Club bibliográfico de la Sociedad Española de Radiología Médica: Historia, análisis y perspectivas tras 10 años de trayectoria / Spanish Society of Medical Radiology Journal Club: history, analysis and perspectives after ten years of experience

Llamamos club bibliográfico (CB) a un grupo de personas que se reúnen para realizar una lectura y un debate crítico de artículos científicos. En medicina, los CB son una parte muy importante del currículo formativo durante la residencia. En 2013 se funda el CB de la Sociedad Española de Radiología Médica (SERAM), con el objetivo de fomentar la adquisición de habilidades no interpretativas y la formación en editorialismo durante el periodo de residencia. Tras casi 10 años de trayectoria han formado parte del CB SERAM más de 137 revisores de 54 hospitales diferentes. En este tiempo, el número de revisores, publicaciones y visitas a nuestro sitio web han aumentado progresivamente. Actualmente, el CB SERAM funciona a través de un flujo de trabajo estructurado, organizado por grupos trimestrales y sustentado por un sistema de revisión por pares. Entre los objetivos de futuro del CB SERAM figuran internacionalizar su contenido más allá de la comunidad hispanohablante, aumentar su presencia en redes sociales (RR.SS) e incorporar contenido audiovisual.(AU)

We define a journal club as a group of people who meet to critically read and discuss scientific articles. In medicine, journal clubs are a very important part of training during residency programs. In 2013, the Spanish Society of Medical Radiology's (SERAM) journal club was established with the aim of promoting the acquisition of non-interpretative skills and training in scientific journalism during residency. After nearly 10 years, more than 137 reviewers at 54 hospitals have formed part of the SERAM's journal club. In this time period, the number of reviewers, publications, and visits to our website have increased progressively. The SERAM's journal club currently employs a structured workflow that is organized into quarterly groups and supported by a peer-review system. In the future, the SERAM's journal club aims to internationalize its content beyond the Spanish-speaking community, increase its presence in social networks, and incorporate audiovisual content.(AU)

Spanish Society of Medical Radiology Journal Club: History, analysis and perspectives after ten years of experience.

We define a journal club as a group of people who meet to critically read and discuss scientific articles. In medicine, journal clubs are a very important part of training during residency programs. In 2013, the Spanish Society of Medical Radiology's (SERAM) journal club was established with the aim of promoting the acquisition of non-interpretative skills and training in scientific journalism during residency. After nearly 10 years, more than 137 reviewers at 54 hospitals have formed part of the SERAM's journal club. In this time period, the number of reviewers, publications, and visits to our website have increased progressively. The SERAM's journal club currently employs a structured workflow that is organized into quarterly groups and supported by a peer-review system. In the future, the SERAM's journal club aims to internationalize its content beyond the Spanish-speaking community, increase its presence in social networks, and incorporate audiovisual content.

Ocorrência de Campylobacter e Enterobacteriaceae em aves silvestres e frangos de corte / Campylobacter and Enterobacteriaceae in wild birds and poultry

As aves silvestres podem ser reservatório de bactérias patogênicas e atuar como veiculadoras desses microrganismos para o ambiente, os animais domésticos e o homem. Portanto, o objetivo deste trabalho foi verificar a ocorrência de Campylobacter spp., Yersinia enterocolitica e Salmonella enterica em aves silvestres capturadas nas áreas próximas de aviários e em frangos de corte alojados nesses estabelecimentos, além de verificar a presença dos genes cdtA, cdtB e cdtC nos isolados de Campylobacter e identificar os sorotipos de Salmonella encontrados. Amostras de fezes de 189 aves silvestres capturadas com redes de neblina nas áreas próximas de 10 aviários e de 200 frangos de corte foram processadas para pesquisa de Campylobacter spp., S. enterica e Y. enterocolitica. Duas espécies de aves silvestres, Sicalis flaveola (canário-da-terra) e Zonotrichia capensis (tico-tico), foram positivas para Salmonella e Campylobacter, respectivamente. Foram isolados Campylobacter spp., S. enterica e Y. enterocolitica de frangos. Todos os isolados de Campylobacter analisados apresentaram os genes cdt. Em dois aviários, Campylobacter foi isolado tanto de frangos como de aves silvestres, entretanto a contaminação mútua entre essas aves não foi comprovada. Este foi o primeiro relato de isolamento de Campylobacter de Z. capensis e de Salmonella do sorotipo Derby de S. flaveola.(AU)

Wild birds can be reservoirs of pathogenic bacteria and act as carriers of these microorganisms to the environment, domestic animals, and humans. Therefore, this study had as objective to verify the occurrence of Campylobacter spp., Yersinia enterocolitica and Salmonella enterica in wild birds captured in the surroundings of the aviaries and in the broilers housed in these establishments. The presence of the cdtA, cdtB and cdtC genes in Campylobacter isolates was also investigated and Salmonella serotypes were identified. Stool samples from 189 wild birds captured with mist nets in around 10 aviaries and from 200 broilers were processed for Campylobacter spp., S. enterica and Y. enterocolitica research. Two species of wild birds, Sicalis flaveola (Saffron Finch) and Zonotrichia capensis (Rufous-collared Sparrow) were positive for Salmonella and Campylobacter, respectively. Campylobacter spp., S. enterica and Y. enterocolitica were isolated from broilers. The cdt genes were found in all Campylobacter isolates. In two aviaries, Campylobacter was isolated from both broilers and wild birds, however the mutual contamination among these birds has not been shown. This was the first report of Campylobacter isolation from Z. capensis and of Derby Salmonella serotype isolation from S. flaveola.(AU)

Abortion and fetal death in bitches due anemia caused by vector-borne diseases / Abortamento e morte fetal em cadelas devido anemia causada por doenças transmitidas por vetores

Doenças infecciosas são as maiores responsáveis por falhas reprodutivas (FR) em cadelas, causando aborto, morte fetal e natimortalidade. Este estudo teve como objetivo investigar a associação entre agentes infecciosos, FR inexplicáveis e anemia em cadelas. Todas as amostras maternas e fetais foram negativas para a presença dos principais agentes infecciosos causadores de FR: herpes vírus canino 1, Neospora caninum, Brucella spp. e B. canis, enquanto agentes como o de Leishmania spp., parvovírus canino, Ehrlichia canis e Anaplasma platys foram encontrados em sangue materno. Coinfecções de A. platys/E. canis e A. platys/Leishmania spp. foram diagnosticadas. Os resultados indicam que os animais com anemia causadas por doenças transmitidas por vetores podem ser mais suscetíveis a sofrerem FR do que animais com valores hematológicos normais.(AU)

Utilidad de la procalcitonina para el diagnóstico de infección en el paciente crítico con cirrosis hepática / Usefulness of procalcitonin for diagnosing infection in critically ill patients with liver cirrhosis

OBJETIVO: Analizar la utilidad de la procalcitonina (PCT) para el diagnóstico de infección en pacientes con cirrosis hepática ingresados en una unidad de cuidados intensivos. DISEÑO: Estudio observacional retrospectivo. ÁMBITO: unidad de cuidados intensivos. polivalente, 24 camas. PARTICIPANTES: Pacientes con cirrosis hepática ingresados en nuestra unidad de cuidados intensivos en los últimos 4 años con diagnóstico de sospecha de infección y determinación de PCT. RESULTADOS: Entre los 255 pacientes con cirrosis ingresados en nuestra unidad; se determinó la PCT para el diagnóstico diferencial de infección en 69 casos (27%). Tres pacientes fueron excluidos del análisis por falta de datos clínicos. La estancia media fue de 10,6 ± 9,2 días y la mortalidad del 65%. El origen de la cirrosis fue vírico (57%) o enólico (37%), con una puntuación de 9,5 ± 2 en la escala de Child-Pugh y 23±8 en la escala de MELD. En 54 pacientes (82%) se estableció el diagnóstico de infección. La infección más frecuente fue la neumonía (72%), seguida de la infección intraabdominal (18%), y la bacteriemia (5%). En los pacientes sin infección la mediana de PCT fue de 0,57 ng/ml (0,28-1,14) frente a 2,99 (1,31-9,4) p < 0,001 en aquellos con infección. La capacidad diagnóstica se mantuvo en los pacientes con infección intraabdominal. El punto de corte diagnóstico se estableció en 0,8ng/ml (sensibilidad 83%, especificidad 75%, AUC 0,82 [0,702-0,93]). CONCLUSIONES: En los pacientes con cirrosis hepática la PCT es útil para identificar la presencia de infecciones bacterianas incluyendo las intraabdominales

OBJECTIVE: To evaluate the usefulness of procalcitonin (PCT) for diagnosing infection in patients with liver cirrhosis admitted to an Intensive Care Unit. DESIGN: A retrospective study was carried out. SCOPE: Intensive Care Unit. Versatile, twenty-four beds. PARTICIPANTS: Patients with liver cirrhosis admitted to our Intensive Care Unit in the last four years with suspected infection and measurement of PCT. RESULTS: Among the 255 patients with cirrhosis admitted to our unit, PCT was determined for the differential diagnosis of infection in 69 cases (27%). Three patients were excluded from analysis due to a lack of clinical data. The average stay was 10.6 ± 9.2 days, with a mortality rate of 65%. The origin of cirrhosis was mainly viral (57%) or alcoholic (37%). The Child-Pugh and MELD scores were 9.5±2 and 23±8, respectively. Infection was diagnosed in 54 patients (82%). The most common infection was pneumonia (72%), followed by intraabdominal infections (18%) and bacteremia (5%). In patients without infection, the median PCT concentration was 0.57ng/ml (range 0.28 to 1.14) versus 2.99 (1.31 to 9.4) in those with infection (p <.001). Diagnostic capacity was maintained in patients with intraabdominal infections. The diagnostic cutoff point was set at 0.8ng/ml (sensitivity 83%, specificity 75%, AUC 0.82 [0.702-0.93]). CONCLUSIONS: In patients with liver cirrhosis, PCT is useful for identifying bacterial infections, including intraabdominal processes

[Usefulness of procalcitonin for diagnosing infection in critically ill patients with liver cirrhosis]. / Utilidad de la procalcitonina para el diagnóstico de infección en el paciente crítico con cirrosis hepatica.

OBJECTIVE: To evaluate the usefulness of procalcitonin (PCT) for diagnosing infection in patients with liver cirrhosis admitted to an Intensive Care Unit. DESIGN: A retrospective study was carried out. SCOPE: Intensive Care Unit. Versatile, twenty-four beds. Participants Patients with liver cirrhosis admitted to our Intensive Care Unit in the last four years with suspected infection and measurement of PCT. RESULTS: Among the 255 patients with cirrhosis admitted to our unit, PCT was determined for the differential diagnosis of infection in 69 cases (27%). Three patients were excluded from analysis due to a lack of clinical data. The average stay was 10.6 ± 9.2 days, with a mortality rate of 65%. The origin of cirrhosis was mainly viral (57%) or alcoholic (37%). The Child-Pugh and MELD scores were 9.5 ± 2 and 23 ± 8, respectively. Infection was diagnosed in 54 patients (82%). The most common infection was pneumonia (72%), followed by intraabdominal infections (18%) and bacteremia (5%). In patients without infection, the median PCT concentration was 0.57 ng/ml (range 0.28 to 1.14) versus 2.99 (1.31 to 9.4) in those with infection (p<.001). Diagnostic capacity was maintained in patients with intraabdominal infections. The diagnostic cutoff point was set at 0.8 ng/ml (sensitivity 83%, specificity 75%, AUC 0.82 [0.702-0.93]). CONCLUSIONS: In patients with liver cirrhosis, PCT is useful for identifying bacterial infections, including intraabdominal processes.

The prevalence of oral leukoplakia in 138 patients with oral squamous cell carcinoma.

OBJECTIVES: To determine the relationship between oral leukoplakia (OL) and oral squamous cell carcinoma (OSCC), and to evaluate possible differences between those carcinomas with and without associated leukoplakia. MATERIAL AND METHODS: A total of 138 patients were studied at the Stomatology Service of the University General Hospital, Valencia, Spain. These patients were divided into two groups: group 1, patients with oral cancer and leukoplakia, and group 2, patients with OSCC but with no associated premalignant lesions. The relationship between this precancerous lesion and the OSCC was evaluated, as well as the possible clinical and histological differences between the tumours of the two groups. RESULTS: Leukoplakia was detected in 27 (19.56%) patients with OSCC. No differences were found between the two groups regarding age and tumour location. However, statistically significant differences were observed with respect to the form, tumour stage and the presence of adenopathies in the cancers with and without leukoplakia; in that the tumours associated with leukoplakia were diagnosed as being at a more initial stage. CONCLUSIONS: Those patients with OL associated with oral cancer presented with tumours at a less advanced stage than those where no associated leukoplakia existed.

New hypoglycaemic agents selected by molecular topology.

New compounds showing hypoglycaemic activity have been designed through a computer aided method based on quantitative structure-activity relationship (QSAR) and molecular connectivity. After calculation of topological indices for a set of 89 compounds including active and inactive with regards to hypoglycaemic action, linear discriminant analysis was performed so that a useful model to predict such an activity was achieved. Later on, the discriminant model was applied on a huge database so that fourteen compounds were selected as potential new hypoglycaemics. From them, just five were finally selected for experimental test on expected hypoglycaemic activity. Among the selected compounds, l-arabitol, Acid blue 161, 1,4-butanediol diglycidil ether and Acid red 151 stand out, which are comparable in potency to standard drugs such as tolbutamide. Acid blue has a glycaemia profile similar to that of tolbutamide but does not lead to a severe hypoglycaemic condition, while the profile of the other agents is near normality.

[Angiocentric lymphoma of the palate]. / Linfoma angiocéntrico localizado en paladar.

Angiocentric lymphomas are very infrequent neoplasms in our geographical setting. They tend to develop in the oronasal region in the form of necrotic lesions--specifically in the midfacial zone--with a rapid course and poor prognosis. Immunohistochemically, the malignant cells have been shown to correspond to T lymphocytes. In addition, recent research supports the possible role of Epstein-Barr virus as a possible etiological factor. We present the case of a 67 year old man with an ulcerated palatinal lesion of recent appearance that was diagnosed as angiocentric lymphoma by histopathological and immunohistochemical study. Following diagnosis, treatment was provided in the form of 3 cycles of CHOP type chemotherapy and radiotherapy.

Linfoma angiocéntrico localizado en paladar / Angiocentric lymphoma of the palate

Los linfomas angiocéntricos son neoplasias muy poco frecuentes en nuestra área geográfica. Suelen presentarse en la región oronasal como lesiones de tipo necrótico, en concreto en la zona mediofacial, con una evolución rápida y un pronóstico sombrío. Inmunohistoquímicamente se ha detectado que en estas neoplasias las células malignas corresponden a linfocitos T. Además estudios recientes apoyan la hipótesis del posible papel del virus de Epstein-Barr como posible factor etiológico. Presentamos en este artículo el caso clínico de un hombre de 67 años con una lesión ulcerada en el paladar, de corto tiempo de evolución y que tras estudio histopatológico e inmunohistoquímico se confirmó se trataba de un linfoma angiocéntrico. Tras su diagnóstico el paciente fue tratado con 3 ciclos de quimioterapia tipo CHOP y radioterapia (AU)

Angiocentric lymphomas are very infrequent neoplasms in our geographical setting. They tend to develop in the oronasal region in the form of necrotic lesions--specifically in the midfacial zone--with a rapid course and poor prognosis. Immunohistochemically, the malignant cells have been shown to correspond to T lymphocytes. In addition, recent research supports the possible role of Epstein-Barr virus as a possible etiological factor. We present the case of a 67 year old man with an ulcerated palatinal lesion of recent appearance that was diagnosed as angiocentric lymphoma by histopathological and immunohistochemical study. Following diagnosis, treatment was provided in the form of 3 cycles of CHOP type chemotherapy and radiotherapy (AU)

Prospective validation of the association of local tumor stage and grade as a predictive factor for occult lymph node micrometastasis in patients with penile carcinoma and clinically negative inguinal lymph nodes.

PURPOSE: We prospectively validated the association of local tumor stage and grade as a predictive factor for occult lymph node micrometastasis in patients with penile carcinoma and clinically negative lymph nodes. MATERIALS AND METHODS: In a retrospective study of 66 patients we demonstrated the predictive value of the association of local tumor stage and grade for occult micrometastasis, identifying 3 risk groups. A therapy strategy was designed according to these risk groups. A total of 37 consecutive patients were included in a prospective study in which the same criteria for risk group allocation and the same therapeutic recommendations were used as in the retrospective study. RESULTS: In the prospective study we noted positive lymph nodes in 11% of stage T1, 63% of stages T2-3, 15% of grade 1, 67% of grade 2 and 75% of grade 3 cases. The incidence of positive nodes was 0% in the low, 83.3% in the high and 33.3% in the intermediate risk group. These rates were similar to those in the retrospective study with no significant difference. CONCLUSIONS: The predictive value of the association of local tumor stage and grade for occult lymph node micrometastasis was validated in a prospective study. This factor allows the differentiation of 3 risk groups of patients with high reliability in the low and high risk groups. However, other prognostic factors are needed in the intermediate risk group to improve the prediction of lymph node involvement.

Feasibility of transurethral resection for muscle infiltrating carcinoma of the bladder: long-term followup of a prospective study.

PURPOSE: We analyzed the long-term results of radical transurethral resection for the treatment of a large series of patients with muscle infiltrating bladder cancer entered into a prospective study to determine progression predictive factors. MATERIALS AND METHODS: The study included 133 patients with invasive bladder cancer treated by radical transurethral resection who had negative biopsies of the muscle layer of the tumor bed. Followup was more than 5 years for all subjects and more than 10 years in 59 (44.4%). A comparative nonrandomized study was performed of a control group of 76 patients with invasive pathological stage pT2-3a, N0-3 bladder cancer treated by cystectomy. In those patients treated by radical transurethral resection univariate and multivariate analyses were performed to establish clinical progression predictive factors. RESULTS: At 5 and 10 years of followup cause specific survival rates were 80.5 and 74.5%, and bladder preservation rates were 82.7 and 79.6%, respectively. No significant difference was noted in terms of cause specific survival, with respect to the control group. The initial presence of associated bladder carcinoma in situ was the only independent progression predictive factor. CONCLUSIONS: For patients with invasive bladder cancer radical transurethral resection is justified when the tumor is clinically limited to the muscular layer and when all biopsies of the periphery and depth of the tumor bed show muscular tissue negative for tumor cells. Patients with initial associated bladder carcinoma in situ should not be excluded from this treatment but endovesical bacillus Calmette-Guerin immunotherapy should be administered and a closer followup is recommended.

[Acinar cell carcinoma of submaxillary gland]. / Carcinoma de células acinares en glándula submaxilar.

Although acine cell neoplasms have for a long time been regarded as benign tumors, they are presently considered to represent the carcinomas. These rare tumors mainly affect the parotid glands, and only exceptionally involve other salivary glands. Clinically, acic cell carcinoma present as isolated tumors simulating a pleomorphic adenoma. The diagnosis is histopathological, and complete surgical removal of the tumor is the treatment of choice, with cervical lymphatic voiding and/or postoperative radiotherapy in selected cases. A prolonged patient follow-up is required, for the tumor may recur many years after surgery. We report a case of acinic cell carcinoma in submaxillary gland.

Upper urinary tract involvement in patients with bladder carcinoma in situ (Tis): its impact on management.

OBJECTIVES: To analyze the biologic behavior and etiologic mechanism of upper-tract involvement in patients with bladder cancer in situ (Tis) and its impact on management of these patients. METHODS: One hundred thirty-eight patients with bladder Tis, 786 with superficial bladder cancer, and 179 patients with invasive bladder cancer treated by cystectomy were studied: 34 (24.6%), 18 (2.3%), and 7 (3.9%) developed upper-tract involvement in each group, respectively. Sixty-three patients with primary urothelial upper-tract tumors were also studied. Taking progression-free survival as an end point, univariate and multivariate analyses were performed. RESULTS: The upper-tract recurrence rate was significantly higher in patients with bladder Tis than in patients with superficial bladder tumors (P <0.001); it was also significantly higher in patients treated with cystectomy because of bladder Tis compared with those treated because of invasive tumors (P <0.01). Patients with bladder Tis and upper-tract involvement showed high rates of upper-tract bilaterality (32.3%) and prostate involvement (67.4%). On pathologic examination, the upper tract showed predominantly superficial (Ta-T1-Tis) tumors (67.4%) and distal ureter location as the only finding (47%). In patients with bladder Tis, upper-tract involvement alone does not have a negative impact on the survival rate according to univariate and multivariate analysis (P = NS). CONCLUSIONS: In patients with bladder Tis, upper-tract involvement represents a diffuse process; therefore, a close evaluation of both the prostate and the upper tract is recommended. Upper-tract involvement has no impact on bladder-preservation strategy. Many of these patients could also be offered a conservative management for the involved upper tract.

Corpus cavernosum invasion and tumor grade in the prediction of lymph node condition in penile carcinoma.

Of the 101 patients with penile cancer, we have analyzed 66 from whom we had enough information: 42 (63.3%) patients with corpora cavernosa invasion (T2-3) and 24 (36.6%) without (T1). With respect to the tumor grade, in 36 (54.3%) patients it was well differentiated (G I), in 23 (34.8%) moderately (G II) and in 7 (10.6%) poorly differentiated (G III). We also analyzed the inguinal lymph node condition. Of the 66 patients, 28 (42.4%) developed nodal metastases, and 38 (57.6%) were considered free of nodal metastases and disease with an average follow-up of 76.2 months (range 38-192). The presence of metastatic nodes was influenced by both tumor stage and grade with significant differences between T2-3 and T1 (p = 0.001) and between G II-III and G I (p < 0.01), but each of them alone was not a sufficiently reliable predictive factor. In order to associate local stages and tumor grades in relation to the presence of metastatic nodes, we checked that none of the patients with T1, G I (group 1) developed nodal metastases, and therefore, 'wait and see' should be the suitable approach. Twenty (80%) of the patients with T2-3, G II-III (group 2) developed metastatic lymph nodes, thus, in this group, an early lymphadenectomy should be performed. In the remaining 22 patients with T1, G II-III and T2, G I (group 3), 8 (36.4%) showed metastatic lymph nodes; in this group, other factors such as age, cultural level and obesity should be taken into account when deciding on lymphadenectomy.

Recurrence of superficial bladder tumors in prostatic urethra.

Of our 276 patients with superficial bladder carcinoma, 242 were male, and 36 of these had recurrence in prostatic urethra, 26 with macroscopic tumors, and 10 with tumors in situ (TIS). These recurrences represent an incidence of 13.3%, with an average follow-up of 34.3 months. When the urethral tumor was limited to the mucosa, we chose conservative therapy, and the patients entered a random program with Mitomycin or Adriamycin administered endovesically. With this program, we could control the disease in 59.3% of the patients. However, 22.2% of them had recurrence with prostatic stromal infiltration, so that we performed a more exhaustive exploration of the prostate, taking biopsies not only at the 5 and 7 o'clock positions, but also making a wider resection in order to find the incipient infiltration of the prostatic stroma, and trying to avoid a possible understaging. When the urethral tumor had infiltrated the prostatic stroma, we performed cystoprostatourethrectomy, getting a survival rate free of disease of 40%. An association with vesical TIS was detected in 61.1% of these patients, with terminal ureteral tumor in 8.3% and with the anterior urethra in 11.1%, showing the diffuse pattern of the disease. We conclude that when recurrence of prostatic urethra is present, it is necessary to monitor the whole urothelium during follow-up.

Carcinoma in situ associated with superficial bladder tumor.

In a sample of 306 patients with superficial bladder tumors (Ta, Tl), 48 were affected by associated carcinoma in situ (TIS). We included 40 of them in a random program with Mitomycin C or Adriamycin, administered endovesically. We found that those patients with associated TIS whose progression rate had increased to 37.1% compared to 8.8% in the original series (p less than 0.01), had a worse prognosis. Besides, 10 of them required radical cystectomy. With this chemotherapy program, we achieved a high rate of complete response (70%), but its duration was limited by a recurrence rate of 42.9%, with a time free of disease of 26.2 months. In the whole group, the survival rate free of disease was 77.5%, with an average follow-up of 37.3 months. On the other hand, we found extravesical recurrences not only in the prostatic urethra (13; 32.5%) but also at the end of the ureter (3; 7.5%).