Neoplasia intraepitelial vulvar: Cribado en población de riesgo / Vulvar intra-epithelial neoplasia: Screening in population at risk

Antecedentes: Las pacientes con neoplasias cervicales intraepiteliales (CIN) tienen mayor riesgo de desarrollar lesiones causadas por el virus del papiloma humano (VPH) en otras localizaciones del tracto genital inferior (entre ellas, la vulva). La vulvoscopia no está incluida en el seguimiento de las mujeres con CIN. Se propone estudiar la eficiencia de incluir la vulvoscopia en dicho seguimiento. Se analiza también la incidencia de la displasia vulvar de alto grado y la influencia de los factores protectores y de riesgo. Material y métodos: Se incluyeron 95 pacientes con diagnóstico de CIN (en pieza de conización). Se recogió toda la información relativa a sus características sociodemográficas y clínicas; se realizó vulvoscopia y, eventualmente, biopsia. Resultados y conclusiones: La media de edad de las pacientes fue de 40 años. El 62,1% de ellas eran o habían sido fumadoras (más de la mitad habían abandonado el hábito tabáquico en el momento del estudio). Solo el 21,1% declararon no utilizar método de barrera. Aunque el 78,9% de las estudiadas eran o habían sido usuarias de anticoncepción hormonal, solo ocho de ellas seguían utilizándola. Ochenta y ocho de las 95 mujeres (92,6%) estaban vacunadas contra el VPH (la mayoría postconización). No se diagnosticó ninguna displasia vulvar de alto grado. La modificación en el estilo de vida tras el diagnóstico de la patología cervical, la transitoriedad de la infección por el VPH y la mayor susceptibilidad del epitelio cervical a esta, se nos muestran como las causas más probables de la discordancia entre la prevalencia de la patología vulvar esperada y la encontrada en la población estudiada.(AU)

Background: Patients with cervical intraepithelial neoplasia (CIN) are more likely to develop lesions caused by the human papilloma virus (HPV) in other locations of the lower genital tract (including the vulva). Vulvoscopy is not included in the follow-up of women with CIN. It is proposed to study the efficiency of including vulvoscopy in follow-up. An analysis is also performed on incidence of high-grade vulvar dysplasia, as well as the influence of protective and risk factors analysed. Material and methods: The study included 95 patients with a diagnosis of CIN in the cone biopsy piece. All the information relative to their socio-demographic and clinical characteristics was collected and included, performing of the vulvoscopy as well as the biopsy. Results and conclusions: The mean age of the patients was 40 years. Just under two-thirds (62.1%) of them were or had been smokers (more than half of those had quit smoking at the time of the study). Only 21.1% said they were not using a barrier method. Although 78.9% of those studied were or had been users of hormonal contraception, only 8 out of the 95 continued using it. Most (88 out of the 95 women) were vaccinated against HPV. No high-grade vulvar dysplasia was diagnosed. The modification in the lifestyle after the diagnosis of the cervical disease, the transience of the HPV infection, and the greater susceptibility of the cervical epithelium to this, are indicated as the most probable causes of the discordance between the expected prevalence of vulvar disease and the effective rate found within the studied population.(AU)

Correlation between physicochemical and ecotoxicological approaches to estimate landfill leachates toxicity.

Leachates from municipal solid waste (MSW) landfills may contain a huge diversity of contaminants; these wastewaters should be considered as potentially hazardous complex mixtures, representing a potential environmental risk for surface and groundwater. Current MSW landfill wastes regulatory approaches deem exclusively on the physicochemical characterization and does not contemplate the ecotoxicological assessment of landfill leachates. However, the presence of highly toxic substances in consumer products requires reconsideration on the need of more specific ecotoxicological assessments. The main aim of this study was to evaluate the toxicity of different MSW landfill leachates using a battery of toxicity tests including acute toxicity tests with Daphnia magna and the anuran Xenopus laevis and the in vitro toxicity test with the fish cell line RTG-2. The additional objective was to study the possible correlation between physicochemical properties and the toxicity results obtained for untreated landfill leachates. The results showed that the proposed test battery was effective for the ecotoxicological characterization of MSW landfill leachates. A moderate to strong correlation between the measured physicochemical parameters and the calculated toxicity units was detected for all toxicity assays. Correlation factors of 0.85, 0.86 and 0.55 for Daphnia, Xenopus and RTG-2 tests, respectively, were found. The discriminant analysis showed that certain physicochemical parameters could be used for an initial categorization of the potential aquatic acute toxicity of leachates; this finding may facilitate leachates management as the physicochemical characterization is currently the most common or even only monitoring method employed in a large majority of landfills. Ammonia, alkalinity and chemical oxygen demand (COD), together with chloride, allowed a proper categorization of leachates toxicity for up to 75% of tested samples, with a small percentage of false negatives.

Solución del caso 4. Reactivación de tuberculosis sobre oleotórax / No disponible

No disponible

["Occult" renal insufficiency due to evaluating renal function using only serum creatinine]. / Insuficiencia renal "oculta" por valoración de la función renal mediante la creatinina sérica.

Timely referral to nephrologists depends on identification of renal failure. Most primary care physicians and specialists rely on serum creatinine as the standard test for determination of renal function. Creatinine clearance requires 24 hours urine collection with many pitfalls and wrong results. We compare serum creatinine and the Cockcroft-Gault (C-G) equation as measure of glomerular filtration rate (GFR). The study included 1,053 outpatients with serum creatinine lower than 2.5 mg/dl referred to our nephrological laboratory for serum creatinine and GFR determination using the C-G formula. Patients were grouped into two groups: normal renal function (serum creatinine < 1.3 mg/dl) and "incipient" abnormal renal function (serum creatinine 1.3-2.5 mg/dl). In the group of females with normal creatinine 22% (60-70 y), 35% (70-80 y) and 57% (> 80 y) had GFR values below 50 ml/min. In the group of males 11.3% (70-80 y) and 33.3% (> 80 y) also had GFR reduction in spite of normal serum creatinine. A severe renal insufficiency with creatinine clearance lower than 30 ml/min was observed in the group with "incipient" renal failure based on serum creatinine: 22.7%, 40% and 82.9% for females and 6%, 22.7% and 57% for male (60-70 y; 70-80 y; and > 80 y respectively). In order to improve management and prevention of renal failure appropriate measurements of renal function other than serum creatinine should be emphasize.

Insuficiencia renal 'oculta' por valoración de la función renal mediante la creatinina sérica / Evaluation of renal function based on serum creatinine: the existence of hidden renal insufficiency

El momento óptimo de referencia de los pacientes a los especialistas de Nefrología depende de la valoración correcta de la función renal. La mayoría de los médicos de atención primaria y otros especialistas se basan en la cifra de creatinina sérica como marcador de la función renal. El aclaramiento de creatinina requiere la correcta recogida de la orina de 24 horas con resultados erróneos que en ocasiones invalidan los resultados. En este trabajo comparamos la creatinina sérica y el aclaramiento de creatinina medido por la fórmula de Crockcroft-Gault como medida del filtrado glomerular (FG). El estudio incluyó 1.053 pacientes ambulatorios remitidos a nuestro laboratorio para la realización de una analítica que incluía creatinina. Sólo se evaluaron aquellos pacientes con creatinina inferior a 2,5 mg/dl, los cuales fueron agrupados en dos grupos: función renal normal e insuficiencia renal incipiente (creatinina sérica entre valores normales y 2,5 mg/dl).En el grupo de mujeres con función renal normal (creatinina inferior a 1,1 mg/dl), el 22 por ciento (60-70 a), 35 por ciento (70-80 a) y 57 por ciento (> 80 a) tenían valores de FG inferiores a 50 ml/min. En el grupo de varones 11,3 por ciento (70-80 a) y 33,3 por ciento (> 80 a) tenían también reducido el FG dentro de rangos de creatinina normal (inferior a 1,3 mg/dl). Se observó una insuficiencia renal severa con FG 80 a respectivamente). La valoración de la función renal basada en los valores de creatinina sérica induce a importantes errores que pueden explicar la referencia tardía a los servicios de Nefrología y la cada vez más creciente necesidad de diálisis de urgencia en pacientes con insuficiencia renal crónica no evaluada correctamente. (AU)

Hypersensitivity pneumonitis producing a BOOP-like reaction: HRCT/pathologic correlation.

SUMMARY: The authors report an unusual case of hypersensitivity pneumonitis presenting on high-resolution CT as large and sharply defined nodular opacities caused by extensive bronchiolitis obliterans with organizing pneumonia. Many of the nodules were surrounded by a halo of ground-glass attenuation. To the authors' knowledge, this is the first time these features have been described in association with hypersensitivity pneumonitis.

Tratamiento renal sustitutivo en el paciente diabético. ¿Quién, cuándo, cómo? / Replacement renal treatment in the diabetic patient. Who, when, how?

No disponible

No disponible

Skeletal malformations in hatchery reared Rana perezi tadpoles.

Skeletal malformations at metamorphosis in Rana perezi tadpoles reared in culture have been studied. Tadpoles were fed ten artificially compounded and fresh diets and kept at two different temperatures. Animals were maintained in fiberglass tanks. Bone damages are related to the nourishment with compound diets. Tadpoles fed such diets showed variable percentages of scoliosis, kyphosis, luxations, and subluxations in the hind limbs, aplasia in phalanges, and wide failures of ossification. The data suggest the origin of the lesions is a deficiency in some compounded diets that could alter collagen metabolism during skeletal adjustments at metamorphosis.