Prueba de Graham y enterobiasis; resultados de 11 años / Graham test and enterobiasis. An 11 years’ study

Enterobius vermicularis es un nematodo intestinal parásito más prevalente en niños en edad escolar. Habitualmente produce prurito anal, irritabilidad, dolor abdominal o pélvico y ocasionalmente vulvovaginitis. El diagnóstico de laboratorio se hace microbiológicamente mediante la prueba de Graham, también llamada “cinta de Graham” y “parche anal”. Se deben tomar por la mañana en tres días consecutivos muestras de los márgenes del ano, recogidas con cinta adhesiva transparente que se adhiere a un portaobjetos. En el periodo de 2001-2011 se recibieron en nuestro laboratorio 6040 muestras de cinta de Graham. De las 5598 muestras bien recogidas, 528 (9,4%) fueron positivas, observándose huevos de E. vermicularis. Correspondían a 335 pacientes con rango de edad de 10 meses a 86 años. El 89,2% era de edad pediátrica. El grupo de edad más numeroso fue el de los seis a los ocho años. La distribución por sexos fue muy similar. Como tratamiento de elección se recomienda mebendazol 100 mg, oral, o albendazol 400 mg, oral, ambos en dosis única repitiendo la misma dosis a las dos semanas (AU)

Enterobius vermicularis is an intestinal nematode more prevalent in school aged children. Usually produces anal itching, dizziness, abdominal or pelvic pain and occasionally vulvovaginitis. Laboratory diagnosis must be performed microbiologically with the Graham test, also called Graham tape. Samples must be collected early in the morning during three consecutive days from the anal edge, with adhesive transparent tape than must be attached to a laboratory slide. During the 2001-2011 period, 6040 Graham tapes were received in our laboratory. Out of the 5598 samples correctly collected 528 (9.4%) were positive for E. vermicularis eggs. They belonged to 335 patients with ages 10 months to 86 years. Most (89.2%) were pediatric patients. The group 6 to 8 years was the most numerous. Sex distribution was very similar. The recommended treatment is mebendazole 100 mg oral or albendazole 400 mg oral, both in single doses, repeating the same doses after 2 weeks (AU)

A phase I clinical trial of thymidine kinase-based gene therapy in advanced hepatocellular carcinoma.

The aim of this phase I clinical trial was to assess the feasibility and safety of intratumoral administration of a first-generation adenoviral vector encoding herpes simplex virus thymidine kinase (HSV-TK) gene (Ad.TK) followed by systemic ganciclovir to patients with advanced hepatocellular carcinoma (HCC). Secondarily, we have analyzed its antitumor effect. Ten patients were enrolled in five dose-level cohorts that received from 10¹° to 2 × 10¹² viral particles (vp). Ad.TK was injected intratumorally and patients received up to three doses at 30-day intervals. Positron emission tomography was used to monitor TK gene expression. Ad.TK injection was feasible in 100% of cases. Treatment was well tolerated and dose-limiting toxicity was not achieved. Cumulative toxicity was not observed. Hepatic toxicity was absent even in cirrhotic patients. Fever, flu-like syndrome, pain at the injection site and pancytopenia were the most common side effects. No partial responses were observed and 60% of patients showed tumor stabilization of the injected lesion. Importantly, two patients who received the highest dose showed signs of intratumoral necrosis by imaging procedures. One of them achieved a sustained stabilization and survived for 26 months. In conclusion, Ad.TK can be safely administered by intratumoral injection to patients with HCC up to 2 × 10¹² vp per patient.

Long-term weight loss maintenance in the United States.

CONTEXT: Although the rise in overweight and obesity in the United States is well documented, long-term weight loss maintenance (LTWLM) has been minimally explored. OBJECTIVE: The aim of this study is to estimate the prevalence and correlates of LTWLM among US adults. DESIGN, SETTING AND PARTICIPANTS: We examined weight data from 14 306 participants (age 20-84 years) in the 1999-2006 National Health and Nutrition Examination Survey (NHANES). We defined LTWLM as weight loss maintained for at least 1 year. We excluded individuals who were not overweight or obese at their maximum weight. RESULTS: Among US adults who had ever been overweight or obese, 36.6, 17.3, 8.5 and 4.4% reported LTWLM of at least 5, 10, 15 and 20%, respectively. Among the 17.3% of individuals who reported an LTWLM of at least 10%, the average and median weight loss maintained was 19.1 kg (42.1 pounds) and 15.5 kg (34.1 pounds), respectively. LTWLM of at least 10% was higher among adults of ages 75-84 years (vs ages 20-34, adjusted odds ratio (OR): 1.5; 95% confidence interval (CI): 1.2, 1.8), among those who were non-Hispanic white (vs Hispanic, adjusted OR: 1.6; 95% CI: 1.3, 2.0) and among those who were female (vs male, adjusted OR: 1.2; 95% CI: 1.1, 1.3). CONCLUSIONS: More than one out of every six US adults who has ever been overweight or obese has accomplished LTWLM of at least 10%. This rate is significantly higher than those reported in clinical trials and many other observational studies, suggesting that US adults may be more successful at sustaining weight loss than previously thought.

La Tomografía axial computarizada en la vigilancia de la patología laboral respiratoria / What does axial computed tomography provide in the surveillance system of respiratory labour disease?

Objetivo: Establecer el interés de la tomografía axial computarizada (TAC) en el sistema de vigilancia de la patología laboral respiratoria. Métodos: Estudio epidemiológico de tipo transversal sobre una población diana de 1.200 trabajadores sospechosos de estar expuestos en su medio laboral a agentes implicados en el desarrollo de enfermedades respiratorias. A partir de los datos obtenidos en un reconocimiento médico específico, que incluye espirometría y TAC, se analizan (mediante pruebas estadísticas de homogeneidad de muestras) diversas variables, posiblemente relacionadas con la aparición de imágenes respiratorias anómalas en esta última, se comparan grupos sectoriales de actividad y se examina la concordancia entre ambos métodos de diagnóstico. Resultados: Casi la mitad de los trabajadores mostraron en la TAC torácica imágenes respiratorias anómalas. La TAC respiratoria anormal fue más frecuente entre ex fumadores, entre los que presentaron un patrón espirométrico anormal, fundamentalmente mixto, y entre los que mostraron alguna anomalía fuera del aparato respiratorio. Fue menos frecuente entre no fumadores y entre los que tenían un patrón espirométrico normal. Los trabajadores sin lesiones respiratorias en la TAC eran más jóvenes. La aparición de imágenes anómalas en la TAC respiratoria no diferenció al sector siderometalúrgico del resto, aunque sus trabajadores presentaban mayor proporción de anomalías pleurales. Conclusiones: La utilización de la TAC torácica podría ayudar a optimizar el manejo de los trabajadores tras un programa de vigilancia de enfermedades respiratorias en el medio laboral(AU)

Objective: To establish the interest of the axial computed tomography use (ACT) in the screening of respiratory labour disease.Methods: Transversal type epidemiologic research on a 1,200 workers target population suspected to be exposed to agents implicated in respiratory disease development in their labour environment. Starting from the values obtained in a specific medical evaluation, which includes spirometry and ACT, diverse variables are analyzed (by statistics tests for homogeneity samples) implicated in the appearance of anomalous respiratory images in this last, activity sectorial groups are compared and validity and security reciprocal from both methods are considered.Results: Nearly half of workers showed anomalous respiratory images in thoracic ACT. Abnormal respiratory ACT was more frequent among ex-smokers, among who showed an abnormal spirometric patron, fundamentally mixed, and among who showed in the ACT some anomaly out of the respiratory system. It was less frequent among no smokers and among who had a normal spirometric patron. Workers whitout respiratory lesions in ACT were younger. The appearance of anomalous images in respiratory ACT didn’t stands out the sidermetallurgic sector from the rest, although their workers showed bigger proportion of pleural anomalies.Conclusions: ACT thoracic use might help to optimize the managing of the workers after a surveillance respiratory diseases program in labour environment (AU)

Irradiación hepática selectiva con microesferas cargadas con Ytrio / No disponible

No disponible

[(18)F]-FDG PET and localized fibrous mesothelioma.

The aim of this article is to present our experience with positron emission tomography (PET) and localized fibrous mesothelioma and to review the literature on this issue. During the past five years we found three patients with a complete clinical history who underwent a CT scan of the thorax and (18)F-fluorodeoxyglucose positron emission tomography ([(18)F]-FDG-PET) and were diagnosed with localized fibrous mesothelioma. Two of the patients were asymptomatic men and the third was a woman with chest pain. The standardized uptake value was 2.1 in one case, and in the other two an absence of FDG uptake was seen. All three had complete resection of the tumor, and in one case the presurgery diagnosis was adenocarcinoma. In one patient the tumor relapsed twice, and the other two patients are alive without any evidence of disease. The value of FDG-PET in the differential diagnosis of pulmonary and pleural abnormalities has gained ground during the last few years. As in most benign tumors, the FDG uptake is usually low (< 2.5) in the localized fibrous mesothelioma. However, more studies are necessary to define the role of FDG-PET in assessing this tumor.

Valor clínico de la tomografía de emisión de positrones con f-18-fdg en el seguimiento de pacientes con cáncer de ovario / Clinical value of positron emission tomography with f-18-fdg in the follow up of patients with cancer of the ovary

Fundamento. La tomografía por emisión de positrones con flúor-18-desoxiglucosa (PET-FDG) es una técnica eficaz en la detección de tejido tumoral. El objetivo del trabajo fue evaluar la PET-FDG en el diagnóstico de enfermedad residual o recidiva en pacientes con cáncer de ovario. Material y métodos. Se incluyeron un total de 24 pacientes diagnosticadas y tratadas por cáncer de ovario con cirugía y posterior quimioterapia. En 12 pacientes el estudio se realizó previo a la cirugía de second-look y en las otras 12 tras objetivarse en el seguimiento un aumento del marcador tumoral. En todas las pacientes se realizó TAC abdomino-pélvico, determinación de los niveles séricos de CA-125 y PET-FDG de tórax, abdomen y pelvis. La PET-FDG se valoró de forma cualitativa, mediante el estudio visual de las imágenes, y cuantitativa mediante el SUV o valor estándar de captación. El diagnóstico definitivo se confirmó mediante el estudio anatomopatológico en 13 casos y en el resto por seguimiento clínico con una media de 11,2ñ5,4 meses (rango 6-24).Resultados. Se consideró positivo un valor de CA-125 superior a 35 UI/ml, obteniendo una sensibilidad del 77 por ciento y una especificidad del 100 por ciento. La sensibilidad del TAC fue del 23 por ciento y la especificidad 91 por ciento. Con la PET-FDG la sensibilidad fue del 92 por ciento y la especificidad del 90 por ciento. Se consideró patológico un valor SUV 3, obteniéndose los mismos resultados que con la valoración visual. La PET-FDG fue positiva en 5 pacientes con TAC no concluyente, 4 con TAC negativo y 2 con CA-125 negativo. Conclusión. Estos resultados preliminares sugieren que la PET-FDG puede ser útil en el seguimiento de pacientes tratadas por cáncer de ovario. La PET-FDG puede ser especialmente eficaz en la diferenciación entre enfermedad residual o recurrencia frente a secuelas del tratamiento cuando la TAC no es concluyente debido a la distorsión anatómica. La PETFDG puede ser más sensible que la elevación del marcador y ante una elevación de éste permite la localización no invasiva de la enfermedad (AU)

[Clinical value of positron emission tomography with F-18-FDG in the follow up of patients with cancer of the ovary]. / Valor clínico de la tomografía de emisión de positrones con F-18-FDG en el seguimiento de pacientes con cáncer de ovario.

BACKGROUND: Positron emission tomography with fluor-18-deoxyglucose (PET-FDG) is an efficient technique for the detection of tumoural tissue. The aim of the paper is to evaluate the PET-FDG in the diagnosis of residual disease or relapse in patients with cancer of the ovary. METHODS: A total of 24 patients, diagnosed and treated for cancer of the ovary with surgery and subsequent chemotherapy, were included. With 12 patients the study was carried out prior to second-look surgery, and with the other 12 after objectivising an increase of the tumoural marker in the follow up. Abdominal-pelvic CAT, determination of the seric levels of CA-125 and PET-FDG of thorax, abdomen and pelvis were carried out on all patients. The PET-FDG was evaluated in a qualitative way through the visual study of the images, and quantitatively through the SUV or standard uptake value. The definitive diagnosis was confirmed through an anatomopathological study in 13 cases and through clinical follow up in the rest with an average of 11.2+/-5.4 months (range 6-24). RESULTS: A CA-125 value higher than 35 UI/ml was considered positive, obtaining a sensitivity of 77% and a specificity of 100%. The sensitivity of the CAT was 23% and the specificity 91%. With the FDG-PET sensitivity was 92% and the specificity 90%. A SUV value >or= 3 was considered pathological, obtaining the same results as with the visual evaluation. The FDG-PET was positive in 5 patients with non-conclusive CAT, 4 with negative CAT and 2 with negative CA-125. CONCLUSION: These preliminary results suggest that the FDG-PET could be useful in the detection of disease in the follow up of patients treated for cancer of the ovary. The FDG-PET could be efficient in the differentiation between residual disease or recurrence, as opposed to sequels to the treatment, when the CAT is not conclusive due to anatomical distortion, since it permits the detection of tumoural lesions undetected by the radiological image techniques but metabolically active. The FDG-PET could be more sensitive than an increased marker value, and facing an increase of the latter it permits a non-invasive localisation of the disease.

Economic evaluation of oral sumatriptan compared with oral caffeine/ergotamine for migraine.

We conducted an economic comparison of oral sumatriptan with oral caffeine/ergotamine in the treatment of patients with migraine. Cost-effectiveness, cost-utility and cost-benefit analyses were conducted from societal and health-departmental perspectives. A decision tree was used. Utilities were assigned to health states using the Quality of Well-Being Scale. Simple and probabilistic sensitivity analyses were also carried out. From a societal perspective, using sumatriptan instead of caffeine/ergotamine resulted in an incremental cost-effectiveness ratio of -25 Canadian dollars ($Can) per attack aborted, an incremental cost-utility ratio of -$Can7507 per quality-adjusted life-year (QALY), and a net economic benefit of $Can42 per patient per year (1995 values). From the perspective of the health department, the incremental cost-effectiveness ratio was $Can98 per attack aborted, the incremental cost-utility ratio was $Can29,366 per QALY; the grade of recommendation based on past decisions regarding health technology for adoption into health insurance plans was 'moderate'. Sensitivity analysis showed that the results were robust to relatively large changes in the input variables. The incremental health benefits obtained from using oral sumatriptan rather than oral caffeine/ergotamine were achieved at moderately acceptable incremental costs, if past decisions on the adoption of other health technologies are used as a guide.