Predictive factors of irritable bowel syndrome improvement: 1-year prospective evaluation in 400 patients.

BACKGROUND: The natural history of the irritable bowel syndrome is poorly understood. AIM: To assess the clinical course of the irritable bowel syndrome and the factors that might predict it. METHODS: An observational prospective study, involving 400 irritable bowel syndrome patients meeting Rome II criteria. Symptoms were recorded in a diary over four non-consecutive months (1, 4, 7 and 10). Demographic data, associated disorders, psychological status and health-related quality of life were obtained. RESULTS: At 1-year follow-up, half of the patients and half of their physicians considered irritable bowel syndrome to have improved, but improvement was minor. Diary data showed that, according to the type of symptom, improvement was small and quite different: diarrhoea in 19% of patients, abdominal pain frequency in 26%, constipation in 33% and abdominal pain intensity in 60%. Factors related to improvement at one year were: severe symptoms and poor health-related quality of life at first visit, irritable bowel syndrome-constipation, good improvement at 3 months, anxiety/depression, stress, symptoms related to meals and absence of comorbidity. By multivariate logistic regression, predictors were: severe basal symptoms and good improvement at 3 months (OR:CI 95%, 1.32:1.09-1.59 and 4.44:2.81-7.05). CONCLUSIONS: At 1-year follow-up, half the patients and their physicians considered the irritable bowel syndrome to have had some improvement but, symptom diaries demonstrated that improvement was small and heterogeneous. Severe basal symptoms and improvement at 3 months were related to better prognosis.

Valoración de la leucocituria para el diagnóstico de infección urinaria / Assessment of leukocyturia in the diagnosis of urinary tract infections

Objetivo: Determinar la sensibilidad de la leucocituria en el sedimento urinario para el diagnostico de ITU en la infancia. Métodos: Estudio retrospectivo de los niños menores de seis años a los que en urgencias se les realizó sedimento urinario y urocultivos. Se ha estudiado la sensibilidad, especificidad, cocientes de probabilidad positivos (CPP) y negativos (CPN), valor predictivo positivo, valor predictivo negativo y curva ROC para la presencia de leucocitos en orina. Resultados: Se han estudiado 511 casos (211 niños y 300 niñas). En 87 casos (17,02 por ciento) se diagnosticó ITU. El diagnóstico de ITU fue más frecuente en los casos que tenían leucocitos en el sedimento urinario respecto a aquellos en que estaban ausentes, 29,93 por ciento versus 3,27 por ciento, p 18 leucocitos en orina, punto de corte en la curva ROC, la sensibilidad fue de 0,83 (0,77-0,88), especificidad de 0,84 (0,81-0,87), CPP de 5,25 (3,97-7,21) y CPN de 0,2 (0,12-0,28). Se calculó la probabilidad postest de no diagnosticar una ITU en ausencia de leucocitos en el sedimento, con lo que para una prevalencia del 2 por ciento, uno de cada 333 sedimentos produce un resultado falso negativo. Conclusiones: El sedimento urinario tiene una elevada sensibilidad para la detección de ITU en la infancia, por lo que parece un método adecuado de screening (AU)

Evaluation of the osteoblast response to a silica gel in vitro.

Many bioactive glasses and glass ceramics contain silica, yet the effect of silica on the osteoblast is not well understood. The osteoblast cell response to a silica surface, without the interference of the other ions present in glasses and glass ceramics has been investigated. A silica sol-gel was prepared which gave a molar ratio of 1:4:4 tetraethyl orthosilicate (TEOS): ethanol:acidified water 0.2 M HCl) and spin cast on to thermanox discs. The gel was characterized in terms of bioactivity and release of silicic acid. Primary human osteoblasts (HOBs) were seeded on the surface of upright or inverted silica discs. Cell activity (alamar blue reduction), number (DNA content) and differentiation (alkaline phosphatase activity, nodule formation and mineralization) were measured. There was no apparant difference in cell number, activity or alkaline phosphatase activity between silica discs and controls. Nodules formed much earlier on the silica surfaces and these eventually mineralized. Nodule formation was reproducibly enhanced on the silica surface and less markedly on the inverted discs. It is likely that both the surface characteristics of the silica gel and silicic acid release from the disc affect osteoblast behaviour.

Colitis cystica profunda: imaging diagnosis and conservative treatment: report of two cases.

UNLABELLED: Rectally localized colitis cystica profunda can simulate mucosecretory carcinoma. PURPOSE AND METHODS: Because endoscopic examination and barium enema do not clarify the diagnosis, other diagnostic imaging methods such as transrectal ultrasonography, computerized tomography, or magnetic resonance imaging are needed. RESULTS: Transrectal ultrasonography identifies multiple cysts in the rectal submucosa, with areas of echorefringent fibrosis between cysts, and confirms the absence of lymph node involvement or invasion of the muscular layer. Findings with computerized tomography and magnetic resonance imaging have not previously been described for colitis cystica profunda. With computerized tomography, the lesion appears as a noninfiltrating entity in the submucosa, with loss of perirectal layers of fatty tissue and thickening of the levator ani muscle. With nuclear magnetic imaging, nodulations produce intense signals that increase in T2, illustrating the mucoprotein content of the cysts. The presence in surgical biopsy material of large, whole cysts confirms the diagnosis. CONCLUSION: Reeducation of bowel habits aimed at avoiding straining and a high-fiber diet together with bulk laxatives can lead to complete remission of lesions in 6 to 18 months.

[The analysis of the gastric mucosa by computerized densitometry]. / Análisis de la mucosa gástrica mediante densitometría computarizada.

An analytical method of histologic imaging of the gastric mucosa by computerized densitometry based on the extraction of components of an image on the basis of its luminous density is described. A group of 10 healthy controls, a group of 10 subjects with gastric ulcer and 10 with duodenal ulcer were included in the study. The method was particularly useful in the identification of atrophic and hypertrophic processes. A decrease was found in the density of parietal and chief cells in atrophic gastritis of the gastric body. In atrophic gastritis of the gastric antrum a decrease was observed in global cell density of the antrum. Patients with gastric ulcer did not present variations versus the control group. In those with duodenal ulcers an increase was observed in the density of surface cell of the gastric body with no variation in the density of parietal and principal cells. This finding challenges the classical concept on the increase in parietal cell mass accompanying duodenal ulcers.