinitis alérgica en el 40,3%, de dermatitis atópica en el 27,1% y de tabaquismo en el 52,9%, con un 55,3% de niños asmáticos afectados de tabaquismo pasivo. Un 55,3% de los pacientes habían presentado bronquiolitis. El 61% de los asmáticos asociaron rinitis alérgica y 48,8% dermatitis atópica. El nivel de gravedad del asma fue un 68,5% asma episódico ocasional, 18,7% asma episódico frecuente, 12,5% asma persistente moderado y 0,3% asma persistente grave. Un 24,7% de los niños asmáticos requirieron acudir a urgencias en el último año. Los meses con más crisis de asma fueron septiembre y octubre con otro pico también en el mes de mayo. Un 59,6% no tenían tratamiento de base, 16,9% usaban corticoides inhalados, 22% tratamiento combinado (β2 de acción larga y corticoide inhalado), 2,4% montelukast y un 10,5% inmunoterapia. El 78,3% de los pacientes estudiados fueron atópicos con un predominio de alergia a ácaros del polvo (68,5%) y del polen de las gramí- neas (34,6%). La duración de la lactancia materna en la población estudiada fue de 90 días, siendo mayor la duración a mayor gravedad del asma (120 días en el asma persistente frente a 60 días en el asma episódico ocasional), (p=0,08). Solamente el 29,2% de los niños asmáticos tenían realizada la espirometría y un 9,5% se derivaron a neumología frente al 30,5% a alergología. El nivel de gravedad del asma se asoció con la presencia de asma en el padre (OR=2,65, p=0,03), asma en los hermanos (OR=3,88, p<0,001) y el antecedente de haber padecido bronquiolitis (OR=1,75, p=0,05). Así mismo, la menor edad de los niños fue el único factor encontrado que predecía el acudir a urgencias (OR=1,12, p=0,03). Conclusiones: El conocimiento del perfil clínico-epidemiológico del asma en AP permitirá mejorar el manejo de esta enfermedad, conocer mejor su impacto real, así como valorar su tendencia futura y gravedad. Se confirma la existencia de una prevalencia alta de asma bronquial por diagnóstico médico de forma similar a las encontradas en el norte de España (AU)

Although bronchial asthma is the most prevalent pediatric chronic disease, there are few studies based on the medical history of Primary Health Care (PHC). In this sense, knowing its clinical features will help to know the real magnitude asthma has in PHC. Methods: Prevalence study of all the children who were diagnosed with asthma (295 children) assigned to four pediatric consultations of PHC in Cantabria (Northern Spain, 2478 children) and where clinical, allergic and epidemiological profile, taken from the data of their medical histories until September 2008, are shown. Results: It was found a prevalence of diagnosed asthma of 11.90% (295 children), with variations from 14.4% to 7.4% depending on the pediatric consultations studied. The active asthma prevalence (asthma crisis during the last year) was of 8.3% (206 children). 59% of all asthmatic children were men. Concerning family antecedents, we must take into account that in some of the children´s parents we have found the presence of asthma in 30.5%, of allergic rhinitis in 40.3%, atopic dermatitis in 27.1% and habit smoking in 52.9%, with 55.3% of asthmatic children affected by passive smoking. 55.3% of the patients had suffered from bronchiolitis. 61% of the asthmatic ones associated allergic rhinitis and a 48.8% atopic dermatitis. Regarding the severity of asthma we found that 68.5% were occasional episodic asthma, 18.7% frequent episodic asthma, 12.5% moderate persistent asthma and 0.3% severe persistent asthma. 24.7% of the asthmatic children required emergency services during last year. September and October are the months with a higher prevalence of asthma attacks and we find another rise of asthma attacks in May. 59.6% did not have base treatment, 16.9% used inhaled corticoids, 22% combined treatment (‚2 of long action and inhaled corticoid), 2.4% montelukast and a 10.5% inmmunotherapy. 78.3% of the studied patients were atopics, 68.5% were allergic to dust mites and a 34.6% to grass pollen. Breastfeeding period of time of the population studied was of 90 days, the more the breastfeeding lasts, the more severe asthma was (120 days of persistent asthma against 60 days of occasional episodic asthma), (p=0,08). Only a 29.2% of the asthmatic children had made the spirometry and a 9.5% were sent to pneumology against the 30.5% who were sent to allergology The level of severity of asthma was associated with the presence of asthma in the father (OR=2,65, p=0,03), asthma in the brothers (OR=3,88, p< 0.001) and the antecedent of to have suffered bronquiolitis (OR=1,75, p=0,05). Also, the smaller age of the children was the only found factor that it predicted going to urgencies (OR=1,12, p=0,03). Conclusions: The knowledge of the clinical-epidemiological profile of asthma in PHC will allow to improve the handling of this disease, to know its real impact, as well as to value its future tendency and severity. The existence of high prevalence of bronchial asthma by medical diagnosis of form similar to the ones found in the north of Spain is confirmed (AU)

[Intraocular lens power calculation in complicated cases: the "Silguero"method]. / Cálculo de lente intraocular en casos complicados: el método "Silguero".

PURPOSE: To report a new method for intraocular lens (IOL) calculation in patients treated by corneal refractive surgery, in whom the application of other methods is not possible because of the absence of necessary data. This method is also applicable in other situations where the IOL calculation is difficult and in cases of IOL exchange because of unexpected refractive difficulties. METHODS: We performed phaco-emulsifications, refracting the patient's eye before IOL implantation, using the refraction data in aphakia as the only variable for the application of the formula, which itself is based on the existing correlation between the graduation of glasses (12 mm) and the IOL power at the lens level. The formula has been applied in 3 patients in whom no other calculation method was applicable. RESULTS: After the appropriate intervention, the 3 patients presented a spherical equivalent below 1 diopter. CONCLUSION: We believe this formula is valid in some situations where other formulas cannot be applied because of the absence of the necessary variables.

Determinantes de la concentración de homocisteína plasmática. Réplica / Determinants of plasma homocysteine concentration. Reply

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Influencia de factores bioquímicos y genéticos en las concentraciones de homocisteína / Influence of biochemical and genetic factors on homocysteine concentrations

Antecedentes En varios estudios se ha analizado la asociación entre el genotipo del gen metilentetrahidrofolato reductasa (MTHFR) y las concentraciones de homocisteína plasmática, pero muy pocos estudios se han realizado en niños. Objetivo Determinar la concentración plasmática de homocisteína total, ácido fólico, folato intraeritrocitario (FCR) y vitamina B12 en un grupo de niños sanos y ver su posible relación con el genotipo MTHFR. Sujetos y métodos Formaron parte del estudio 83 participantes (45 chicos y 38 chicas) de edad comprendida entre 1 semana y 18 años. Las muestras de plasma y sangre completa se almacenaron a -80 °C para su posterior determinación de los parámetros bioquímicos y moleculares. La determinación de homocisteína total se realizó mediante ensayo de inmunofluorescencia polarizada; mientras que la concentración sérica de ácido fólico, folato intraeritrocitario y vitamina B12 se determinó mediante inmunoanálisis electroquimioluminiscente. El análisis molecular se realizó mediante reacción en cadena de la polimerasa (PCR), y posterior digestión enzimática, del ADN obtenido de las muestras de sangre. Resultados Las concentraciones plasmáticas de homocisteína se correlacionaron negativamente con las de ácido fólico, vitamina B12 y FCR, pero positivamente con la edad (p < 0,005).Se ha encontrado una interacción entre la edad-genotipo MTHFR y las concentraciones de ácido fólico, vitamina B12 y FCR, pero no con las concentraciones de homocisteína. Conclusiones Nuestras observaciones sugieren que la concentración de homocisteína en la población pediátrica sana está más influida por factores bioquímicos como el ácido fólico, que genéticos (AU)

[Influence of biochemical and genetic factors on homocysteine concentrations]. / Influencia de factores bioquímicos y genéticos en las concentraciones de homocisteína.

BACKGROUND: Several studies have examined the association between the methylenetetrahydrofolate reductase (MTHFR) genotype and plasma homocysteine concentrations in adults but few studies have been performed in children. OBJECTIVE: To determine plasma concentrations of total homocysteine, folate, vitamin B12, and red cell folate in a group of healthy children and to determine their possible relationship with the MTHFR genotype. SUBJECTS AND METHODS: Eighty-three subjects (45 boys and 38 girls), aged between 1 week and 18 years, were included in the study. Plasma and whole blood samples were stored at 80 C for biochemical and molecular analysis. Plasma total homocysteine was determined by fluorescence polarization immunoassay. Serum concentrations of folate, vitamin B12, and red cell folate were measured by electrochemiluminescence immunoassay. Genotypic analysis was performed by polymerase chain reaction amplification of genomic DNA extracted from blood leukocytes. RESULTS: Plasma homocysteine concentrations were negatively correlated with folate, vitamin B12, and red cell folate but were positively correlated with age (p < 0.005). There was an association between age-MTHFR genotype and folic acid, vitamin B12, and red cell folate, but not with homocysteine concentrations. CONCLUSIONS: Our results suggest that in a healthy pediatric population, homocysteine concentrations are determined by biochemical factors, such as folic acid, more than by genetic factors.

Multicenter randomized study comparing initial daily induction with high dose lymphoblastoid interferon vs. standard interferon treatment for chronic hepatitis C.

One hundred fifty-five chronic hepatitis C patients were assigned at random to receive natural lymphoblastoid interferon (IFN)alpha-n1, s.c., for 13 months in one of three treatment regimens: initial daily induction with 10 million units (MU) followed (group 1, n = 50) or not (group 2, n = 52) by 1 month of rest and then three times weekly 10 MU (2 months), 5 MU (2 months), and 3 MU (8 months); group 3 (n = 53) received tiw 5 MU (2 months) followed by 3 MU (11 months). By intention-to-treat analysis, ALT normalization at completion of treatment was greater in patients who received continuous IFNalpha-n1 therapy with initial daily induction (group 2: 24/52, 46%) compared with those given intermittent therapy with initial daily induction (group 1: 17/50, 34%) and those who received standard IFNalpha-n1 therapy (group 3, 18/53, 34%; P not significant). The sustained ALT response was 26%, 27% and 21% and the sustained virological response was 20%, 27%, and 19%, in groups 1, 2, and 3, respectively. A trend was observed towards a higher biochemical and virological end-of-treatment response in patients given induction therapy (17%) compared with standard therapy (6%, P = 0.053). Sustained biochemical and virological responses were 20%, 27%, and 17% in groups 1, 2, and 3, respectively. Platelet and leukocyte counts decreased following daily high-dose treatment and remained low until therapy cessation (P < 0.001). The data suggest that daily s.c. induction with 10 MU IFNalpha-n1 followed by intermittent or continuous maintenance therapy for 1 year does not improve the results achieved with the standard 1-year IFNalpha course in the treatment of chronic hepatitis C patients.

[Repair of Descemet's membrane detachment after cataract surgery]. / Reparación del desprendimiento de membrana de Descemet tras cirugía de cataratas.

PURPOSE/METHODS: We present two cases of Descemet's membrane detachment, the first one after extracapsular cataract extraction with scleral tunnel incision and the other after clear corneal incision used for phacoemulsification cataract extraction. These two cases were treated with intracameral injection of 20% sulfur hexafluoride gas (SF(6)). RESULTS/CONCLUSIONS: Both cases responded satisfactorily to treatment. After four months of follow-up, the corneas remain clear with a visual acuity of 0.9 and 0.8, respectively. The relative facility of the 20% sulfur hexafluoride gas (SF(6)) technique, its safety, and good prognosis, makes it the treatment of choice in this disease.

Zollinger-Ellison syndrome due to gastrin-secreting ovarian cystadenocarcinoma. Case report.

Zollinger-Ellison syndrome in a 76-year-old woman is reported. The source of the hypergastrinemia proved to be an ovarian cystadenocarcinoma. Resection was performed and the diagnosis was confirmed histologically, immunohistochemically and by determination of gastrin in tumor tissue and in serum. The long-term result was good.

[Solitary ulcer of the rectum]. / Ulcera solitaria del recto.

In our center solitary ulcer of the rectum has a low incidence. There has been only one case in more than 13,000 distal endoscopic studies performed in the last ten years. Its rarity, and its possible confusion with other pathologies of the distal colon motivated our interest in this disease. The clinical and diagnostic features and therapeutic attitude in solitary rectal ulcer are remarked.

[Choledocholithiasis in non-cholecystectomized patients: endoscopic sphincterotomy and afterwards ... cholecystectomy?]. / Coledocolitiasis en pacientes no colecistectomizados: esfinterotomía endoscópica y después...colecistectomía?

Choledocholithiasis in patients with a gallbladder "in situ" is presently one of the most frequent indications of endoscopic sphincterotomy. The crucial problem of these patients is whether or not they require eventual cholecystectomy to avoid the risks of potential complications of cholelithiasis. Of the 39 patients (mean age 80.1 +/- 8.2 years) with choledocholithiasis and gallbladder "in situ" released from this hospital from October 1979 to December 1985 after a successful endoscopic sphincterotomy (expulsion, spontaneous or not, of gallstones), 33 (84.6%) have been followed-up for an average of 41.5 +/- 20.8 months (7-92 range). During this time only one patient (3%) developed acute cholecystitis that required cholecystectomy, and two (6%) denoted mild pains in the right upper quadrant, while the other 30 (91%) remained asymptomatic. Over these years 10 patients (30.3%) died from nonbiliary causes. In conclusion, in elderly or high surgical risk patients who present choledocholithiasis and gallbladder "in situ", endoscopic sphincterotomy is effective. Later cholecystectomy to prevent the complications of cholelithiasis would not be justified as a routine measure in most of these patients.

[Intestinal angiodysplasia: a presentation of 7 cases and review of the literature]. / Angiodisplasia intestinal: presentación de siete casos y revisión de la literatura.

Seven cases of intestinal angiodysplasia that required surgery for hemostatic control are presented, with a review of their clinical, endoscopic, arteriographic and histologic features. The average age of presentation was 52.43 years, there was a predominance in women, and the principal clinical manifestation was recurrent rectal hemorrhage. The most common location was the cecum and ascendant colon. Arteriographic diagnosis was achieved in only two patients.

[Pneumococcal endocarditis: apropos of 3 cases]. / Endocarditis neumocócica: a propósito de 3 casos.

Streptococcus pneumoniae is a common pathogen in man. The incidence of endocarditis caused by this organism has diminished in the last decades, and now it is an exceptional condition. Three patients with pneumococcal endocarditis are reported. Their clinical and epidemiological features are reviewed and compared with previous literature. One of the instances was due to a strain with high resistance to penicillin; vancomycin was a valid alternative therapy.