Tomografía computarizada del divertículo de Meckel complicado en adultos / Computed tomography of complicated Meckel's diverticulum in adults

Objetivo: Revisar la embriología, los hallazgos clínicos y la apariencia en la tomografía computarizada multidetector (TCMD) del divertículo de Meckel (DM) complicado en adultos. Conclusión: La presencia de un DM en una TCMD debe sospecharse cuando se observa una estructura tubular ciega conectada al íleon terminal por un cuello de tamaño variable. Las reconstrucciones multiplanares y la enterografía por TC pueden ayudar al diagnóstico. En pacientes con síntomas de obstrucción o inflamación intestinal, se debe considerar la posibilidad de un DM complicado; especialmente cuando el íleon terminal y el apéndice vermiforme son normales. La angiografía por TCMD, en casos de hemorragia digestiva aguda, puede identificar extravasación de contraste y acumulación de sangre en el DM. La observación de la arteria onfalomesentérica es diagnóstica de DM. Otros hallazgos en la TCMD, como la presencia de enterolitos o cambios inflamatorios en torno al DM, pueden facilitar el diagnóstico

Objective: To review the embryology, the clinical findings and the appearance in multidetector computed tomography (MDCT) of complicated Meckel's diverticulum (DM) in adults. Conclusion: The presence of an MD in a MDCT should be suspected when a blind tubular structure connected to the terminal ileum by a neck of variable size is observed. Multiplanar 2D reconstructions images and CT enterography can help in the diagnosis. In patients with symptoms of obstruction or intestinal inflammation, the possibility of a complication secondary to a MD should be considered, especially when the terminal ileum and the vermiform appendix are normal. MDCT angiography, in cases of acute gastrointestinal bleeding, can identify contrast extravasation and accumulation of blood in the MD, and could demonstrate the persistent omphalomesenteric artery, which is diagnostic of MD. Other MDCT findings such as the presence of enteroliths or associated inflammatory changes around the MD can facilitate the preoperative diagnosis of MD complications

Computed tomography of complicated Meckel's diverticulum in adults. / Tomografía computarizada del divertículo de Meckel complicado en adultos.

OBJECTIVE: To review the embryology, the clinical findings and the appearance in multidetector computed tomography (MDCT) of complicated Meckel's diverticulum (DM) in adults. CONCLUSION: The presence of an MD in a MDCT should be suspected when a blind tubular structure connected to the terminal ileum by a neck of variable size is observed. Multiplanar 2D reconstructions images and CT enterography can help in the diagnosis. In patients with symptoms of obstruction or intestinal inflammation, the possibility of a complication secondary to a MD should be considered, especially when the terminal ileum and the vermiform appendix are normal. MDCT angiography, in cases of acute gastrointestinal bleeding, can identify contrast extravasation and accumulation of blood in the MD, and could demonstrate the persistent omphalomesenteric artery, which is diagnostic of MD. Other MDCT findings such as the presence of enteroliths or associated inflammatory changes around the MD can facilitate the preoperative diagnosis of MD complications.

Determination of vitamin B(6) in cooked sausages.

A reverse-phase high-performance liquid chromatography (HPLC) method has been described for the determination of various active forms of vitamin B(6) in meat products. Different extracting agents were tested to solubilize fully the analyte for quantification. The best data were obtained by extracting the samples with 5% (w/v) metaphosphoric acid. Separation by HPLC was performed with fluorescence detection (excitation, 290 nm; emission, 395 nm), on a 10 cm x 0.46 cm i.d. Hypersil BDS C(18) 5 microm column using a mixture of 50 mM phosphate buffer (pH 3.2) and acetonitrile (99:1, v/v) as mobile phase. Precision of the method was 0.5% (within a day) and 4.3% (between days). The detection limits were 0.020 mg/100 g for pyridoxal and pyridoxamine, 0.017 mg/100 g for pyridoxamine phosphate, 0.500 mg/100 g for pyridoxal phosphate, and 0.033 mg/100 g for pyridoxol, with a signal-to-noise ratio of 3. The recovery ranged from 92.0 to 100.0%.

Simultaneous determination of nicotinic acid and nicotinamide in cooked sausages.

A simple and sensitive method for determining simultaneously nicotinic acid and nicotinamide content in cooked sausages by ion-pair reversed-phase liquid chromatography is described. Samples are extracted with ultrapure water, centrifuged, deproteinized with zinc hydroxide, filtered, and chromatographed with UV detection at 261 nm on a 25 cm x 4 mm i.d. Spherisorb ODS-2 cartridge using as mobile phase a mixture consisting of 5 mM heptanesulfonic acid adjusted to pH 3.3 with phosphoric acid and acetonitrile (75:25, v/v). Both vitamins are measured on a reversed-phase column with a single ion-pair reagent. Precision of the method was 0.5 and 1.0% (within a day) and 2.3 and 4.5% (between days) for nicotinic acid and nicotinamide, respectively. The detection limit was 0.300 mg/100 g. The recovery was >92% of nicotinic acid and nicotinamide added to samples of meats. Twenty samples of six different products have been analyzed in duplicate. The mean value for nicotinic acid ranged between 0.908 and 1.267 mg/100 g of fresh weight and for nicotinamide between 1.968 and 2.880 mg/100 g of fresh weight.

Complicaciones de las prótesis esofágicas de Wallstent. resultados comparativos entre las prótesis recubiertas y las no recubiertas / Complications associated with the implantation of Wallstent endoprostheses in esophagus. Comparison between coated and uncoated prostheses

Objetivo. El objetivo de este trabajo es presentar nuestra experiencia en las prótesis esofágicas autoexpandibles en cuanto a las complicaciones a corto y a largo plazo, estudiando la permeabilidad primaria y secundaria de las prótesis no cubiertas y las recubiertas. Pacientes y método. Se han colocado 62 prótesis metálicas esofágicas de Wallstent (42 no recubiertas y 20 recubiertas) en 44 pacientes con carcinoma inoperable. La implantación de los stent ha sido peroral y con control fluoroscópico, requiriendo un ingreso hospitalario de 24 h. El estudio de la per meabilidad de las prótesis se ha estudiado con el test actuarial de Kaplan-Meier. Resultados. En 5 pacientes se requirió la colocación de 2 prótesis por estenosis muy larga. Respecto a las complicaciones inmediatas, en un paciente se produjo obstrucción inmediata de la malla al presentar un tumor muy blando; además, hubo un caso de hematemesis posprocedimiento. Un 45 por ciento de los pacientes con prótesis recubierta y un 19 por ciento con prótesis no recubierta presentaron dolor retrosternal importante. En cuanto a las complicaciones tardías, se observaron 2 casos de neumonía aspirativa, 2 pacientes con hematemesis y un caso con migración tardía de dos prótesis coaxiales 8 meses después de implantadas. El estudio de la permeabilidad primaria puso de manifiesto diferencias significativas entre los dos tipos de prótesis (92 y 90 días de mediana). En 8 pacientes existió obstrucción tumoral tardía tratada con una nueva prótesis, alcanzando este grupo una media de supervivencia de 260 días. Conclusiones. Las prótesis recubiertas producen más dolor retrosternal. No hay diferencias de permeabilidad en ambos tipos de prótesis. En caso de obstrucción tumoral del stent se debe valorar la colocación de una segunda prótesis (AU)

Determination of total riboflavin in cooked sausages.

A simple and rapid method for determining riboflavin content in cooked sausages by ion-pair reversed-phase liquid chromatography has been set up. Samples were subjected to acid and enzymatic hydrolysis. Sample extracts were directly chromatographed, avoiding purification and concentration treatment. Final determination was performed by high-performance liquid chromatography with fluorescence detector (excitation, 227 nm; emission, 520 nm), on a 25 cm x 4 mm i.d. Spherisorb ODS-2 cartridge using a mixture of 5 mM heptanesulfonic acid adjusted to pH 2.7 with phosphoric acid and acetonitrile (75:25, v/v) as mobile phase. Precision of the method was 1.3% (within a day) and 2.6% (between days). The detection limit was 0.015 mg/100 g. The recovery was >95%.

Determination of thiamin in cooked sausages.

A reliable and rapid high-performance liquid chromatography (HPLC) method has been set up for the determination of total thiamin in difficult sample matrices such as cooked sausages. Different hydrolysis conditions and enzymes were tested to release the vitamin from its phosphate ester. The best data in the enzymatic digestion were obtained by incubating the samples with 6% clara-diastase at 50 degrees C for 3 h. After oxidation of thiamin to thiochrome, the sample extracts were purified by using a C(18) Sep-Pak cartridge. Final determination was performed by reversed-phase HPLC with fluorescence detector (excitation 360 nm, emission 430 nm), on a low-cost 25 cm x 4 mm i.d. Spherisorb C(8) cartridge using a mixture of 5 mM phosphate buffer pH 7.0 and acetonitrile (70:30, v/v) as mobile phase. Precision of the method was 1.5% (within a day) and 5. 2% (between days). The detection limit was 0.015 mg/100 g. All the recoveries from the different cooked sausages were better than 90% of thiamin hydrochloride added to samples of meats. In the samples analyzed, the mean value for thiamin was between 0.039 and 0.508 mg/100 g fresh weight.

[The characteristics, management and prognosis of the acute myocardial infarct patient in the Valencian Community in 1995: the results of the PRIMVAC Registry (The Registry Project of Acute Myocardial Infarct in Valencia, Alicante and Castellón). As representatives of the PRIMVAC investigators]. / Características, manejo y pronóstico del paciente con infarto agudo de miocardio en la Comunidad Valenciana en 1995: resultados del registro PRIMVAC (Proyecto de Registro de Infarto Agudo de Miocardio de Valencia, Alicante y Castellón). En represntación de los investigadores del PRIMVAC.

BACKGROUND AND OBJECTIVES: Regional registers of patients with acute myocardial infarction are scarce in Spain. The PRIMVAC register (Proyecto de Registro de Infarto agudo de Miocardio de Valencia, Alicante y Castellón) was initiated to obtain updated information on the management of these patients in the Valencia Autonomous Community. Data of the first twelve months of the register are presented. METHODS: The 17 participating hospitals cover 2,833,938 inhabitants. Demographic, clinical, procedural and outcome data as well as predictive variables of mortality were analysed in the patients with acute myocardial infarction during their stay in the coronary care units from 1 December 1994 to 30 November 1995. RESULTS: During 12 months, 2,377 patients were included. Mean age was 65.3 years (SD 11.9) and 23.2% were female. Left ventricular failure was present in 39.8%. Thrombolytic therapy was applied in 42.1% with a median time delay of 195 min from chest pain onset. This time was longer in the women (250 min) and in the elderly (210 min). The in-coronary-care-unit-mortality rate was 13.9%. Age, female gender, diabetes, previous myocardial infarction, Q wave and right ventricular infarction independently predicted increased early mortality. CONCLUSION: Present data show the feasibility of an acute myocardial infarction register in the Valencia Autonomous Community. Although an acceptable level of thrombolysis has been reached, the mortality rate is still high. The long delay in initiating thrombolysis, particularly in female and elderly patients is remarkable.

[The RICVAL study. Acute myocardial infarct in the city of Valencia. Data on 1,124 patients during the first twelve months of the registry (December, 1993--November, 1994)]. / Estudio RICVAL. El infarto agudo de miocardio en la ciudad de Valencia. Datos de 1,124 pacientes en los primeros 12 meses del Registro (diciembre de 1993-noviembre de 1994). Investigadores del RICVAL.

BACKGROUND AND OBJECTIVES: Information on the management of acute myocardial infarction in Spain is still scarce. The Register of Acute Myocardial Infarction of Valencia City (RICVAL) was established to collect, in a prospectively and uniformly way, data of patients with acute myocardial infarctions discharged from Valencia coronary care units, in order to obtain updated information on the management of these patients. Data of the first twelve months of the register are presented. METHODS: Using standardised variables, demographic, clinical, procedural and outcome data from patients with acute myocardial infarction were collected at the eight hospitals collaborating in the RICVAL, from 1 December 1993 to 30 November 1994. RESULTS: The eight participating hospitals cover 1,665,720 people. During 12 months, 1,124 patients were discharged from the participating coronary care units. Mean age was 65.1 years and 23.9% were female. The case fatality rate was 16.9%. Left ventricular failure (Killip 2, 3 and 4) was present in 42%. Thrombolytic therapy was applied in 43.5% with a median time delay of 210 minutes from chest pain onset. The delay time in initiating thrombolysis was longer in the women and in the elderly. CONCLUSION: Analysis of present data shows the feasibility of an acute myocardial infarction register in Valencia City. The RICVAL study will allow a better knowledge of demographic, clinical, procedural and outcome data in patients with myocardial infarction. The case fatality rate is still high when we consider that an acceptable level of thrombolytic therapy has been reached. The long delay time in initiating thrombolysis, particularly in the elderly and in the women, must be emphasized.

[Differential characteristics and survival of women with acute myocardial infarction. Registry of Acute Myocardial Infarctions of the City of Valencia (RICVAL). Researchers of the RICVAL]. / Características diferenciales y supervivencia del infarto agudo de miocardio en la mujer. Registro de infartos agudos de miocardio de la ciudad de Valencia (RICVAL). Investigadores del RICVAL.

INTRODUCTION AND OBJECTIVES: The prevalence of women who are admitted to the hospital after acute myocardial infarction is lower to that of men and their prognosis is worse. The reason for these differences is unclear. We studied the demographic and historical variables, the evolution, treatment and early survival in 269 women included in the Register of Acute Myocardial Infarctions of the City of Valencia (RICVAL) and compared them with the 855 men included in the same Register. PATIENTS AND METHODS: Register of patients admitted into a Coronary Care Unit in the City of Valencia since December, 1st, 1993 until November 30th, 1994. RESULTS: 23.9% of the patients were women with a mean age of 71.9 +/- 9 years; 46.8% of them were diabetics, 55.4% hypertensives, and 6.7% smokers. The women arrived for treatment later than men and 34.9% of them were thrombolised. The incidence in women of severe heart failure (Killip III and IV) was 40.1% and the mortality 29.7%. In women with thrombolytic treatment the mortality was 29.8%. In the logistic regression model performed, female sex predicted a higher mortality rate (odds ratio [OR] = 1.30; confidence interval [CI], 1.05-1.61). CONCLUSIONS: Early mortality in women after acute myocardial infarction is higher than in men in the RICVAL Register. The longer delay in initiating medical care and thrombolysis might be the cause for the higher proportion of heart failure among women and explain their worse prognosis after an acute myocardial infarction compared to men.

Incidence of community-acquired pneumonia and Chlamydia pneumoniae infection: a prospective multicentre study.

This one year prospective multicentre study was designed to determine the incidence of community-acquired pneumonia in adults. It was carried out in primary health care centres and three reference hospitals, located in the 'Maresme' region (Barcelona, Spain) serving a population of 39,733 subjects over 13 years of age. Patients suspected of having contracted community-acquired pneumonia were visited by their family doctors and referred to the three reference hospitals for confirmation of the diagnosis. Patients attending the emergency services of these hospitals were also included. Urine and blood samples were obtained for culture, antigen detection, blood count, serological tests, blood gases and biochemical profile. The diagnosis of community-acquired pneumonia was made in 105 patients. Forty-six patients had an identifiable microbial etiology. Chlamydia pneumoniae was the most common pathogen (16 cases) followed by Streptococcus pneumoniae (13 cases) and Mycoplasma pneumoniae (8 cases). In conclusion; the annual incidence rate of community-acquired pneumonia in adults in this area was 2.6 cases per 1,000 inhabitants and Chlamydia pneumoniae was the most frequent causative pathogen.

[Multicenter study of the prevalence of type 2 human immunodeficiency virus infection in Spain (1990)]. / Estudio multicéntrico de la prevalencia de infección por el virus de la inmunodeficiencia humana tipo 2 en España (1990).

BACKGROUND: HIV-2 is a new retrovirus which may produce AIDS and has been mainly described in individuals from West Africa. More than 400 cases have been reported in France and Portugal while in Spain very few cases of HIV-2 infection have been reported with few studies having been made concerning the prevalence of the disease. This multicentric study analyzes the prevalence of HIV-2 infection in subjects of different risk groups in Spain and evaluates the diagnostic efficacy of different methodologies. METHODS: The presence of HIV-2 antibodies was analyzed in 902 serum samples of high risk individuals collected in 1990 from: 386 drug addicts, 246 not drug addict prostitutes, 184 West Africans and 86 homo/bisexual individuals. These samples were from Barcelona, Sevilla, and Malaga. The detection of antibodies was carried out by enzymatic immunoanalysis (EIA), Western blot (WB) and an enzymoimmuno-dot (EID) designed with synthetic peptides. RESULTS: Positive serology only for HIV-2 was detected in 7 samples from African immigrants. Two drug addicts presented double reactivity HIV-1/HIV-2 in all the tests suggesting double infection. No prostitutes or homo/bisexual males were identified with positive serology for HIV-2. Cross-reactivity between HIV-1 and HIV-2 was more frequently detected in WB than in EID. Greater discordance was found in the results obtained by EIA, WB, and EID in the West Africans than in the analysis of the samples of native subjects. CONCLUSIONS: This study demonstrates that, for the time being, HIV-2 infection in Spain is rare although from among immigrants from endemic areas subjects with behavior to risk of transmission to the autochthonous population have been identified. The use of techniques designed with synthetic peptides may be of use to discriminate HIV-1 and HIV-2 infection in positive samples by enzymatic immunoanalysis (EIA) and Western blot which use a viral lysate as antigenic material.

[Prospective study of community-acquired pneumonias seen in a general hospital. Diagnostic errors]. / Estudio prospectivo de las neumonías extrahospitalarias atendidas en un hospital general. Error diagnóstico.

BACKGROUND: The patients with community acquired pneumonias seen in an emergency service of a basic general hospital during one year were evaluated to assess their etiological, clinical and radiological features, and also to investigate the initial and final diagnosis of the disease, its evolution and the parameters associated with each microbiological type. METHODS: A medical team investigated daily the clinical records. For etiologic diagnosis, blood cultures, serological studies, urine counterimmunoelectrophoresis (CIE) and, in individualized patients, pleural fluid culture, bronchoaspirate and bronchoalveolar lavage were performed. The discordance between the initial clinical and radiological diagnosis and the microbiological results, and also the initial and final diagnostic errors were analyzed. RESULTS: 311 cases of pneumonia (150 adults and 161 children) were diagnosed. 95 (30%) had microbiological confirmation. Streptococcus pneumoniae was the most commonly isolated organism. Serologic studies were the diagnostic method with the highest yield. Complications developed in 28% of the patients and the mortality rate was 2%. There was a relationship between mortality and a high respiratory rate on admission. The initial-final diagnostic discrepancy was 43% in atypical pneumonias and 40% in bacterial pneumonias. CONCLUSIONS: Clinical parameters permitting the differentiation between atypical and bacterial pneumonia were not found. The initial diagnostic error was 12%, consisting of false positives in all instances, and the final diagnostic error included 15% false positives and 10% false negatives. Underlying diseases have a influence on the evolution of pneumonia. The mean respiratory rate on admission should be measured as a prognostic indicator. In the present study, urine CIE was a poorly sensitive method.

[Prevalence of type 1 human immunodeficiency virus (HIV) infection in African patients residing in Catalonia]. / Prevalencia de la infección por el virus de la inmunodeficiencia humana (VIH) tipo 1 en enfermos africanos residentes en Cataluña.

278 black patients from West Africa, living in Maresme, a coastal area north of Barcelona were studied in order to determine the prevalence of HIV-1 infection. During the first period (1984-86), 102 patients were studied, 3 of them were positive for HIV-2, but none was positive for HIV-1. In the second period (1987-89), 176 patients were studied and 15 were positive for HIV-1. Sexual intercourse with prostitutes of low social level was the only risk factor in all of them. Nine of these 15 patients had other STD, 4 parasite infections, 5 AIDS related-syndrome and 2 AIDS. These findings alert us to the high prevalence of HIV-1 infection in this group of patients (8.5%) and call for stricter measures to enforce hygiene in the area of prostitution.

[Perirenal hematoma caused by spontaneous upper calix rupture]. / Hematoma perirrenal por rotura espontánea calicial superior.

We report a case of perirenal hematoma from spontaneous rupture of the upper urinary tract associated with parenchymal rupture due to a calculus lodged in the pelvic ureter. The clinical features were pain confined to the renal fossa, leukocytosis and Hct of 36%. Diagnosis was made by percutaneous punction pyelography.

[Lateral fistulas of the neck]. / Fístulas laterales del cuello.

We present four new cases of lateral fistulas of the neck which were studied with a fistulographic method, using hydrosoluble iodine contrast. In three of the four cases we were able to demonstrate the existence of an incomplete external branchial fistula, while in the fourth case a complete branchial fistula was seen. In all cases the histopathological examination confirmed the presence of fistulous tracts which were caused by disturbances of embryonic development.