[Prevalence of human papillomavirus in Spanish women from a population screening program]. / Prevalencia de virus del papiloma humano en mujeres españolas de un programa de cribado poblacionales de riesgo.

OBJECTIVE: The human papillomavirus (HPV), is necessary to cause a woman developing cervical cancer. The aim of the study was to estimate the prevalence of women with HPV infection, covered by the program of prevention and early detection of cervical cancer of Castile and León (Spain). METHODS: Samples of women included in the screening program were analyzed. Including a total of 120,326 cervical swab samples, collected in the period from January 2012 to December 2014. RESULTS: 12,183 HPV positive samples were detected, representing a prevalence of 9.6 ‰, (IC 95% 9.5%-9.8%) in the female population. High-risk HPV were found in higher proportion that HPV low-risk genotypes. HPV prevalence correlates inversely with women age. Coinfections of multiple genotypes were found in one third of screened women population. CONCLUSIONS: Data showed in this study are the first and wider Spanish results from a cervical cancer screening program population non opportunistic based on HPV detection. These results would serve as a reference for future prevalence studies and to evaluate the future impact of HPV vaccination campaigns.

Social class based on occupation is associated with hospitalization for A(H1N1)pdm09 infection. Comparison between hospitalized and ambulatory cases.

This study aimed to analyse the existence of an association between social class (categorized by type of occupation) and the occurrence of A(H1N1)pmd09 infection and hospitalization for two seasons (2009-2010 and 2010-2011). This multicentre study compared ambulatory A(H1N1)pmd09 confirmed cases with ambulatory controls to measure risk of infection, and with hospitalized A(H1N1)pmd09 confirmed cases to asses hospitalization risk. Study variables were: age, marital status, tobacco and alcohol use, pregnancy, chronic obstructive pulmonary disease, chronic respiratory failure, cardiovascular disease, diabetes, chronic liver disease, body mass index >40, systemic corticosteroid treatment and influenza vaccination status. Occupation was registered literally and coded into manual and non-manual worker occupational social class groups. A conditional logistic regression analysis was performed. There were 720 hospitalized cases, 996 ambulatory cases and 1062 ambulatory controls included in the study. No relationship between occupational social class and A(H1N1)pmd09 infection was found [adjusted odds ratio (aOR) 0·97, 95% confidence interval (CI) 0·74-1·27], but an association (aOR 1·53, 95% CI 1·01-2·31) between occupational class and hospitalization for A(H1N1)pmd09 was observed. Influenza vaccination was a protective factor for A(H1N1)pmd09 infection (aOR 0·41, 95% CI 0·23-0·73) but not for hospitalization. We conclude that manual workers have the highest risk of hospitalization when infected by influenza than other occupations but they do not have a different probability of being infected by influenza.

Tendencia y estacionalidad del virus respiratorio sincitial en Valladolid durante el periodo 1993-2010 / Trend and seasonality of respiratory syncytial virus in Valladolid (Spain) during 1993-2010

Objetivo: Describir la tendencia y la estacionalidad de las infecciones por el virus respiratorio sincitial (VRS) en el Área de Salud de Valladolid Este durante el periodo 1993-2010.Pacientes y métodos: Se incluyeron en el estudio las muestras analizadas entre enero de 1993 y diciembre de 2010 por el Servicio de Microbiología e Inmunología del Hospital Clínico Universitario de Valladolid. Las muestras se clasificaron en función de la edad del paciente y el método de diagnóstico. El análisis virológico se llevó a cabo mediante técnicas de diagnóstico rápido, cultivo celular o microarrays. Se calcularon las tasas anuales referidas al área cubierta por el hospital para identificar la tendencia desde 1993 hasta 2010. Los meses epidémicos se establecieron mediante el índice epidémico, y la periodicidad mediante el método cosinor. Resultados: De 4.103 muestras analizadas de pacientes con síntomas respiratorios, en 1.644 (40,1%) se confirmó la presencia de VRS. Casi el 90% de los casos confirmados se dieron en pacientes menores de 2 años, y el 59,5% en menores de 1 año. Las tasas fluctuaron cada 2-4 años, alcanzando valores máximos en 2002 y 2003, con 41,5 y 44,9 casos por 100.000 habitantes-año, respectivamente. Aunque se produjeron casos durante todo el año, los periodos epidémicos se dieron entre septiembre y marzo, detectándose la mayor incidencia en enero y la menor en julio. Conclusiones: Los datos epidemiológicos (prevalencia del virus en muestras respiratorias y distribución por edad) fueron similares a los descritos en otros estudios. Los periodos epidémicos se describieron entre septiembre y marzo, alcanzado el máximo de incidencia en enero y el mínimo en julio. A pesar de ello, a lo largo de los 18 años estudiados sólo en 5 años no hubo circulación de VRS durante 2-3 meses, y en 8 más el VRS estuvo ausente durante un mes. No hay ningún dato que permita anticipar la ausencia de circulación del virus, aspecto importante para la profilaxis de esta infección (AU)

Purpose: The aim of the study is to describe the trend and seasonality of respiratory syncytial virus (RSV) infections in the East Valladolid Health Administrative-Division during the period1993-2010.Patients and Methods: Samples processed in the area of Eastern Valladolid by the Department of Microbiology and Immunology at the Hospital Clínico Universitario of Valladolid between January 1993 and December 2010 were included in the analysis. Cases were classified by age and diagnostic method. Virological diagnosis of the cases was carried out through rapid assay methods, shell-vial cell culture assay or microarray techniques. Annual rates were calculated to identify the trend of the infection from 1993 to 2010. The epidemic index was used to establish epidemic months and cosinor method to evaluate periodicity. Results: From 4,103 samples processed, collected from patients with respiratory symptoms, 1,644 (40.1%) were confirmed to be RSV possitive. Almost 90% of the confirmed cases appeared in patients under 2 years old, 59.5% in younger than1 year old children. The infection trend seems to fluctuate every 2-4 years with higher rate in 2002 and 2003, accounting for 41.5 and 44.9 cases detected per 100,000 inhabitants-year, respectively. Although cases were detected throughout all the year, epidemic periods were detected from September to March with highest values in January and lowest values in July. Conclusions: Epidemiological data (VRS prevalence in respiratory samples and distribution of cases by age) was similar to those obtained in previous studies. Epidemic periods were described from September to March with the highest numbers of cases in January and lowest values in July. In spite of this, along the eighteen years studied there were eight years without RSV detection in one month and only five years without detection in 2-3 months. There is no data that allows to predict the lack of circulation for RSV, being an important factor for the prophylaxis of the infection (AU)

Score to identify the severity of adult patients with influenza A (H1N1) 2009 virus infection at hospital admission.

The objective of this paper was to develop a prognostic index for severe complications among hospitalized patients with influenza A (H1N1) 2009 virus infection. We conducted a prospective observational cohort study of 618 inpatients with 2009 H1N1 virus infection admitted to 36 Spanish hospitals between July 2009 and February 2010. Risk factors evaluated included host-related factors and clinical data at admission. We developed a composite index of severe in-hospital complications (SIHC), which included: mortality, mechanical ventilation, septic shock, acute respiratory distress syndrome, and requirement for resuscitation maneuvers. Six factors were independently associated with SIHC: age >45 years, male sex, number of comorbidities, pneumonia, dyspnea, and confusion. From the ß parameter obtained in the multivariate model, a weight was assigned to each factor to compute the individual influenza risk score. The score shows an area under the receiver operating characteristic (ROC) curve of 0.77. The SIHC rate was 1.9 % in the low-risk group, 10.3 % in the intermediate-risk group, and 29.6 % in the high-risk group. The odds ratio for complications was 21.8 for the high-risk group compared with the low-risk group. This easy-to-score influenza A (H1N1) 2009 virus infection risk index accurately stratifies patients hospitalized for H1N1 virus infection into low-, intermediate-, and high-risk groups for SIHC.

[Evaluation of the appropriateness of stays in a third level hospital]. / Evaluación de la adecuación de las estancias en un hospital de tercer nivel.

BACKGROUND: Appropriateness Evaluation Protocol (AEP) has proved to be a useful tool for reviewing the utilisation of hospital resources. The aim of this article is to determine the proportion of inappropriate admissions and stays, as well as their causes, in patients hospitalised in the Hospital Clínico Universitario de Valladolid (HCUV). MATERIAL AND METHODS: A retrospective, analytical, observational, cohort study. The period of study was one year (2004). A sample of 1,630 admissions was gathered. Case definition, variables of interest and the model of data gathering were carried out in accordance with the AEP. The principal variables were analysed by means of a basal analysis and the possible relations between them. RESULTS: Fifty-four percent of the admissions showed at least one day of inappropriate stay, with the global rate of inappropriateness being 34.17%. Amongst the causes responsible for inappropriateness, 68.9% of admissions showed at least one criterion falling under the responsibility of the doctor or the hospital, and 51.3% were due to delays in the development of study or treatment. CONCLUSIONS: The utilisation of methods of identification of inappropriate use such as AEP show applications both in planning and in hospital management, by making it possible to identify hospital problems causing delays, principally problems of an organisational type, making it possible to develop interventions aimed at reducing inappropriate use.

Evaluación de la adecuación de las estancias en un hospital de tercer nivel / Evaluation of the appropriateness of stays in a third level hospital

FUNDAMENTO The Appropriateness Evaluation Protocol (AEP) se ha mostrado como una herramienta útil para la revisión de la utilización de los recursos hospitalarios. El objetivo de este trabajo es conocer la proporción de ingresos y estancias inadecuadas, así como sus causas, en pacientes hospitalizados en el Hospital Clínico Universitario de Valladolid (HCUV). MATERIAL Y MÉTODOS Estudio observacional analítico de cohortes retrospectivo. El período de estudio ha sido de un año (2004). Se seleccionó una muestra de 1.630 ingresos. La definición de caso, las variables de interés y el modelo de recogida de datos se han llevado a cabo conforme al AEP. Se han analizado las principales variables mediante un análisis basal y las posibles relaciones entre ellas. RESULTADOS El 54% de los ingresos presentaron al menos un día de estancia inadecuada, siendo la tasa de inadecuación global del 34,17%. Entre las causas responsables de la inadecuación, el 68,9% de los ingresos presentaron al menos un criterio englobado dentro de la responsabilidad del médico o del hospital, y el 51,3% debido a retrasos en el desarrollo del estudio o tratamiento. CONCLUSIONES La utilización de métodos de identificación del uso inapropiado como el AEP presenta aplicaciones tanto en planificación como en gestión hospitalaria, al permitir identificar problemas hospitalarios causantes de demoras, principalmente problemas de tipo organizativo, permitiendo el desarrollo de intervenciones encaminadas a la reducción del uso inapropiado

BACKGROUND The Appropriateness Evaluation Protocol (AEP) has proved to be a useful tool for reviewing the utilisation of hospital resources. The aim of this article is to determine the proportion of inappropriate admissions and stays, as well as their causes, in patients hospitalised in the Hospital Clínico Universitario de Valladolid (HCUV). MATERIAL AND METHODS A retrospective, analytical, observational, cohort study. The period of study was one year (2004). A sample of 1,630 admissions was gathered. Case definition, variables of interest and the model of data gathering were carried out in accordance with the AEP. The principal variables were analysed by means of a basal analysis and the possible relations between them. RESULTS Fifty-four percent of the admissions showed at least one day of inappropriate stay, with the global rate of inappropriateness being 34.17%. Amongst the causes responsible for inappropriateness, 68.9% of admissions showed at least one criterion falling under the responsibility of the doctor or the hospital, and 51.3% were due to delays in the development of study or treatment. CONCLUSIONS The utilisation of methods of identification of inappropriate use such as AEP show applications both in planning and in hospital management, by making it possible to identify hospital problems causing delays, principally problems of an organisational type, making it possible to develop interventions aimed at reducing inappropriate use

Complicaciones de la cirugía del estómago / Complications in stomach surgery

Se exponen la frecuencia, etiopatogenia, clínica, diagnóstico, evolución y tratamiento de las diferentes complicaciones aparecidas en una serie de 1.000 gastrectomías consecutivas, por úlcera o por cáncer (681 y 319 casos, respectivamente), así como en 151 casos de vagotomía gástrica proximal. Entre las complicaciones operatorias hemos observado: rotura del bazo, en el 1,6 por ciento; lesiones biliares, 0,29 por ciento; ningún caso de desinserción de la papila, lesiones de los conductos pancreáticos, de los pedículos vasculares del hígado o perforación del esófago. Un caso de explosión de intestino grueso, aislado para sustituir el estómago tras una gastrectomía total. En el postoperatorio inmediato, la dehiscencia del muñón duodenal la hemos observado en el 0,8 por ciento; dehiscencias en el 0,13 por ciento de las gastroenteroanastomosis y en el 4 por ciento de las anastomosis del esófago, antes de la llegada de las suturas mecánicas, que empleamos desde entonces sistemáticamente en esta localización; pancreatitis aguda, en el 0,3 por ciento; necrosis, en el remanente gástrico, en el 0,3 por ciento; gastroplejía e íleo paralítico en el 0,7 por ciento (vagotomía gástrica proximal); disfagia, que desaparece espontáneamente, en el 39 por ciento de los casos de vagotomía gástrica proximal (AU)

Laboratory evaluation of the effect of prophylaxis for thromboembolism with fractionated heparin in patients undergoing laparoscopic cholecystectomy.

OBJECTIVE: We studied the effect of prophylaxis for thromboembolism with low-molecular-weight heparin (LMWH) during hospitalization on the biological hemostasis system in patients who had undergone laparoscopic cholecystectomy. METHODS: This was a prospective paired cohort study without a control group (i.e., a before-after study). The subjects were 20 patients operated on laparoscopically for uncomplicated cholelithiasis. All patients received LMWH 2 h before the operation and 24 h after the first dose. Mean duration of surgery was 70 min. Pneumoperitoneum was accomplished at 14 mmHg, and all patients were operated on in the inverted Trendelenberg position (30 degrees). Patients were mobilized within 24 h, and were discharged within 48 h after surgery. As parameters of hemostasis we studied anti-Xa factor activity (anti-Xa), antithrombin III (AT III), partial active thromboplastin time (PTT) and fibrinogen. Samples were taken for laboratory analyses under basal conditions the day before the operation (first determination), 1 h after the first preoperative dose of LMWH was given (second), at the end of the operation (third), 24 h after surgery (fourth), and on postoperative day 7 (fifth). RESULTS: Mean basal values of all parameters were within the normal range. Mean anti-Xa activity was significantly higher in the second and third determinations than in the first and fifth measurements (p < 0.05). Mean PTT was significantly elevated on the second determination and decreased thereafter; however, none of the results differed significantly from the normal value. Mean AT III was significantly lower in the third determination in comparison with the first and fifth measurements. Fibrinogen was significantly higher in the fourth and fifth determinations than in the second and third measurements. Among all parameters and sampling times, the only values outside the normal range were anti-Xa activity on the second, third and fourth determinations. CONCLUSIONS: Plasma anti-Xa factor activity was increased preoperatively, and remained elevated for 24 h after surgery, returning to basal values on postoperative day 7. Partial thromboplastin time was slightly prolonged after the first dose of LMWH, indicating good antithrombotic action.

DNA content by flow cytometry in gastric carcinoma: pathology, ploidy and prognosis.

BACKGROUND/AIMS: The prognostic relevance of histopathologic findings in gastric carcinoma is well established. Studies on DNA-ploidy are still scanty and contradictory. METHODOLOGY: Histopathologic parameters, DNA ploidy and S-phase were evaluated in 78 cancer patients curatively resected, using formalin-fixed paraffin-embedded tissue. RESULTS: Thirty-nine tumors (50%) were aneuploid. No significant correlation was found between histologic data and ploidy, but tumors with nodal involvement were more frequently aneuploid. In univariate analysis, tumor location (p=0.05), tumor size (p=0.01), differentiation grade (p=0.02), Lauren classification (p=0.01), deeper infiltration of gastric wall (p=0.001), nodal affectation (p=0.0000) and number of lymph nodes (p=0.01), TNM stage (p=0.0000), type of gastrectomy performed (p=0.04), and DNA ploidy (p=0.04) significantly influenced survival. S-phase values had no effect on prognosis. In the multiple regression model, factors independently associated with survival were TNM stage (p=0.0009), nodal affectation (p=0.01) and, marginally, ploidy (p=0.08). CONCLUSIONS: In gastric carcinoma curatively resected, the more relevant prognostic factors were stage and nodal involvement. Fifty percent of the tumors were aneuploid. Aneuploidy was significantly associated with poorer prognosis.

[Normal values for basal serum gastrin with and without stimulation]. / Estudio de los valores normales de la gastrina sérica basal y tras estimulación.

In the present work we report a study of the basal gastrin serum levels and stimulated serum gastrin levels after an hyperproteic meal, in a group of 20 healthy volunteers, with neither actual nor previous digestive symptoms. 60% were males, with a mean age of 35, 7 years, the highest percentage (40%) belonging to the fourth decade of life. The procedure used to determine serum gastrin levels is described. The mean value of the 3 samples obtained in basal conditions was of 51.01 pg/ml. The mean value of the 6 samples obtained after the stimulation meal was of 73.4 pg/ml. The results obtained in this study are discussed and compared with the ones of the reviewed literature.

[Risk factors of peptic ulcer hemorrhage]. / Estudio de factores de riesgo de la hemorragia por úlcera péptica.

A retrospective analysis is made of the risk factors in 229 patients admitted to hospital with hemorrhage from peptic ulcer. The factors that have been studied are: 1) age. 2) type of ulcer lesion. 3) associated disease. 4) antiinflammatory intake. 5) prior ulcer symptoms. 6) intensity and outcome of the bleeding episode. 7) endoscopic findings. 8) treatment modality. 9) mortality. The analysis of these factors tries to establish, by means of the square chi test with Yates correction, the possible relations between the factors, to determine which ones will have a pronostic value. From the results obtained we conclude that the factors with the highest pronostic importance are: 1) With respect to the severity of the bleeding episode, antiinflammatory intake and duodenal location of the ulcer lesion. 2) With respect to the need for urgent surgical treatment, antiinflammatory intake and prior ulcer symptoms. 3) With respect to mortality, severity, persistence and recurrence of bleeding, and the need for urgent surgical treatment. Finally, it is important to mention the absence of pronostic value, with respect to mortality, of advanced age and the endoscopic findings of active and/or recent bleeding.

[Hydatid cyst of the diaphragm. Apropos of a case]. / Kyste hydatique du diaphragme. A propos d'un cas.

We report a case of hydatid cyst of diaphragma in a 70 year-old male, who was admitted to hospital in emergency for right basithoracic pain, aggravated by cough and deep breathing. Laboratory tests were normal. Standard roentgenographs showed a right-sided subpulmonic opacity. Pleural aspiration fluid revealed hemorrhagic pleural effusion. Lung scintigraphy showed and hypoperfused area at the base. Abdominal echography evidenced an hepatic cyst referred to the diaphragma. Thoracoabdominal CT-scans indicated a calcium-loaded mass on the postero-lateral aspect of the right lobe of liver. Surgical exploration revealed an independent hepatic cyst localized in the latero-costal bundles of the diaphragma which was removed en masse.

[Compensatory reaction of the ascending colon following jejuno-ileal bypass. Experimental study]. / Reacción compensadora del colon ascendente tras el by-pass yeyuno-íleal. Estudio experimental.

The series of physiopathologic consequences and the adaptive response that appears in the residual intestine following intestinal by-pass surgery has been widely studied. The same is not true for the ascending colon. Having demonstrated the adaptive changes this organ undergoes after a massive enterectomy, we carried out the present study to evaluate the compensatory reaction after an intestinal by-pass. A total of 115 Wistar rats weighing 350-550 g were used. Twenty animals made up group 0 (control), 30 underwent intestinal section (group II) and 65 received a jejuno-ileal by-pass (group III), with latero-lateral anastomosis. After weight control was performed the animals were sacrificed at 15, 30, 45 and 60 days, and samples were taken from the ascending colon for optical microscopy (OM), scanning electronic microscopy (SEM) and transmission electronic microscopy (TEM). All objective data were quantified and statistical studies carried out. The by-pass animals showed statistically significant ponderal drops (p less than 0.001), an expression of the malabsorption disorder the by-pass produced. Groups 0 (control) and I (IS) showed no macroscopic, microscopic or ultrastructural changes. The by-pass animals, however, manifested colic dilatation with a significant increase in thickness, to the detriment of the muscularis and mucosa, and greater crypt depth with a relative decrease in the number of goblet cells. Enterocytes increased in number and size. These changes were statistically significant in relation to groups 0 and I. The above findings were confirmed ultrastructurally. In the scanning electronic microscopy after 30 days, the colic mucosa had an irregular appearance, with elevations but no foliated appearance.(ABSTRACT TRUNCATED AT 250 WORDS)

[Carcinoma of the gastric stump after resection of benign disease (32 cases)]. / Carcinomas del muñón gástrico tras resección por enfermedad benigna (32 casos).

Gastric stump carcinomas have a poor prognosis; the etiology, diagnosis and treatment are not well-defined. The authors analyze their experience with 32 patients with carcinoma of the gastric stump after gastric resection for peptic ulcer; the age of the patients was 44-72 years. The period of latency, since the previous resection, was 28 years. At the time of diagnosis, all patients were symptomatic. The radiological study was positive in 69% of cases and endoscopic exploration and biopsy in 100%. 47% of patients could be resected but the surgery was considered radical only in 4. The tumors were always adenocarcinomas; the muscular layer was infiltrated in 86% of cases and to adjacent organs in 52%. 76% of cases presented lymph node metastases and 31% distant metastases. There were 8 postoperative deaths (28%). The five years survival was 4.2%. The poor prognosis of this lesion emphasizes the importance of early diagnosis and treatment as well as that of periodic follow-up of gastrectomized patients older than 50.

Surgical management of malignant tumors of the esophagogastric junction: a retrospective review of 188 patients.

A series of 188 patients with cancer of the esophagogastric junction were operated from 1960 to 1985. Their age range was 18-79 years old and 73% were males. Mean duration of symptomatology was five months and 93% were affected by dysphagia. Surgery was limited to exploratory laparotomy in 17 patients (9%), feeding gastrostomy in 14 (7.5%), Celestin endoluminal tube in 31 (16.5%), jejunal by-pass in one and tumoral resection in 125 (66.5%). The predominant procedures of resection were total (64%) and proximal gastrectomy (28%). To restore digestive continuity, the stomach was used in 40 (32%) cases, jejunum in 67 (53.6%) and colon in 18 (14.4%). Eighty-eight per cent of tumors were adenocarcinomas. Seventeen per cent of patients died in the post-operative period: 18.4% following resection (17.5% following partial gastrectomy and 18.8% following total gastrectomy) and 14% following palliative measures. Five-year survival rates were 11.8% for resected cases, 8.7% for total gastrectomized patients and 18.2% for partial gastrectomized tumors.

[Extrahepatic biliodigestive anastomoses. Analysis of 227 cases]. / Anastomosis biliodigestivas extrahepáticas. Análisis de 227 casos.

The authors analyze their experience with 227 biliodigestive anastomoses to compare the early and late results. Choledocholithiasis (49%) and cancer of the pancreas (25%) were the most common processes. Choledochoduodenostomy (48%), cholecystojejunostomy (22%), sphincteroplasty (18%) and hepaticojejunostomy (9%) were the techniques most often used. In 61% of cases (90% of the malignant tumors) there was an emergency indication. Twenty-one percent of the patients presented serious complications in the postoperative period (14% of the benign tumors), half of which depended on the bypass. Postoperative peritonitis (2%), external biliary fistula (4%) and acute pancreatitis (2%) were the most significant surgical complications. Hepaticojejunostomy induced the largest number of bypass-dependent complications. There were 12 deaths due to medical causes (5%), these being most numerous in subjects with neoplasms and cholecystojejunostomy, and 8 of surgical origin (4%), half of them in carriers of a hepaticojejunostomy. There was a clear decline in the morbidity of patients operated on in recent years. In the long term, 91% of the patients remained free of discomfort or had minimal symptoms. Choledochoduodenostomy or sphincteroplasty produced the best results. It is concluded that biliodigestive anastomoses yield the best early and late results with minimal secondary effects.