Intramural gastric abscesses in a dog.

A 6-year-old, female neutered Labrador retriever was presented with a chronic history of vomiting and anorexia. Abdominal ultrasound identified two large cavitated structures with echogenic content in the gastric fundus and pyloric region. CT revealed the intraparietal nature of these structures, one in the greater curvature and another one extending from the lesser curvature to the pyloric antrum. Surgical exploration revealed two areas of thickened gastric wall with intramural purulent material. Debridement and partial resection of the abscess (deroofing) were performed via a routine gastrotomy approach. Histopathology of a gastric wall sample revealed neutrophilic inflammation with intralesional vegetal foreign body. The presence of intralesional foreign body with a positive bacterial culture and macroscopic absence of peritonitis may suggest an intramural migrating vegetal foreign body. Gastric wall abscess should be included in a differential diagnosis in dogs with a history of chronic vomiting and the presence of gastric wall cavitated structures. Surgical debridement through a routine gastrotomy opening alleviated the clinical signs related to the intramural gastric abscesses in this dog with no recurrence at 22 months.

Prophylaxis therapy in haemophilia A: current situation in Spain.

The Spanish Epidemiological Study in Haemophilia carried out in 2006 enrolled 2400 patients [2081-86.7% with haemophilia A (HA) and 319-13.3% with haemophilia B]; 465 of them (19.4%) were on prophylaxis. These rates were higher in patients with severe haemophilia (45.4%) and severe paediatric cases (72.5%). On the basis of information recorded in this study, we analysed the current situation of prophylaxis therapy administered to patients with HA in Spain, as well as their orthopaedic status. Prophylaxis was used in 399 (19.2%) patients with HA; such prophylaxis was primary (PP) in 20.3% and secondary (SP) in 75.9% of cases. Among severe HA patients, 313 (45.9%) were on prophylaxis (22.3% on PP and 74.7% on SP). Taking into account the patients' age, 34.7% of severe HA adults were on prophylaxis (6% PP and 92.1% SP), whereas 71.5% of severe HA paediatric patients (40.5% PP and 55.4% SP) received this kind of treatment. Established haemophilic arthropathy (EHA) was detected in 142 from 313 severe HA patients (45.3%) on prophylaxis, but only in 2.9% of patients under PP vs. 59% of patients receiving SP. There was no EHA in adult severe HA patient on PP, whereas 70.4% on SP had joint damage (P < 0.00001). Among paediatric severe HA patients, EHA was detected in 3.3% under PP and 37.8% under SP (P < 0.00001). In conclusion, our data suggest that an early initiation of prophylaxis avoids EHA in the long-term in patients with severe HA. We should emphasize the early onset of prophylaxis regimens.

Haemophilia in Spain.

To determine the prevalence of haemophilia A and B and their complications in Spain, and to characterize the health care network providing support to haemophiliac patients. The study examines clinical and genetic characteristics, treatment options, and complications observed during the course of the disease. Cross-sectional multi-centre study. The study population were patients with HA and HB in active follow-up at any Spanish hospital by December 2006. We studied 2400 haemophiliacs, 2081 (86.7%) HA and 319 (13.3%) HB patients. Illness was severe in 32.3% of patients, moderate in 16.4%, and mild in 51.3%. Genetic screening was carried out in 32.6% of the patients. Treatment administered in 2006 consisted of coagulation factor concentrates in 60% of patients. Until December 2006, 45.8% of severely ill patients were taking prophylaxis. The mean number of bleeding episodes in 2006 was four for patients not receiving primary prophylaxis and 1.3 for those taking primary prophylaxis. Thirty percent of patients had established haemophiliac arthropathy in at least one joint; 16.8% of patients were HIV-infected and 34.8% HCV-infected. Inhibitors were detected in 10% of severe HA patients and in 6.5% of severe HB patients. Immune tolerance induction therapy was started in 34 patients. This is the first comprehensive study on the epidemiology of haemophilia in Spain. It will enable us to draw comparisons with neighbouring countries, to assess the quality of care provided to haemophiliacs in Spain, and to provide evidence-based guidance for the even provision and improvement of such care.

Development of a new disease-specific quality-of-life questionnaire to adults living with haemophilia.

A haemophilia-specific health-related quality-of-life questionnaire (named 'Hemofilia-QoL') was developed to assess quality-of-life in adults with haemophilia, and was psychometrically tested. Seventy-three interviews with haemophilia patients and health care professionals were used to generate the items included in the questionnaire, and expert ratings on the items formulated were used to screen them for potential omission. This was followed by psychometric testing in a sample of 35 patients. Preliminary psychometric testing of the revised questionnaire version, which contains 10 domains (physical health, physical role, joint damage, pain, treatment satisfaction, emotional role, mental health, social support), showed acceptable reliability (alpha = 0.94 for the Hemofilia-QoL total score) and validity, and this will be examined in a subsequent study with a larger patient sample.

[Recurrent ischemic strokes secondary to acquired hypercoagulability in a patient with prostatic adenocarcinoma]. / Infartos cerebrales isquémicos de repetición por hipercoagulabilidad adquirida en el adenocarcinoma de próstata.

Hypercoagulable states are frequently associated to malignancies. We report the case of a 67 year-old patient with prostatic cancer (T3NxM1) and deep venous thrombosis, whose initial coagulation studies were normal. He was treated with acenocumarol and hormonal blockade with flutamide and leuprolerin acetate. Six months later he developed recurrent brain ischemic strokes in the territories of both median cerebral arteries, that did not respond to anticoagulant treatment. Coagulation studies, showed a procoagulant activity with a probable paraneoplastic origin. We conclude that prostatic adenocarcinoma treated with hormonal blockage may promote a complex procoagulant state leading to recurrent occlusive arterial disease, refractory to anticoagulation.

A new Spanish family with Hb Louisville.

The clinical, hematological, and biochemical characteristics of a new family with heterozygous hemoglobin (Hb) Louisville are described. The family showed a decrease in both oxygen affinity and cooperativity with the normal Bohr effect. This family has the greatest number of affected members reported to date. Among the descendants, two first cousins (III-10 and III-11), both of whom are affected by the heterozygous trait of Hb Louisville, had had three abortions of undetermined causes.

[Paget's disease involving the face. Apropos of 4 cases]. / Maladie de Paget à localisation faciale. A propos de quatre cas.

This study describes four cases of Paget's deforming dystrophy involving the jaw. In three of them the course of the disease affected only the bone involved whilst in the fourth the bones of the vault of the skull and some cranial nerves were affected in time. The prevalence of the female sex and of involvement of the maxilla was evident. The mandible was involved in only one case. Biochemical abnormalities were the same in all cases as well as being identical to those in cases of Paget's disease with multiple bone involvement. The authors suggest medical treatment (calcitonin, Na etidronate, mitramycin ) and surgery only when required for bone remodelling when there is interference with function.