Rol de las imágenes en la evaluación de la invaginación intestinal del adulto: un estudio retrospectivo de 10 años / Role of imaging in the evaluation of intussusception in adults: a 10-year retrospective study

Introducción: La invaginación intestinal es la introducción de un segmento de asas intestinales en otro segmento adyacente. A diferencia de la población pediátrica, cuya etiología es principalmente idiopática, en el adulto se asocia con mayor frecuencia a patologías graves. El uso cada vez mayor de estudios imagenológicos en la evaluación abdominal ha llevado a mayor detección de invaginaciones intestinales sin enfermedad subyacente, en las que no es posible determinar una causa de base. El objetivo de este estudio fue revisar la presentación clínica, estudio y tratamiento en pacientes con diagnóstico imagenológico de invaginación intestinal en ecografía o tomografía computarizada de abdomen. Método: Se realizó un estudio descriptivo retrospectivo a partir de los informes radiológicos de ecografías y tomografías computarizadas de abdomen obtenidas en un periodo de 10 años en una institución hospitalaria. Resultados: Se obtuvieron 40 casos. En el 10% de ellos, la invaginación intestinal fue un hallazgo incidental en un estudio por otra causa. En el 68% de los casos no se identificó una causa subyacente, demostrándose resolución espontánea en el 75% de los casos con estudio posterior. El síntoma más frecuente fue el dolor abdominal, presente en el 60% de los pacientes. La ubicación más habitual fue entero-enteral en el 90% de los casos. Solo en el 8% de los casos la invaginación intestinal se atribuyó a una causa maligna. Hubo resolución quirúrgica en 7 pacientes. Conclusión: El aumento en el uso de imágenes para el estudio abdominal ha demostrado que existe un porcentaje importante de invaginaciones intestinales que son idiopáticas y que presentarán resolución espontánea.(AU)

Introduction: Intussusception is the insertion of a bowel loop segment into an adjacent segment. Unlike in children, where the condition is mainly idiopathic, intussusception in adults is more often associated with severe disease. The growing use of imaging studies to evaluate the abdomen has resulted in a higher rate of detection of cases of intussusception without underlying disease in which it is not possible to determine the cause. This study aimed to review the clinical presentation, evaluation, and treatment of patients in whom abdominal ultrasonography or computed tomography diagnosed intussusception. Method: We retrospectively reviewed radiology reports of abdominal ultrasound and computed tomography studies done at our hospital in a 10-year period. Results: In the 40 cases found, intussusception was an incidental finding in 10%. No underlying cause was identified in 68%, and posterior imaging studies showed spontaneous resolution in 75%. The most common symptom was abdominal pain, being present in 60%. Intussusception affected only the small bowel in 90% of cases (entero-enteric intussusception). Intussusception was attributed to malignancy in only 8% of cases. In 7 patients, intussusception was resolved surgically. Conclusion: The increased use of abdominal imaging has shown that a significant proportion of cases of intussusception are idiopathic and resolve spontaneously.(AU)

Role of imaging in the evaluation of intussusception in adults: A 10-year retrospective study.

INTRODUCTION: Intussusception is the insertion of a bowel loop segment into an adjacent segment. Unlike in children, where the condition is mainly idiopathic, intussusception in adults is more often associated with severe disease. The growing use of imaging studies to evaluate the abdomen has resulted in a higher rate of detection of cases of intussusception without underlying disease in which it is not possible to determine the cause. This study aimed to review the clinical presentation, evaluation, and treatment of patients in whom abdominal ultrasonography or computed tomography diagnosed intussusception. METHOD: We retrospectively reviewed radiology reports of abdominal ultrasound and computed tomography studies done at our hospital in a 10-year period. RESULTS: In the 40 cases found, intussusception was an incidental finding in 10%. No underlying cause was identified in 68%, and posterior imaging studies showed spontaneous resolution in 75%. The most common symptom was abdominal pain, being present in 60%. Intussusception affected only the small bowel in 90% of cases (entero-enteric intussusception). Intussusception was attributed to malignancy in only 8% of cases. In 7 patients, intussusception was resolved surgically. CONCLUSION: The increased use of abdominal imaging has shown that a significant proportion of cases of intussusception are idiopathic and resolve spontaneously.

Role of imaging in the evaluation of intussusception in adults: a 10-year retrospective study. / Rol de las imágenes en la evaluación de la invaginación intestinal del adulto: un estudio retrospectivo de 10 años.

INTRODUCTION: Intussusception is the insertion of a bowel loop segment into an adjacent segment. Unlike in children, where the condition is mainly idiopathic, intussusception in adults is more often associated with severe disease. The growing use of imaging studies to evaluate the abdomen has resulted in a higher rate of detection of cases of intussusception without underlying disease in which it is not possible to determine the cause. This study aimed to review the clinical presentation, evaluation, and treatment of patients in whom abdominal ultrasonography or computed tomography diagnosed intussusception. METHOD: We retrospectively reviewed radiology reports of abdominal ultrasound and computed tomography studies done at our hospital in a 10-year period. RESULTS: In the 40 cases found, intussusception was an incidental finding in 10%. No underlying cause was identified in 68%, and posterior imaging studies showed spontaneous resolution in 75%. The most common symptom was abdominal pain, being present in 60%. Intussusception affected only the small bowel in 90% of cases (entero-enteric intussusception). Intussusception was attributed to malignancy in only 8% of cases. In 7 patients, intussusception was resolved surgically. CONCLUSION: The increased use of abdominal imaging has shown that a significant proportion of cases of intussusception are idiopathic and resolve spontaneously.

Diagnostic Accuracy, Item Analysis and Age Effects of the UPSIT Spanish Version in Parkinson's Disease.

OBJECTIVE: The University of Pennsylvania Smell Identification Test (UPSIT) is the most commonly used test to detect olfactory impairment in Parkinson's disease (PD), but the cut-off score for clinical purposes is often difficult to establish because of age and sex effects. The current work aims to study the sensitivity and specificity of the UPSIT Spanish version and its accuracy in discriminating PD patients at different age groups from healthy controls (HC), and to perform an item analysis. METHOD: Ninety-seven non-demented PD patients and 65 HC were assessed with the UPSIT Spanish version. Sensitivity, specificity, and diagnostic accuracy for PD were calculated. Multiple regression analysis was used to define predictors of UPSIT scores. RESULTS: Using the normative cut-off score for anosmia (≤18), the UPSIT showed a sensitivity of 54.6% with a specificity of 100.0% for PD. We found that, using the UPSIT cut-off score of ≤25, sensitivity was 81.4% and specificity 84.6% (area under the receiver operating characteristic curve = 0.908). Diagnosis and age were good predictors of UPSIT scores (B = -10.948; p < .001; B = -0.203; p < .001). When optimal cut-off scores were considered according to age ranges (≤60, 61-70, and ≥71), sensitivity and specificity values were >80.0% for all age groups. CONCLUSIONS: In the Spanish UPSIT version, sensitivity and specificity are improved when specific cut-off scores for different age groups are computed.

[Cognitive impairment in very elderly patients: a retrospective study in a neurology service]. / Deterioro cognitivo en el paciente muy anciano: estudio retrospectivo en una consulta de neurologia.

INTRODUCTION: A considerable proportion of very elderly patients with cognitive impairment are attended in the general neurology offices. There are few studies about the clinical characteristics of these patients. AIM: To describe the background and clinical features of very elderly patients who come to the general neurology clinic due to cognitive complaints or suspected cognitive impairment. PATIENTS AND METHODS: We retrospectively studied 336 patients (296 patients < 85 years vs. 40 patients >= 85 years of age) who had been mostly referred by primary care physicians. Cognitive performance was measured by the Mini-Mental State Examination and the overall (i.e., cognitive and functional) clinical situation was measured by the Clinical Dementia Rating scale. RESULTS: Older patients had more frequently cognitive impairment (mild cognitive impairment or dementia), both at the first visit and at the one-year follow-up visit (p < 0.0005). No differences were found in symptom duration (2.0 ± 2.1 vs. 1.5 ± 1.4 years), type of symptoms, or comorbidity. Alzheimer's disease was the most frequent etiological diagnosis in both age groups (82.4% vs. 75.0%; p > 0.05). CONCLUSIONS: Very elderly patients studied in the neurology office have a higher risk of presenting cognitive impairment, despite being comparable in terms of symptoms and time of evolution. These results could be explained from the hypotheses of brain reserve and combined brain pathology.

TITLE: Deterioro cognitivo en el paciente muy anciano: estudio retrospectivo en una consulta de neurologia.Introduccion. Una considerable proporcion de pacientes muy ancianos con deterioro cognitivo son atendidos en las consultas generales de neurologia, pero existen pocos estudios acerca de las caracteristicas clinicas de estos pacientes. Objetivo. Describir los antecedentes y rasgos clinicos de los pacientes muy ancianos que acuden a consulta general de neurologia por quejas o sospecha de deterioro cognitivo. Pacientes y metodos. Se estudio retrospectivamente a 336 pacientes (296 pacientes < 85 años frente a 40 pacientes >= 85 años) que habian sido remitidos en su mayoria desde la atencion primaria. El rendimiento cognitivo se midio mediante el test minimental de Folstein, y la situacion clinica global (cognitiva y funcional), mediante la escala de estadificacion clinica de la demencia. Resultados. Los pacientes de mas edad presentaban con mayor frecuencia deterioro cognitivo (alteracion cognitiva leve o demencia), tanto en la primera visita como en la visita de seguimiento al cabo de un año (p < 0,0005). No se encontraron diferencias en el tiempo desde el inicio de los sintomas (2,0 ± 2,1 frente a 1,5 ± 1,4 años), el tipo de sintomas ni la comorbilidad. La enfermedad de Alzheimer fue el diagnostico etiologico final mas frecuente en los dos grupos de edad (82,4% frente a 75%; p > 0,05). Conclusiones. Los pacientes muy ancianos estudiados en la consulta de neurologia presentan con mayor frecuencia deterioro cognitivo, a pesar de tener un tiempo de evolucion y una sintomatologia similares. Estos resultados podrian explicarse desde la hipotesis de la reserva cerebral y de la patologia cerebral combinada.

Cortical thinning correlates of changes in visuospatial and visuoperceptual performance in Parkinson's disease: A 4-year follow-up.

BACKGROUND: Growing evidence highlights the relevance of posterior cortically-based cognitive deficits in Parkinson's disease (PD) as possible biomarkers of the evolution to dementia. Cross-sectional correlational studies have established a relationship between the degree of atrophy in posterior brain regions and visuospatial and visuoperceptual (VS/VP) impairment. The aim of this study is to address the progressive cortical thinning correlates of VS/VP performance in PD. METHODS: Forty-four PD patients and 20 matched healthy subjects were included in this study and followed for 4 years. Tests used to assess VS/VP functions included were: Benton's Judgement of Line Orientation (JLOT), Facial Recognition (FRT), and Visual Form Discrimination (VFDT) Tests; Symbol Digit Modalities Test (SDMT); and the Pentagon Copying Test (PCT). Structural magnetic resonance imaging data and FreeSurfer were used to evaluate cortical thinning evolution. RESULTS: PD patients with normal cognition (PD-NC) and PD patients with mild cognitive impairment (PD-MCI) differed significantly in the progression of cortical thinning in posterior regions. In PD-MCI patients, the change in VS/VP functions assessed by PCT, JLOT, FRT, and SMDT correlated with the symmetrized percent change of cortical thinning of occipital, parietal, and temporal regions. In PD-NC patients, we also observed a correlation between changes in FRT and thinning in parieto-occipital regions. CONCLUSION: In this study, we establish the neuroanatomical substrate of progressive changes in VS/VP performance in PD patients with and without MCI. In agreement with cross-sectional data, VS/VP changes over time are related to cortical thinning in posterior regions.

[Partial splenectomy in sickle cell disease]. / Esplenectomía parcial en pacientes con drepanocitosis.

INTRODUCTION: Total splenectomy in sickle cell disease is related to a high risk of fulminant sepsis and increased incidence of other events, which have not been reported in patients with partial splenectomy. In this study we examined the patients with sickle cell disease and partial splenectomy and compared the clinical and laboratory results with non-splenectomized patients. MATERIAL AND METHODS: We studied 54 patients with sickle cell disease who underwent partial splenectomy in childhood from 1986 until 2011 at the Institute of Hematology and Immunology. They were compared with 54 non-splenectomized patients selected by random sampling with similar characteristics. RESULTS: Partial splenectomy was performed at a mean age of 4.1 years, with a higher frequency in homozygous hemoglobin S (70.4%), and the most common cause was recurrent splenic sequestration crisis. The most common postoperative complications were fever of unknown origin (14.8%) and acute chest syndrome (11.1%). After splenectomy there was a significant increase in leukocytes, neutrophils, and platelets, the latter two parameters remained significantly elevated when compared with non-splenectomized patients. There was no difference in the incidence of clinical events, except hepatic sequestration, which was more common in splenectomized patients. CONCLUSION: Partial splenectomy was a safe procedure in patients with sickle cell disease. There were no differences in the clinical picture in children splenectomized and non-splenectomized except the greater frequency of hepatic sequestration crisis in the first group.

Structural MRI correlates of the MMSE and pentagon copying test in Parkinson's disease.

BACKGROUND: Cognitive impairment in Parkinson's disease (PD) is common and recent studies have focused on addressing the most suitable screening tool for its assessment. MMSE is commonly used in clinical practice and longitudinal studies found a relationship between the MMSE pentagon copying item and progression to dementia, but its neuroanatomical correlates have been poorly investigated. The aim of this study is to investigate the MRI structural correlates of the global MMSE and the pentagon item scores in PD patients in the absence of dementia. METHODS: We selected a sample of 92 PD patients and 36 controls. MMSE was used as a global measure of cognitive status, and the pentagon copying test as a measure of visuospatial performance. FreeSurfer software was used to assess intergroup differences in cortical thickness (CTh) and global atrophy measures, as well as their relationship with cognitive performance. RESULTS: Compared to controls, patients showed significant differences in measures of global atrophy, which correlated with performance on MMSE and the pentagon item. Regional differences in CTh were seen between PD patients and controls bilaterally in the temporo-parietal-occipital region. Patients with impaired performance compared with those of normal performance also showed CTh reductions in these regions. CONCLUSION: Our results suggest MMSE and the pentagon item reflect brain changes which at a regional level involve mainly posterior regions. Correlates of the pentagon item were seen in the same regions where PD patients exhibited significant thinning, and involved more areas and bigger cluster sizes than the correlates of MMSE global scores.

[Renal transplantation in the northwest of Spain: analysis of the activity in the region of Galicia]. / Trasplante renal en el noroeste español. Análisis de la actividad en la Comunidad Autnoma de Galicia.

BACKGROUND: Spain is the world leader in organ transplant rates, and the national average is maintained in the northwestern Spanish region of Galicia. However, there is no official registry recording transplantation results in this region. In this paper we report a study of patient and graft survival and risk factors among kidney transplant patients in Galicia between January 1996 and December 2000. METHODS: Patients receiving kidney transplants in Galicia in the above period were monitored up to the end of 2001, deaths and graft losses were recorded and analysed by actuarial and Kaplan-Meier methods, and possible risk factors for death and graft loss were evaluated using Cox's proportional hazards model. RESULTS: In the study period, 672 kidneys were transplanted, all from deceased donors. Graft and patient survival rates were respectively 80% and 94% after 1 year, and 67% and 83%, after 5 years. Two-thirds of graft losses occurred within the first year and the most common cause was vascular thrombosis (44%). Independent risk factors for graft loss were donor asystole (relative risk [RR] = 3.41, 95% confidence interval [CI]: 1.73-6.73), donor age (RR = 1.54, CI: 1.05-2.27 for 40-60-year-olds, RR = 2.59, CI: 1.66-4.07 for over-60s, relative to under-40s), donation from outside the institution in which implant was performed (RR = 1.43, CI: 1.02-2.02), acute rejection (RR = 2.32, CI: 1.63-3.22), and retransplantation (RR = 1.56, CI: 1.03-2.37). The main causes of death were infections (38%), followed by cardiovascular pathologies (30%) and tumours (11%). CONCLUSIONS: The kidney transplant rate varies excessively within Galicia; the global rate is 50 per million inhabitants per year. Patient survival is similar to those recorded in national registers, but graft survival is deficient, apparently due to a high incidence of vascular thrombosis.

Trasplante renal en el noroeste español. Análisis de la actividad en la Comunidad Autónoma de Galicia / Renal transplantation in the northwest of spain: analysis of the activity in the region of Galicia

Introducción: España encabeza la actividad trasplantadora internacional y Galiciase sitúa en un nivel semejante; sin embargo, la ausencia de registros oficialesimpide tener conocimiento de los resultados en esta Comunidad Autónoma.Por ello, analizamos el trasplante renal en Galicia en los últimos años, para determinarsus resultados en cuanto a supervivencia y factores de riesgo.Metodología: Seguimiento, entre uno y seis años, de los trasplantes realizadosen Galicia entre enero-1996 y diciembre-2000, analizando pérdidas de injertos ypacientes en función de distintas variables relacionadas con receptor y donante.Para estudiar la supervivencia se utilizaron los métodos actuarial y de Kaplan-Meier, y para evaluar factores de riesgo, el modelo de riesgos proporcionales deCox.Resultados: Se realizaron 672 trasplantes, todos procedentes de donante cadáver,siendo la supervivencia del injerto del 80% y 67% después de uno y cincoaños; mientras que la del paciente fue del 94% y 83%. El 67% de las pérdidasde injerto se producen en los primeros doce meses, siendo la causa más frecuentela trombosis vascular (44%). Los factores de riesgo independientes para la pérdidadel injerto fueron donación en asistolia (riesgo relativo [HR] = 3,41; intervalode confianza al 95% [CI]: 1,73-6,73); edad del donante (RR = 1,54, IC: 1,05-2,27 entre 40-60 años; RR = 2,59, CI: 1,66-4,07 en mayores de 60; siempre enrelación a los menores de 40); injerto generado en hospital no trasplantador (RR= 1,43; CI: 1,02-2,02); rechazo agudo (RR = 2,32; CI: 1,63-3,22) y retrasplante(RR = 1,56; CI: 1,03-2,37). Las infecciones fueron la principal causa de muerte(38%), seguidas de patologías cardiovasculares (30%) y tumores (11%).Conclusiones: La tasa de trasplantes, aunque con significativas diferencias territoriales,es de 50 por millón de población y la supervivencia del paciente es comparablea la de cualquier registro internacional; sin embargo, la supervivencia delinjerto, posiblemente debido a elevada incidencia de trombosis vascular, es manifiestamentemejorable

Background: Spain is the world leader in organ transplant rates, and the nationalaverage is maintained in the northwestern Spanish region of Galicia. However,there is no official registry recording transplantation results in this region. In thispaper we report a study of patient and graft survival and risk factors among kidneytransplant patients in Galicia between january 1996 and december 2000.Methods: Patients receiving kidney transplants in Galicia in the above periodwere monitored up to the end of 2001, deaths and graft losses were recordedand analysed by actuarial and Kaplan-Meier methods, and possible risk factors fordeath and graft loss were evaluated using Cox’s proportional hazards model.Results: In the study period, 672 kidneys were transplanted, all from deceaseddonors. Graft and patient survival rates were respectively 80% and 94% after1 year, and 67% and 83% after 5 years. Two-thirds of graft losses occurred withinthe first year and the most common cause was vascular thrombosis (44%).Independent risk factors for graft loss were donor asystole (relative risk [RR] =3.41, 95% confidence interval [CI]: 1.73-6.73), donor age (RR = 1.54, CI: 1.05-2.27 for 40-60-year-olds, RR = 2.59, CI: 1.66-4.07 for over-60s, relative to under-40s), donation from outside the institution in which implant was performed (RR= 1.43, CI: 1.02-2.02), acute rejection (RR = 2.32, CI: 1.63-3.22), and retransplantation(RR = 1.56, CI: 1.03-2.37). The main causes of death were infections(38%), followed by cardiovascular pathologies (30%) and tumours (11%).Conclusions: The kidney transplant rate varies excessively within Galicia; the globalrate is 50 per million inhabitants per year. Patient survival is similar to thoserecorded in national registers, but graft survival is deficient, apparently due to ahigh incidence of vascular thrombosis

Trasplante renal en el noroeste español. Análisis de la actividad en la Comunidad Autónoma de Galicia / Renal transplantation in northwestern Spain

Introducción: España encabeza la actividad trasplantadora internacional y Galicia se sitúa en un nivel semejante; sin embargo, la ausencia de registros oficiales impide tener conocimiento de los resultados en esta Comunidad Autónoma. Por ello, analizamos el trasplante renal en Galicia en los últimos años, para determinar sus resultados en cuanto a supervivencia y factores de riesgo. Metodología: Seguimiento, entre uno y seis años, de los trasplantes realizados en Galicia entre enero-1996 y diciembre-2000, analizando pérdidas de injertos y pacientes en función de distintas variables relacionadas con receptor y donante. Para estudiar la supervivencia se utilizaron los métodos actuarial y de Kaplan- Meier, y para evaluar factores de riesgo, el modelo de riesgos proporcionales de Cox. Resultados: Se realizaron 672 trasplantes, todos procedentes de donante cadáver, siendo la supervivencia del injerto del 80% y 67% después de uno y cinco años; mientras que la del paciente fue del 94% y 83%. El 67% de las pérdidas de injerto se producen en los primeros doce meses, siendo la causa más frecuente la trombosis vascular (44%). Los factores de riesgo independientes para la pérdida del injerto fueron donación en asistolia (riesgo relativo [HR] = 3,41; intervalo de confianza al 95% [CI]: 1,73-6,73); edad del donante (RR = 1,54, IC: 1,05- 2,27 entre 40-60 años; RR = 2,59, CI: 1,66-4,07 en mayores de 60; siempre en relación a los menores de 40); injerto generado en hospital no trasplantador (RR = 1,43; CI: 1,02-2,02); rechazo agudo (RR = 2,32; CI: 1,63-3,22) y retrasplante (RR = 1,56; CI: 1,03-2,37). Las infecciones fueron la principal causa de muerte (38%), seguidas de patologías cardiovasculares (30%) y tumores (11%). Conclusiones: La tasa de trasplantes, aunque con significativas diferencias territoriales, es de 50 por millón de población y la supervivencia del paciente es comparable a la de cualquier registro internacional; sin embargo, la supervivencia del injerto, posiblemente debido a elevada incidencia de trombosis vascular, es manifiestamente mejorable

Background: Spain is the world leader in organ transplant rates, and the national average is maintained in the northwestern Spanish region of Galicia. However, there is no official registry recording transplantation results in this region. In this paper we report a study of patient and graft survival and risk factors among kidney transplant patients in Galicia between january 1996 and december 2000. Methods: Patients receiving kidney transplants in Galicia in the above period were monitored up to the end of 2001, deaths and graft losses were recorded and analysed by actuarial and Kaplan-Meier methods, and possible risk factors for death and graft loss were evaluated using Cox’s proportional hazards model. Results: In the study period, 672 kidneys were transplanted, all from deceased donors. Graft and patient survival rates were respectively 80% and 94% after 1 year, and 67% and 83% after 5 years. Two-thirds of graft losses occurred within the first year and the most common cause was vascular thrombosis (44%). Independent risk factors for graft loss were donor asystole (relative risk [RR] = 3.41, 95% confidence interval [CI]: 1.73-6.73), donor age (RR = 1.54, CI: 1.05- 2.27 for 40-60-year-olds, RR = 2.59, CI: 1.66-4.07 for over-60s, relative to under- 40s), donation from outside the institution in which implant was performed (RR = 1.43, CI: 1.02-2.02), acute rejection (RR = 2.32, CI: 1.63-3.22), and retransplantation (RR = 1.56, CI: 1.03-2.37). The main causes of death were infections (38%), followed by cardiovascular pathologies (30%) and tumours (11%). Conclusions: The kidney transplant rate varies excessively within Galicia; the global rate is 50 per million inhabitants per year. Patient survival is similar to those recorded in national registers, but graft survival is deficient, apparently due to a high incidence of vascular thrombosis

Factores de riesgo para la desestimación de riñones en Galicia. ¿Es posible incrementar su utilización? / Risk factors for refusing kidneys in galicia. ¿is it possible to increase its use?

Los cambios demográficos, junto con el incremento de la demanda de órganos yde la experiencia de los equipos trasplantadores, conlleva una constante modificaciónde las características de los donantes y, en consecuencia, de la proporción deórganos utilizados y desestimados.Pretendemos analizar la utilización y desestimación de riñones generados en Galicia,para lo cual hicimos un seguimiento de los donantes renales generados entre1996 y 2000, estudiando las causas de no extracción y desestimación de riñones yanalizando la influencia que sobre ellas ejercen las características de los donantes.Para evaluar factores de riesgo de no utilización de los injertos se elaboraron modelosde regresión logística múltiple, estimando odds ratios con intervalos de confianzaal 95%.Se extrajeron 836 riñones de 433 donantes, de los que se implantaron 697. El17% de los órganos extraídos, porcentaje que en los dos últimos años se aproximóal 25%, se desestimaron, bien por resultados de las biopsias (27%), patologías previasdel donante (22%), problemas anatómicos (16%), isquemia prolongada(12%) o ausencia de receptor (14%).La edad media de los injertos desechados fue significativamente mayor que la delos implantados, de modo que superar los 45 años representó un factor de riesgo independientepara la desestimación de riñones (OR = 1,76 y p = 0,05, para edadesentre 45 y 59 años; OR = 6,1 y p = 0,000, para mayores de 60 años), al igual que lofueron los antecedentes de hipertensión arterial (OR = 1,59 y p = 0,044), los niveleselevados de creatinina sérica (OR = 1,83 y p = 0,005) y la presencia de anticuerposfrente al virus de la hepatitis C (OR = 5,65 y p = 0,001) y para el antígeno del corede la hepatitis B (OR = 2,91 y p = 0,017).En definitiva, los donantes añosos y con patología asociada permiten incrementarel número de injertos, aunque conllevan un incremento de los desestimados, que alcanzancasi el 20% de los generados; sin embargo, más de la mitad de los mismosse desecharon por causas potencialmente evitables, por lo que podrían haber sidovalorados para implantar en receptores límites

Introduction. Demographic changes along with an increase in the demand oforgans and an increase in the expertise of transplantation teams, lead to a constantmodification of donors’ characteristics and, accordingly, of the supply of theorgans used and refused.Objective. Analyze the use and refusal of kidneys generated in Galicia.Subjects and method. A follow-up of kidney donors was carried out between1996 and 2000, studying the reasons for non extraction and refusal of kidneysand analyzing the influence that donors’ characteristics have on them. In order toevaluate the risk factors of not using grafts, multiple logistic regression patternswere made, assessing odds ratios with confidence intervals at 95%.Results. 836 kidneys were recovered from 433 donors, and 697 were implantedout of them. 17% of the organs extracted, a percentage approaching 25% inthe two latest years, were discarded, due to the biopsy findings (27%), donor’sprevious conditions (22%), anatomical disorders (16%), prolonged cold ischemia(12%) or recipient not located or unsuitable (14%).The average age of refused grafts was significantly higher than that of implantedones, in such a way that having more than 45 years old was an independentrisk for refusing kidneys (OR = 1.76 and p = 0.05, for 45-59 years old; OR = 6.1and p = 0.000, for older than 60 years old). The same happened with history ofhypertension (OR = 1.59 and p = 0.044), high serum creatinine level (OR = 1.83and p = 0.005) and positive serology for HCV (OR = 5.65 and p = 0.001) andanti-HBc (OR = 2.91 and p = 0.017).Conclusions. Elderly donors and donors with concomitant diseases enable us toincrease the number of grafts, although they also lead to an increase in refusals,which nearly amounts to 20% of the ones generated. However, more than thehalf were refusede due to pontentially avoidable reasons and therefore these couldhave been valued for transplantation to limit recipients

[Risk factors for refusing kidneys in Galicia. Is it possible to increase its use?]. / Factores de riesgo para la desestimación de riñones en Galicia. Es posible incrementar su utilización?

INTRODUCTION: Demographic changes along with an increase in the demand of organs and an increase in the expertise of transplantation teams, lead to a constant modification of donors' characteristics and, accordingly, of the supply of the organs used and refused. OBJECTIVE: Analyze the use and refusal of kidneys generated in Galicia. Subjects and method. A follow-up of kidney donors was carried out between 1996 and 2000, studying the reasons for non extraction and refusal of kidneys and analyzing the influence that donors' characteristics have on them. In order to evaluate the risk factors of not using grafts, multiple logistic regression patterns were made, assessing odds ratios with confidence intervals at 95%. RESULTS: 836 kidneys were recovered from 433 donors, and 697 were implanted out of them. 17% of the organs extracted, a percentage approaching 25% in the two latest years, were discarded, due to the biopsy findings (27%), donor's previous conditions (22%), anatomical disorders (16%), prolonged cold ischemia (12%) or recipient not located or unsuitable (14%). The average age of refused grafts was significantly higher than that of implanted ones, in such a way that having more than 45 years old was an independent risk for refusing kidneys (OR = 1.76 and p = 0.05, for 45-59 years old; OR = 6.1 and p = 0.000, for older than 60 years old). The same happened with history of hypertension (OR = 1.59 and p = 0.044), high serum creatinine level (OR = 1.83 and p = 0.005) and positive serology for HCV (OR = 5.65 and p = 0.001) and anti-HBc (OR = 2.91 and p = 0.017). CONCLUSIONS: Elderly donors and donors with concomitant diseases enable us to increase the number of grafts, although they also lead to an increase in refusals, which nearly amounts to 20% of the ones generated. However, more than the half were refused due to pontentially avoidable reasons and therefore these could have been valued for transplantation to limit recipients.

Trombosis del seno lateral y la vena yugular interna como complicación de la otitis media aguda / Lateral sinus and internal jugular vein thrombosis as a complication of acute otitis media

Las complicaciones de la otitis media aguda (OMA) son poco frecuentes actualmente. Presentamos un caso de mastoiditis aguda con trombosis de los senos venosos sigmoide y lateral y de la vena yugular interna como complicaciones de una OMA (AU)

Complications of acute otitis media are not common nowadays. We present a case of acute mastoiditis with thrombosis of the sigmoid and lateral sinuses and internal jugular vein as a complication of acute otitis media (AU)

Enfermedades autoinmunes asociadas a la enfermedad celíaca / Autoimmune disorders associated with celiac disease

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Avances en el conocimiento de la patogenia de la enfermedad celíaca / Celiac disease pathogeny: recent advances

En los últimos años se han realizado grandes progresos en el conocimiento de la patogenia de la enfermedad celíaca. Estudios recientes han permitido identificar secuencias de péptidos de la gliadina que actúan como epítopos para las células T intestinales gluten-específicas. La desamidación de la gliadina por la transglutaminasa tisular parece influir en la respuesta de estas células T intestinales.El descubrimiento hasta el momento de unos quince epítopos dominantes permite pensar que en un futuro se podrá utilizar inmunoterapia antígenoespecífica en la enfermedad celíaca (AU)

[Acute mastoiditis: an increasing entity]. / Mastoiditis aguda: una entidad emergente.

BACKGROUND: Mastoiditis used to be the most common complication of acute otitis media. However, once antibiotics became widely available, it was rarely reported. Recently, this complication has become more frequent. OBJECTIVES: To determine the frequency of acute mastoiditis in our center in the last few years and to analyze the clinical and bacteriologic characteristics of the patients with this diagnosis. METHODS: Retrospective analysis of all patients admitted to our hospital with a diagnosis of acute mastoiditis from 1994-2001. RESULTS: One hundred patients were diagnosed with acute mastoiditis during the study period. The mean age was 2 years and 10 months (range: 2 months-13 years) and the median age was 15 months. The mean number of episodes was 12.5 cases of acute mastoiditis per year, but 52 % of the cases occurred from 1999-2001. Culture of middle ear effusions was performed in 47 patients, revealing Streptococcus pneumoniae in 17, Haemophilus influenzae in 3, and other pathogens in 10 children. Cultures were sterile in 17 patients. Three children did not respond to medical therapy and required mastoidectomy. CONCLUSIONS: In the last few years, the incidence of acute mastoiditis in our population has increased considerably. This complication is more common in children aged less than 2 years.

Mastoiditis aguda: una entidad emergente / Acute mastoiditis: an increasing entity

Antecedentes: La mastoiditis es la complicación más frecuente de la otitis media aguda. Sin embargo, con la introducción de los antibióticos pasó a ser una complicación excepcional. Recientemente se describe un incremento de su frecuencia. Objetivos: Estudiar la frecuencia de mastoiditis aguda diagnosticada en nuestro hospital en los últimos años y analizar los cambios clínicos y bacteriológicos. Métodos: Estudio retrospectivo de todos los casos de mastoiditis aguda diagnosticados durante el período 1994 a 2001. Resultados: Se analizan un total de 100 casos de mastoiditis aguda. La edad media de los pacientes fue de 2 años y 10 meses, con unos límites entre los 2 meses y los 13 años y la edad mediana de 15 meses. La media de mastoiditis aguda por año fue de 12,5 casos. Sin embargo, el 52% de los casos se presentaron en los últimos 3 años. En 47 casos se obtuvo cultivo del oído medio, aislándose Streptococcus pneumoniae en 17 casos, Haemophilus influenzae en 3 casos, otros patógenos en 10 y en 17 casos el cultivo fue estéril. Se realizó mastoidectomía por mala respuesta al tratamiento clínico en 3 niños. Conclusiones: Los casos de mastoiditis aguda diagnosticados en nuestro centro han aumentado de forma significativa en los últimos años. Esta patología se presenta con mayor frecuencia en niños menores de 2 años (AU)