¿Es la tuberculosis ganglionar una verdadera enfermedad tuberculosa? / Is lymph node tuberculosis a true tuberculosis disease?

Introducción: La presencia de adenopatías intratorácicas es el patrón característico de la tuberculosis pediátrica. Puede interpretarse como una infección o una enfermedad tuberculosa, con las consiguientes diferencias terapéuticas. El objetivo de este estudio fue determinar si los pacientes con adenopatías intratorácicas aisladas presentan diferencias clínicas, diagnósticas y microbiológicas respecto a los pacientes con otras formas de enfermedad tuberculosa. Material y métodos: Se estudiaron todos los pacientes menores de 14 años diagnosticados de enfermedad tuberculosa en Cantabria entre 2005 y 2014. Se clasificaron en dos grupos: pacientes con adenopatías intratorácicas exclusivamente y pacientes que presentaron otras formas de tuberculosis. Se compararon entre ambos grupos los síntomas clínicos, la velocidad de sedimentación globular, el resultado de la prueba de la tuberculina (PT) y el aislamiento microbiológico. Resultados: Se diagnosticaron 81 pacientes con enfermedad tuberculosa. El 38,3% presentó tuberculosis ganglionar intratorácica y el resto otras formas de tuberculosis. La media de edad ± desviación estándar en el momento del diagnóstico fue de 70,46 ± 43,6 meses. Los pacientes con tuberculosis ganglionar resultaron asintomáticos con mayor frecuencia y presentaron diámetros de induración de la PT significativamente mayores. El aislamiento microbiológico se consiguió en un 25,9% del total. No se observaron diferencias significativas en el aislamiento microbiológico entre ambos grupos (el 35,5 frente al 16,13%; p= 0,074). En ningún paciente con adenopatías detectadas mediante tomografía computarizada se aisló Mycobacterium tuberculosis. Discusión: El aislamiento de M. tuberculosis constituye el gold standard para el diagnóstico de enfermedad tuberculosa, estableciendo el diagnóstico diferencial con la infección. En este estudio, los pacientes con tuberculosis ganglionar presentaron un porcentaje de aislamiento microbiológico similar a los pacientes con otras formas de tuberculosis. Según estos resultados, el aislamiento microbiológico de las tuberculosis ganglionares no sería un hallazgo casual, por lo que las formas ganglionares deberían considerarse una enfermedad en lugar de una infección tuberculosa

Introduction: The presence of intrathoracic lymph nodes is the characteristic pattern of pediatric tuberculosis but can be interpreted as infection or tuberculosis disease with different therapeutic approaches. The aim of this study was to determine if patients with isolated intrathoracic lymph nodes had clinical, diagnostic and microbiological features compared with patients diagnosed with other forms of tuberculosis disease. Material and methods: All patients younger than 14 years of age diagnosed with tuberculosis in Cantabria between 2005 and 2014 were included in the study. They were classified into two groups: patients with exclusively intrathoracic adenopathies and those with other forms of tuberculosis. Clinical symptoms, erythrocyte sedimentation rate, tuberculin skin test (TST) results and microbiological isolation between the two groups were compared. Results: A total of 81 patients were diagnosed with tuberculosis, 38.3% had nodal tuberculosis and the rest other forms of tuberculosis. The mean age at diagnosis was 70.46 ± 43.6 months. Patients with nodal tuberculosis were more frequently asymptomatic and had significantly higher TST induration diameters. Microbiological isolation was achieved in 25.9% of the patients and no significant differences in microbiological isolation between the two groups were observed (35.5 vs. 16.13%; p= 0.074). No Mycobacterium tuberculosis was isolated in any patient with lymphadenopathies detected by computed tomography. Discussion: The microbiological isolation is the gold standard of tuberculosis disease. Isolation of M. tuberculosis was not significantly superior in the group of patients with exclusive lymph node tuberculosis suggesting that lymph node tuberculosis should be considered a true tuberculosis disease

Efectividad de la maniobra lordosante en el diagnóstico del síndrome facetario lumbar / Lordosis manoeuvre in the diagnosis of lumbar facet syndrome

En los pacientes con lumbalgia establecer la etiopatogenia lleva al tratamiento más adecuado. En ausencia de signos de alarma, deben intentar clasificarse según el origen anatómico, mediante anamnesis y exploración física. Un grupo importante es el de origen facetario, pero su diagnóstico clínico preciso es complejo y largo. En la práctica clínica se observa que los pacientes con un proceso degenerativo avanzado no realizan extensión ni rotaciones de la columna lumbar, sino flexión de rodillas, falseando la exploración. Por ello, se diseñó una maniobra nueva, sencilla y rápida para el diagnóstico de síndrome facetario lumbar (SFL), confirmado mediante denegación facetaria. Hipótesis. La nueva maniobra diagnóstica es mejor que la exploración clínica tradicional y, probablemente, mejor que las pruebas de imágen. Material y métodos. Estudio prospectivo de una serie de 68 pacientes (01/01/2012-30/06/2013). Se comparan: maniobra clásica (MC), diagnóstico por imagen (DI) y maniobra nueva (maniobra lordosante [ML]). Exploración y bloqueo por un autor, valoración efectividad por otro. Criterios de exclusión. Deformidad o inestabilidad. Objetivo. Determinar la efectividad de una maniobra nueva (ML) en el diagnóstico del SFL (confirmación mediante efectividad del bloqueo rama dorsal del ramo medial de la raíz lumbar, RMRDRL). Estadística. Paquete R. Resultados. ML más efectiva (p < 0,0001; Kappa 0,524 p < 0,001); además, tanto MC como DI no se correlacionaron con resultado de la denervación (Kappa MC: 0,078; p = 0,487 y DI: 0,195; p = 0,105). Hubo correlación entre DI (TAC/RM) con ML (p = 0,024; Kappa 0,289 p = 0,014); aunque no con MC, ni entre DI (radiología simple) con MC ni ML. Conclusiones. Se presenta una maniobra diagnóstica para SFL más fiable, rápida y sencilla. La exploración clínica es más efectiva que las pruebas de imagen en SFL (AU)

In lumbar pain patients an aetiopathogenic diagnosis leads to a better management. When there are alarm signs, they should be classified on an anatomical basis through anamnesis and physical examination. A significant group is of facet origin (lumbar facet syndrome [LFS]), but the precise clinical diagnosis remains cumbersome and time-consuming. In clinical practice it is observed that patients with an advanced degenerative disease do not perform extension or rotation of their lumbar spine when prompted to extend it, but rather knee flexion, making the manoeuvre meaningless. For this reason, a new simple and quick clinical test was developed for the diagnosis of lumbar facet syndrome, with a facet block-test as a confirmation. Hypothesis. The new test is better than a classic one in the diagnosis of facet syndrome, and probably even better than imaging studies. Materials and methods. A prospective study was conducted on a series of 68 patients (01/01/2012-30/06/2013). A comparison in between: classic manoeuvre (CM), imaging diagnostics (ID), and the new lordosis manoeuvre (LM) test. Examination and block test by one author, and evaluation of results by another one. Exclusion criteria. Deformity and instability. using a physical. Objective. To determine the effectiveness of a new clinical test (LM) for the diagnosis of LFS (as confirmed by a positive block-test of medial branch of dorsal ramus of the lumbar root, RMRDRL). Statistics. R package software. Results. The LM was most effective (p<.0001; Kappa 0.524, p<.001). There was no correlation between either the CM or ID and the block-test results (Kappa, CM: 0.078; p=.487, and ID: 0.195; p=.105). There was a correlation between ID (CAT/MR) and LM (p=.024; Kappa 0.289 p=.014), although not with CM. There was no correlation between ID (plain X-rays) and CM or LM. Conclusions. A new test for diagnosis of LFS is presented that is reliable, quick, and simple. Clinical examination is more reliable than imaging test for the diagnosis of LFS (AU)

Lordosis manoeuvre in the diagnosis of lumbar facet syndrome. / Efectividad de la maniobra lordosante en el diagnóstico del síndrome facetario lumbar.

UNLABELLED: In lumbar pain patients an aetiopathogenic diagnosis leads to a better management. When there are alarm signs, they should be classified on an anatomical basis through anamnesis and physical examination. A significant group is of facet origin (lumbar facet syndrome [LFS]), but the precise clinical diagnosis remains cumbersome and time-consuming. In clinical practice it is observed that patients with an advanced degenerative disease do not perform extension or rotation of their lumbar spine when prompted to extend it, but rather knee flexion, making the manoeuvre meaningless. For this reason, a new simple and quick clinical test was developed for the diagnosis of lumbar facet syndrome, with a facet block-test as a confirmation. HYPOTHESIS: The new test is better than a classic one in the diagnosis of facet syndrome, and probably even better than imaging studies MATERIALS AND METHODS: A prospective study was conducted on a series of 68 patients (01/01/2012-30/06/2013). A comparison in between: classic manoeuvre (CM), imaging diagnostics (ID), and the new lordosis manoeuvre (LM) test. Examination and block test by one author, and evaluation of results by another one. EXCLUSION CRITERIA: Deformity and instability. using a physical. OBJECTIVE: To determine the effectiveness of a new clinical test (LM) for the diagnosis of LFS (as confirmed by a positive block-test of medial branch of dorsal ramus of the lumbar root, RMRDRL). STATISTICS: R package software. RESULTS: The LM was most effective (p<.0001; Kappa 0.524, p<.001). There was no correlation between either the CM or ID and the block-test results (Kappa, CM: 0.078; p=.487, and ID: 0.195; p=.105). There was a correlation between ID (CAT/MR) and LM (p=.024; Kappa 0.289 p=.014), although not with CM. There was no correlation between ID (plain X-rays) and CM or LM. CONCLUSIONS: A new test for diagnosis of LFS is presented that is reliable, quick, and simple. Clinical examination is more reliable than imaging test for the diagnosis of LFS.

Descripción de un brote de tuberculosis y utilidad de la ecografía mediastínica / Description of tuberculosis outbreak and usefulness of mediastinal ultrasound

Objetivos: Describir un brote escolar de tuberculosis y comparar las características con otros brotes. Proponer la ecografía mediastínica como ayuda en el diagnóstico y seguimiento. Pacientes y métodos: Estudio descriptivo retrospectivo de la transmisión de la infección tuberculosa en microepidemia. Criterios de infección: Mantoux ≥ 5 mm, paciente asintomático, estudio radiológico, microbiológico y analítico normal. Criterios de enfermedad: Mantoux ≥ 5 mm y alguno de los estudios anteriores patológico. Se utilizó la ecografía mediastínica como método complementario de la radiografía de tórax (RxT). Se realizó una tomografía computarizada (TC) cuando el resultado combinado de la ecografía y la RxT no fue concluyente. Resultados: De los 412 alumnos, 17 presentaron infección y 16 enfermedad tuberculosa. Además, 4 contactos extraescolares resultaron enfermos. Manifestaciones clínicas: un eritema nudoso, una púrpura de Schönlein-Henoch, 12 con tos y 9 con fiebre. RxT en enfermos: 3 normales, 7 no concluyentes y 10 con los siguientes hallazgos: 2 neumonías, 2 atelectasias, 2 complejos primarios y 4 pacientes exclusivamente con adenopatías. Todos los enfermos con RxT normal o indeterminada presentaron adenopatías mediastínicas visualizadas en la ecografía, excepto en 3 demostradas por TC. Aislamiento microbiológico: 6 casos (31%). Conclusiones: El número de enfermos respecto a infectados fue superior a otros brotes. Existe una gran variabilidad en el enfoque diagnóstico de las microepidemias de tuberculosis. Resulta compleja la diferenciación entre infección y enfermedad. La clínica, analítica y la RxT son inespecíficas. Existen enfermos con RxT normal, ecografía patológica y aislamiento microbiológico. La ecografía mediastínica puede tener un papel importante en el diagnóstico y el seguimiento de enfermedad tuberculosa (AU)

Objectives: Describe a school outbreak of tuberculosis and compare the features with other outbreaks. Propose mediastinal ultrasound as an aid in its diagnosis and monitoring. Patients and methods: Retrospective descriptive study of the transmission of tuberculosis infection in a micro-epidemic. Infection criteria: Mantoux≥5 mm, asymptomatic patient, with normal radiological, microbiological and analytical studies. Disease criteria: Mantoux ≥5 mm and any of the above pathological studies. Mediastinal ultrasound was used as a complementary method of chest radiography (CXR). Computed tomography (CT) as the combined result of ultrasound and CXR was inconclusive. Results: Seventeen out of 412 students were infected and 16 with tuberculosis disease. In addition, 4 out-school contacts were diagnosed of tuberculosis. Clinical manifestations: one erythema nodosum, one Henoch-Schönlein purpura, twelve with cough and fever nine. CXR results in patients: 3 normal, 7 inconclusive, and 10 with the following findings:2 pneumonia, 2 pulmonary atelectasis, 2 primary complexes, 4 patients only with lymphadenopathy. All patients with normal or indeterminate CXR showed mediastinal lymphadenopathy visualized on ultrasound but 3 demonstrated by CT. Microbiological isolation: 6 cases (31%).Conclusions: The number of infected patients was higher compared to other outbreaks There is great variability in the diagnostic approach to tuberculosis micro-epidemics. It is complex to differentiate between infection and disease. The clinical, laboratory and CXR are nonspecific. There are patients with normal CXR, pathological ultrasound and microbiological isolation. Mediastinal ultrasound can play an important role in the diagnosis and management of tuberculosis disease (AU)

[Description of tuberculosis outbreak and usefulness of mediastinal ultrasound]. / Descripción de un brote de tuberculosis y utilidad de la ecografía mediastínica.

OBJECTIVES: Describe a school outbreak of tuberculosis and compare the features with other outbreaks. Propose mediastinal ultrasound as an aid in its diagnosis and monitoring. PATIENTS AND METHODS: Retrospective descriptive study of the transmission of tuberculosis infection in a micro-epidemic. Infection criteria: Mantoux ≥ 5mm, asymptomatic patient, with normal radiological, microbiological and analytical studies. Disease criteria: Mantoux ≥ 5mm and any of the above pathological studies. Mediastinal ultrasound was used as a complementary method of chest radiography (CXR). Computed tomography (CT) as the combined result of ultrasound and CXR was inconclusive. RESULTS: Seventeen out of 412 students were infected and 16 with tuberculosis disease. In addition, 4 out-school contacts were diagnosed of tuberculosis. CLINICAL MANIFESTATIONS: one erythema nodosum, one Henoch-Schönlein purpura, twelve with cough and fever nine. CXR results in patients: 3 normal, 7 inconclusive, and 10 with the following findings: 2 pneumonia, 2 pulmonary atelectasis, 2 primary complexes, 4 patients only with lymphadenopathy. All patients with normal or indeterminate CXR showed mediastinal lymphadenopathy visualized on ultrasound but 3 demonstrated by CT. Microbiological isolation: 6 cases (31%). CONCLUSIONS: The number of infected patients was higher compared to other outbreaks There is great variability in the diagnostic approach to tuberculosis micro-epidemics. It is complex to differentiate between infection and disease. The clinical, laboratory and CXR are nonspecific. There are patients with normal CXR, pathological ultrasound and microbiological isolation. Mediastinal ultrasound can play an important role in the diagnosis and management of tuberculosis disease.

SLC11A1 promoter gene polymorphisms and fibrosis progression in chronic hepatitis C.

BACKGROUND AND AIMS: The solute carrier family 11 member 1 (SLC11A1) gene (formerly Nramp1) encodes for the protein solute carrier family 11, member 1. It affects susceptibility and clinical outcome of autoimmune and infectious diseases. We investigated the possible role of the functional polymorphism located in the promoter region of SLC11A1 and tumour necrosis factor (TNF) genes in the progression of fibrosis in chronic hepatitis C. METHODS: A total of 242 Caucasian Spanish patients with biopsy proven chronic hepatitis C and 194 healthy control subjects were genotyped for SLC11A1 and TNF promoter polymorphisms. RESULTS: No significant differences in the distribution of frequencies among patient and control groups were observed. The SCL11A1 homozygous 2/2 genotype was rarely detected among patients showing advanced fibrosis (2/82; 2.4%) but was highly represented in those with mild fibrosis (29/160; 18.1%; odds ratio (OR) 8.85 (95% confidence interval (CI) 1.9-55.2, p(c) = 0.002). In patients carrying allele 3 of SLC11A1, the presence of -238 TNF A/G was associated with advanced fibrosis (14/26 (53.8%) v 68/216 (31.4%); OR 2.53 (95% CI 1.03-6.23); p = 0.02). CONCLUSIONS: SLC11A1 gene promoter polymorphism could influence fibrosis progression in chronic hepatitis C in that the homozygous genotype 2/2 exerts a protective effect against cirrhosis development. Also, the combination of TNF -238 A/G and the presence of allele 3 is conducive to progression to pre-cirrhotic or cirrhotic stages of the disease.

Intravenous eradication therapy for bleeding gastroduodenal ulcer associated with Helicobacter pylori infection.

OBJECTIVE: To evaluate the efficacy of an ultrashort intravenous triple therapy against Helicobacter pylori infection in patients with bleeding peptic ulcer. METHODS: Thirty patients with bleeding peptic ulcer were studied prospectively. At endoscopy, two corpus and antrum biopsies were obtained for urease testing and culture. If H. pylori infection was found (positive urease test), the patient was treated with omeprazole 40 mg bid, metronidazole 500 mg tid and ampicillin 2000 mg fid for three days and then with ranitidine 150 mg bid for 2 months until eradication. In all patients a [13C]urea breath test was done at 2-month intervals, and in patients with gastric ulcer an endoscopy was also done and biopsies for culture and urease testing were obtained. RESULTS: Eradication efficacy (intention-to-treat) was 86.6% (26 out of 30). All schedules were administered in full and no patient had any adverse reactions. No patients had rebleeding. CONCLUSIONS: Ultrashort three-day triple therapy can achieve an eradication rate greater than 80%, with good acceptance and compliance, and without adverse events.

[Anti-Sp100 and anti-Gp210 in the diagnosis of primary biliary cirrhosis in patients with autoimmune cholangitis]. / Anti-Sp100 y anti-Gp210 en el diagnóstico de cirrosis biliar primaria en pacientes con colangitis autoinmune.

We describe 2 women with features of autoimmune cholangitis. Serum biochemical studies showed cholestasis and increased immunoglobulin M with negative antimitochondrial antibodies. Markers of hepatitis B and C viruses were absent. Both had positive antinuclear antibodies. One had a speckled pattern (multiple nuclear dots) and the other a perinuclear pattern (pore nuclear). In the first case anti-Sp100 was positive by EIA and in the second anti-Gp210 was detected by immunoblot. Diagnosis of primary biliary cirrhosis was made and the patients were treated with UDCA. Current knowledge indicates that determination of anti-Sp100 and anti-Gp210 substantially improves diagnosis of primary biliary cirrhosis as these ANA are highly specific for this disease. These autoantibodies may lead to the classification of different groups of patient included in autoimmune cholangitis. All patients with autoimmune cholangitis should be tested for anti-Sp100 and anti-Gp210.

Color Doppler diagnosis of left ventricular pseudoaneurysm.

A patient underwent mitral valve replacement because of mitral insufficiency secondary to bacterial endocarditis. Early postoperatively, routine examination with "color Doppler" correctly identified the presence of a left ventricular pseudoaneurysm. To our knowledge, this is the first case of left ventricular pseudoaneurysm diagnosed by this new technique.