Negative-Pressure Therapy to Reduce the Risk of Wound Infection Following Diverting Loop Ileostomy Reversal: An Initial Study.

OBJECTIVE: To evaluate if the application of a negative-pressure therapy system (Prevena Incision Management System, Kinetics Concepts Inc, [KCI] an Acelity Company, San Antonio, Texas) on ileostomy-closure surgical wounds would reduce surgical site infections (SSIs) in comparison with conventional closure and dressing. DESIGN: Prospective interventional pilot study. SETTING: La Paz University Hospital, tertiary care academic hospital in Madrid, Spain. PATIENTS: The Prevena device was applied on the wounds of 17 consecutive patients undergoing ileostomy reversal. Control subjects were 43 patients undergoing the same procedure, in which conventional dressings were used for the wound. INTERVENTION: The device was applied on the wound immediately after surgery (under sterile conditions) and maintained for 5 to 7 days. Patients were evaluated daily, and on the seventh postoperative day, the device was removed and wounds carefully inspected. Another evaluation was performed a month after the surgical intervention in the outpatient clinic. MAIN OUTCOME MEASURE: The primary end point of the study was the detection of SSI (defined according to the Centers for Disease Control and Prevention definitions). Other intervention-related complications were also registered. MAIN RESULTS: There were no significant differences in demographic variables between groups. In the control group, 9 patients (21%) presented SSI, with statistical significance (P < .038) when compared with the intervention group (0%). There were no complications associated with the application of the Prevena device. Other complications (for example, ileus or obstruction) occurred in 30% of patients. CONCLUSIONS: The negative-pressure Prevena System was safe and easy to use and may prevent SSIs in dirty wounds, such as those from ileostomy closure.

Role of micro-RNA in colorectal cancer screening.

MicroRNAs are involved in carcinogenesis through postranscriptional gene regulatory activity. These molecules are involved in various physiological and pathological functions, such as apoptosis, cell proliferation and differentiation, which indicates their functionality in carcinogenesis as tumour suppressor genes or oncogenes. Several studies have determined the presence of microRNAs in different neoplastic diseases such as colon, prostate, breast, stomach, pancreas, and lung cancer. There are promising data on the usefulness of quantifying microRNAs in different organic fluids and tissues. We have conducted a review of the determinations of microRNAs in the diagnosis of colorectal cancer.

Is video-assisted thoracoscopic diaphragmatic plication a widespread technique for diaphragmatic hernia in adults? Review of the literature and results of a national survey.

Diaphragmatic plication is the most accepted treatment for symptomatic diaphragmatic hernia in adults. The fact that this pathology is infrequent and this procedure not been widespread means that this is an exceptional technique in our field. To estimate its use in the literature, we carried out a review in English and Spanish, to which we added our series. We found only six series that contribute 59 video-assisted mini-thoractomy for diaphragmatic plications in adults, and none in Spanish. Our series will be the second largest with 18 cases. Finally, we conducted a survey in all the Spanish Thoracic Surgery units in Spain: none reported more than 10 cases operated by thoracoscopy in the last 8 years (except our series) and most continue employing thoracotomy as the main approach. We believe that many patients with symptomatic diaphragmatic hernia could benefit from the use of such techniques.

Implications of the histological determination of microRNAs in the screening, diagnosis and prognosis of colorectal cancer.

MicroRNAs are short non-coding RNA molecules that participate in the regulation of gene expression. Several studies have demonstrated the involvement of microRNAs in oncogenesis and a variety of physiological functions. We conducted a literature review of studies that evaluated histological microRNAs in colorectal cancer. Although additional clinical studies are required to substantiate the relationship between microRNAs and colorectal cancer, there is preliminary evidence that microRNAs are related to the diagnosis and prognosis of colorectal cancer.

[Epigenetics and colorectal cancer]. / Epigenética y cáncer colorrectal.

The epigenetic and physiological mechanisms that alter the structure of chromatin include the methylation of DNA, changes in the histones, and changes in RNA. A literature review has been carried out using PubMed on the evidence published on the association between epigenetics and colorectal cancer. The scientific literature shows that epigenetic changes, such as genetic modifications may be very significant in the origin of neoplastic disease, contributing both to the development and progression of the disease.

Detection of hepatitis C virus in thyroid tissue from patients with chronic HCV infection.

Thyroid dysfunctions are common in chronic hepatitis C virus (HCV) infection. HCV-RNA has been detected by reverse-transcription polymerase chain reaction (PCR) in thyroid from HCV infected patients with acquired immunodeficiency syndrome. However, morphological evidence of HCV replication in thyroid cells from immune competent patients has not been provided. In situ hybridization and real-time-PCR were used to analyze HCV-RNA replication in thyroid tissue from 11 patients (3 anti-HCV, serum HCV-RNA positive; 8 anti-HCV negative). Genomic and antigenomic HCV-RNA was detected in the thyroid of the 3 anti-HCV positive patients at concentrations of 2.6 x 10(4), 1.7 x 10(4), and 8.6 x 10(3) copies/microg of total RNA (genomic) and 3.2 x 10(2), 4.3 x 10(3) and 2.9 x 10(2) HCV-RNA copies/microg of total RNA (antigenomic). No HCV-RNA was detected in the thyroid tissue of the 8 anti-HCV negative patients. Presence of genomic/antigenomic HCV-RNA in the 3 anti-HCV positive cases was confirmed by in situ hybridization. Signals were observed in the cytoplasm of the thyroid cells. In conclusion, the data obtained indicate that HCV may infect cells of the thyroid in immune competent patients with chronic HCV infection. The pathogenic implications of this finding merit further research.

[Obstructive sleep apnoea syndrome]. / Síndrome de apneas-hipopneas durante el sueño.

INTRODUCTION: Obstructive sleep apnoea (OSA) is highly prevalent in children and a major public health problem. An attempt is made to determine the clinical and polysomnographic presentation of paediatric OSA in our area. PATIENTS AND METHODS: Retrospective descriptive study of sleep tests conducted on children up to 14 years-old from 1999 to 2012 in the Sleep Unit of the University Hospital of Albacete. Age, gender, anthropometric, clinical data, indication and variables of sleep study, treatment, and outcomes were collected. RESULTS: The study included 234 children. OSA was found in 71.8%, with 42.3% moderate and 44.6% severe. The majority were male (60.7%) and the mean age 5 was years, of whom 78% were pre-school or school age. There was overweight/obesity in 44%, with 93.4% snoring, apnoea 84.5%, and 5.4% daytime sleepiness. There were 23 polysomnographies and 145 polygraphies, with a median apnoea/hypopnoea index (AHI) of 10, Sat.O2 minimum 84%, desaturation index 8, and mean sleep supine 53.65% and supine events 57.61%. Treatment was lifestyle modifications 29.2%, CPAP 6%, and surgery 42.9%. Improved snoring and/or apnoea 69.4%, and weight 32.4% of overweight/obesity children. CONCLUSIONS: Most of the studied children had a pathological AHI. Almost half were overweight/obese, and a high percentage had moderate-severe OSA. Most frequent treatment was surgery. The clinical outcome was favourable in almost 70%. Less than a third with OSA and overweight/obesity improved weight.

Primary Squamous Cell Carcinoma of the Stomach.

Squamous cell carcinoma (SCC) of the stomach is a rare entity. There are several theories regarding the development of this tumor, but its pathogenesis remains obscure. Fewer than 100 cases of primary SCC of the stomach have been published in the literature. Due to advanced stage at the time of diagnosis in most of these cases, the prognosis is generally poor. In the case presented here, endoscopy revealed a vegetative tumor in the stomach described as SCC by biopsy. Following curative surgery, adjuvant chemotherapy was administered; however, the patient died 3 years and 4 months after surgery after recurrence was diagnosed.

Decadencia del arte clínico y auge de la medicina tecnológica / Decline of clinical art and tecnological medicine boom

En la actualidad existe consenso en que el arte clínico se ha ido deteriorando durante los últimos 50 años. Este problema ha suscitado atención internacional mediante el incremento de publicaciones, cursos, symposia y congresos. El menoscabo de la docencia a la cabecera del paciente y el consecuente declive de las habilidades clínicas tienen diversas causas; en particular, el uso abusivo e inadecuado de las nuevas tecnologías. En consecuencia, se hace difícil si no imposible obtener una recopilación apropiada de los síntomas padecidos por el enfermo. Junto con la anamnesis, la exploración física es preceptiva para el correcto diagnóstico y prescripción del tratamiento oportuno.En este artículo se se exponen las causas de la decadencia del arte clínico y cómo recuperar el ancestral patrimonio de la práctica médica. (AU)

Currently there is a consensus that the clinical art have been greatly deteriorating during the past 50 years. This problem has raised worldwide attention through as increase in publications, courses, symposia and congress. The erosion of bedside teaching and the consequent decline of clinical skills, notably wrongfull and inadequate use of new technologies. At as result, it becomes difficult if not impossible obtain an appropiate collection of the synptoms sufferick for the sick. Together with the medical history, the physical examination is mandatory for the correct diagnosis and developing the treatment plan.In this paper, the decline of clinical art is exposed and how this ancient heritage of medical practice can be recovered. (AU)

Decadencia del arte clínico y auge de la medicina tecnológica / Decline of clinical art and tecnological medicine boom

En la actualidad existe consenso en que el arte clínico se ha ido deteriorando durante los últimos 50 años. Este problema ha suscitado atención internacional mediante el incremento de publicaciones, cursos, symposia y congresos. El menoscabo de la docencia a la cabecera del paciente y el consecuente declive de las habilidades clínicas tienen diversas causas; en particular, el uso abusivo e inadecuado de las nuevas tecnologías. En consecuencia, se hace difícil si no imposible obtener una recopilación apropiada de los síntomas padecidos por el enfermo. Junto con la anamnesis, la exploración física es preceptiva para el correcto diagnóstico y prescripción del tratamiento oportuno. En este artículo se se exponen las causas de la decadencia del arte clínico y cómo recuperar el ancestral patrimonio de la práctica médica.(AU)

Currently there is a consensus that the clinical art have been greatly deteriorating during the past 50 years. This problem has raised worldwide attention through as increase in publications, courses, symposia and congress. The erosion of bedside teaching and the consequent decline of clinical skills, notably wrongfull and inadequate use of new technologies. At as result, it becomes difficult if not impossible obtain an appropiate collection of the synptoms sufferick for the sick. Together with the medical history, the physical examination is mandatory for the correct diagnosis and developing the treatment plan. In this paper, the decline of clinical art is exposed and how this ancient heritage of medical practice can be recovered.(AU)

[Splenic lymphangioma. A rare tumour. Presentation of 3 cases and a literature review]. / Linfangioma esplénico. Un tumor raro. Presentación de 3 casos y revisión de la bibliografía.

BACKGROUND: Lymphangiomas are benign tumours, considered to be congenital malformations of the lymphatic system that predominately affect children, with only a few cases reported in adults. The most common sites of these lesions are the neck (75%) and axillary region (20%), but rarely found in the spleen. OBJECTIVE: A description is presented of 3 cases of incidentally detected splenic lymphangioma, one in a child and in 2 adults, respectively, as well as a literature review. CLINICAL CASES: After a clinical and physical examination, all patients had an abdominal ultrasound, CT scan and a complete splenectomy, followed by a histopathological study on the removed spleen. Two patients were asymptomatic, and the paediatric patient referred to intermittent abdominal pain without other symptoms. The clinical and physical examinations related to the mass were negative. The final diagnosis was based on a combination of radiological and histopathological findings. Total splenectomy was undertaken in all cases without complications. CONCLUSIONS: Splenic lymphangioma is very rare, and more so in adults. This condition is often asymptomatic and is incidentally detected by imagenology due to any other differet cause. The final diagnosis should be based on a combination of clinical, radiological, and histopathological findings. Splenectomy is the treatment of choice and the prognosis is good.

[Subclinical hypothyroidism and cardiovascular risk]. / HIPOTIROIDISMO SUBCLÍNICO Y RIESGO CARDIOVASCULAR.

OBJECTIVE: To assess whether subclinical hypothyroidism can behave as a cardiovascular risk factor or a modifier thereof, identifying epidemiological variables and estimated in a sample of patients diagnosed in the province of Albacete (Spain) cardiovascular risk. METHODOLOGY: Observational, descriptive study was carried out in Albacete during the first half of January 2012 in patients of both genders with subclinical hypothyroidism. The following variables were analyzed: Fasting glucose , total cholesterol , HDL cholesterol, LDL cholesterol , triglycerides , TSH , T4 , weight, height, Body Mass Index , blood pressure, a history of cardiovascular disease , cardiovascular risk factors and estimated cardiovascular risk. RESULTS: 326 patients younger than 65 years at 78% without cardiovascular risk factors in 48.61 %, with female predominance (79.2 %). The prevalence of cardiovascular risk factors was identified: smoking (33.2 %), diabetes mellitus (24.9%), hypertension (23.4 %), lipid abnormalities (28.9%) and atrial fibrillation (4,9%). No association between subclinical hypothyroidism and most lipid profile parameters that determine a pro- atherogenic profile, except with hypertriglyceridemia was found. Likewise, neither association with increased cardiovascular risk was found. DISCUSSION: The profile of patients with subclinical hypothyroidism is a middle-aged woman with no cardiovascular risk factors in half of cases. It has been found relationship between subclinical hypothyroidism and hypertriglyceridemia, but not with the other parameters of lipid profile, other cardiovascular risk factors or with increased risk. However, 25% of diabetics and 22% of non-diabetics are at moderate to high cardiovascular risk.

Objetivos: Valorar si el hipotiroidismo subclínico puede comportarse como un factor de riesgo cardiovascular o un modificador del mismo, identificando variables epidemiológicas y riesgo cardiovascular estimado en una muestra de sujetos diagnosticados en la provincia de Albacete. Método: Estudio observacional, descriptivo y transversal realizado en Albacete durante la primera quincena de enero de 2012 en pacientes de ambos géneros con hipotiroidismo subclínico. Se analizaron las siguientes variables: glucemia basal, colesterol total, colesterol HDL, colesterol LDL, triglicéridos, TSH, T4, peso, talla, I.M.C., tensión arterial, antecedentes de patología cardiovascular, factores de riesgo cardiovascular y riesgo cardiovascular estimado. Resultados: Se obtuvieron 326 pacientes, con predominio femenino (79,2 %), menores de 65 años en el 78% y sin factores de riesgo cardiovascular en el 48,61%. La prevalencia de los factores de riesgo cardiovascular identificados fué: tabaquismo (33,2%), diabetes mellitus (24,9%), hipertensión arterial (23,4%), alteraciones lipídicas (28,9%) y fibrilación auricular (4,9 %). No se encontró asociación entre hipotiroidismo subclínico y la mayoría de los parámetros del perfil lipídico que condicionan un perfil pro-aterogénico, salvo con la hipertrigliceridemia. Asimismo, tampoco se constató asociación con riesgo cardiovascular aumentado. Conclusiones: El perfil del paciente con hipotiroidismo subclínico es una mujer de mediana edad sin factores de riesgo cardiovascular en la mitad de casos. Se ha encontrado relación entre hipotiroidismo subclínico e hipertrigliceridemia, pero no con el resto de parámetros del perfil lipídico, otros factores de riesgo cardiovascular o con aumento de dicho riesgo. Sin embargo, un 25% de diabéticos y un 22% de no diabéticos están en situación de riesgo cardiovascular moderado-alto.

[Short bowel: from resection to transplantation]. / Intestino corto: de la resección al trasplante.

Short bowel syndrome (SBS) is characterized by a significant reduction in the effective intestinal surface by an anatomical or functional loss of the small intestine. It mainly occurs after extensive bowel resection, intestinal intrinsic disease or surgical bypass. The main complications are malabsorption, maldigestion, malnutrition, dehydratation and, potentially, lethal metabolic lesions. The treatment is based on appropiate, individualized nutritional support; however, the most recent outcomes on bowel transplantation (BT) and a great rate of survivors achieving complete digestive autonomy and able to carry out activities according to their age allow for considering BT as the first choice therapy in patients with irreversible intestinal failure in whom poor prognosis with parenteral nutrition is foreseen. In this paper the most outstanding aspects of SBS are revised.

El síndrome de intestino corto (SIC) es un cuadro clínico caracterizado por una importante disminución de la superficie intestinal efectiva por una pérdida anatómica o funcional del intestino delgado. Aparece por la práctica de resecciónes intestinales extensas, enfermedad intestinal intrínseca o bypass quirúrgico. Sus principales complicaciones son malabsorción, maldigestion, malnutrición, deshidratación y, potencialmente, lesiones metabólicas letales. Un soporte nutricional adecuado e individualizado constituye la base del tratamiento; no obstante, los resultados más recientes del trasplante intestinal (TI) y la gran proporción de supervivientes que consiguen autonomía digestiva completa y desempeñan actividades acordes con su edad, permiten considerar el TI como el tratamiento de elección en enfermos con fallo intestinal irreversible en los que es previsible una mala evolución con nutrición parenteral. En este artículo se exponen los aspectos más relevantes del SIC.

Primary and secondary prevention of colorectal cancer.

INTRODUCTION: Cancer is a worldwide problem as it will affect one in three men and one in four women during their lifetime. Colorectal cancer (CRC) is the third most frequent cancer in men, after lung and prostate cancer, and is the second most frequent cancer in women after breast cancer. It is also the third cause of death in men and women separately, and is the second most frequent cause of death by cancer if both genders are considered together. CRC represents approximately 10% of deaths by cancer. Modifiable risk factors of CRC include smoking, physical inactivity, being overweight and obesity, eating processed meat, and drinking alcohol excessively. CRC screening programs are possible only in economically developed countries. However, attention should be paid in the future to geographical areas with ageing populations and a western lifestyle.19,20 Sigmoidoscopy screening done with people aged 55-64 years has been demonstrated to reduce the incidence of CRC by 33% and mortality by CRC by 43%. OBJECTIVE: To assess the effect on the incidence and mortality of CRC diet and lifestyle and to determine the effect of secondary prevention through early diagnosis of CRC. METHODOLOGY: A comprehensive search of Medline and Pubmed articles related to primary and secondary prevention of CRC and subsequently, a meta-analysis of the same blocks are performed. RESULTS: 225 articles related to primary or secondary prevention of CRC were retrieved. Of these 145 were considered valid on meta-analysis: 12 on epidemiology, 56 on diet and lifestyle, and over 77 different screenings for early detection of CRC. Cancer is a worldwide problem as it will affect one in three men and one in four women during their lifetime. There is no doubt whatsoever which environmental factors, probably diet, may account for these cancer rates. Excessive alcohol consumption and cholesterol-rich diet are associated with a high risk of colon cancer. A diet poor in folic acid and vitamin B6 is also associated with a higher risk of developing colon cancer with an overexpression of p53. Eating pulses at least three times a week lowers the risk of developing colon cancer by 33%, after eating less meat, while eating brown rice at least once a week cuts the risk of CRC by 40%. These associations suggest a dose-response effect. Frequently eating cooked green vegetables, nuts, dried fruit, pulses, and brown rice has been associated with a lower risk of colorectal polyps. High calcium intake offers a protector effect against distal colon and rectal tumors as compared with the proximal colon. Higher intake of dairy products and calcium reduces the risk of colon cancer. Taking an aspirin (ASA) regularly after being diagnosed with colon cancer is associated with less risk of dying from this cancer, especially among people who have tumors with COX-2 overexpression.16 Nonetheless, these data do not contradict the data obtained on a possible genetic predisposition, even in sporadic or non-hereditary CRC. CRC is susceptible to screening because it is a serious health problem given its high incidence and its associated high morbidity/mortality. CONCLUSIONS: (1) Cancer is a worldwide problem. (2) A modification of diet and lifestyle could reduce morbidity and mortality. (3) Early detection through screening improves prognosis and reduces mortality.

Gastric necrosis: A late complication of nissen fundoplication.

Gastric necrosis is a rare condition because of the rich blood supply and the extensive submucosal vascular network of the stomach. "Gas-bloat" syndrome is a well known Nissen fundoplication postoperative complication. It may cause severe gastric dilatation, but very rarely an ischemic compromise of the organ. Other factors, such as gastric outlet obstruction, may concur to cause an intraluminal pressure enough to blockade venous return and ultimately arterial blood supply and oxygen deliver, leading to ischaemia. We report a case of a 63-year-old women, who presented a total gastric necrosis following laparoscopic Nissen fundoplication and a pyloric phytobezoar which was the trigger event. No preexisting gastric motility disorders were present by the time of surgery, as demonstrated in the preoperative barium swallow, thus a poor mastication (patient needed no dentures) of a high fiber meal (cabbage) may have been predisposing factors for the development of a bezoar in an otherwise healthy women at the onset of old age. A total gastrectomy with esophagojejunostomy was performed and patient was discharged home after a 7-d hospital stay with no immediate complications. We also discuss some technical aspects of the procedure that might be important to reduce the incidence of this complication.

[Efficacy of motivational interventions in the treatment of overweight and obesity]. / Eficacia de las estrategias de motivacion en el tratamiento del sobrepeso y obesidad.

INTRODUCTION AND OBJECTIVES: Changing unhealthy behaviors: Diet and physical activity are key to treating obesity. The objective of this study is to determine whether an intervention group motivational intervention group by nurses trained by expert psychologist, complementary to the usual intervention is more effective than the latter in the treatment of overweight and obesity in relation to weight reduction percentage and the persistence over time of the reduction achieved. METHODS: A multicenter randomized clinical trial of intervention in overweight and obese patients. Randomization of the intervention by health areas (ZBS). Two groups located in different centers separated, one of which will receive motivational intervention group (study group) and the other routine monitoring (control group) were established. VARIABLES: Sociodemographic, results: percentage of patients reduced by 5% of its weight and maintenance over time, anthropometric assessment, assessment of cardiovascular risk factors and laboratory data. RESULTS: 696 patients were studied; 377 control and 319 study group. In both groups the weight down in each of the visits. The mean percentage weight reduction stood at 1% for the control group and 2.5% in the intervention group (p -value = 0.009). 55.8% of patients reduced the weight in the control group and 65.5% of the study group (p -value = 0.0391). 18.1% of the control patient lost more than 5% by weight, in the intervention group, this percentage increased to 26.9%; statistically significant ( p -value = 0.0304). For the 10% target no significant differences at 2 years were detected (5% vs. 8%). It was found that after two years the BMI in the control group an average 0.9 kg/m2 and 2.4 kg/m2 was reduced in the study group ( p -value = 0.0237). CONCLUSION: based motivational group intervention program can improve anthropometric and lifestyle parameters in obese patients treated in a primary care center.

Introducción y objetivos: La modificación de conductas no saludables: dietas y actividad física son fundamentales para tratar la obesidad. El objetivo de este estudio es determinar si una intervención de motivación en grupo, por profesionales de enfermería entrenados por psicólogo experto, complementariamente a la intervención habitual, es más eficaz que esta última en el tratamiento del sobrepeso y obesidad en relación a reducción porcentual del peso, y la persistencia en el tiempo de la reducción conseguida. Métodos: Ensayo clínico aleatorio multicéntrico de intervención en pacientes con sobrepeso y obesidad. Asignación aleatoria de la intervención por Zonas Básicas de Salud (ZBS). Se establecen dos grupos situados en centros diferentes separados, uno de los cuales recibirá la intervención de motivación en grupo (grupo de estudio) y el otro el seguimiento habitual (grupo control). Variables: Sociodemográficas, de resultados: porcentaje de pacientes que reducen un 5 % de su peso y mantenimiento en el tiempo, valoración antropométrica, valoración de factores de riesgo cardiovascular y datos analíticos. Resultados: Se evaluaron 696 pacientes; 377 grupo control y 319 del de estudio. En ambos grupos el peso descendía en cada una de las visitas. La reducción porcentual media del peso se situó en el 1% para el grupo control y del 2,5% en el grupo intervención (p-valor = 0,009). El 55,8% de los pacientes redujeron el peso en el grupo control y el 65,5% del grupo de estudio (p-valor = 0,0391). El 18,1% de los paciente del grupo control redujeron más del 5% del peso, en el grupo intervención este porcentaje aumentó hasta el 26.9%; estadísticamente significativo (p-valor = 0,0304). En el caso del objetivo del 10% no se detectaron diferencias significativas a los 2 años (5% vs. 8%). Se detectó que a los dos años el IMC en el grupo control se redujo una media 0,9 kg/m2 y 2,4 kg/ m2 en el grupo de estudio (p-valor = 0,0237). Conclusión: el programa basado en intervención motivacional en grupo puede mejorar parámetros antropométricos y estilos de vida en pacientes obesos tratados en un centro de Atención Primaria.

Inflammatory pseudotumour of the spleen associated with splenic tuberculosis.

Inflammatory pseudotumor (IPT) of the spleen is an uncommon entity with an uncertain aetiology. Inflammatory pseudotumors present diagnostic difficulties because the clinical and radiological findings tend to suggest a malignancy. The symptoms include weight loss, fever, and abdominal pain. Most cases of splenic IPT present solitary relatively large well circumscribed masses on imaging. The diagnosis in the majority of the cases is made after histopathologic study of splenectomy specimens. The IPTs that occur in the spleen and liver are typically associated with Epstein-Barr virus. Thirty-seven percent of all new cases of active tuberculosis infection are extrapulmonary tuberculosis and tuberculous lymphadenitis the most commonly occurring form of extrapulmonary tuberculosis. We report the case of an inflammatory pseudotumor of the spleen associated with splenic tuberculous lymphadenitis in a 50-year-old female patient who was preoperatively diagnosed with a malignant spleen tumour based on her history of breast of carcinoma.

[Tumor markers in colorectal cancer]. / Marcadores tumorales en el cáncer colorrectal.

INTRODUCTION: In 2008, colorectal cancer represented the third most commonly diagnosed tumor in Spain, and the second tumor with more deaths. Despite the new potential biomarkers in colorectal cancer, there are many challenges that need to be overcome, resulting in a need for the standardization of its determinations. DISCUSSION: The continuous advance in tumor disease knowledge makes this review a summary of the current accepted, recommended and studied tumor markers for the diagnosis and monitoring of colorectal cancer, such as fecal markers, tissue markers and serological markers, and various prognostic markers on which there are different lines of treatment in colorectal cancer. CONCLUSIONS: Oncological guidelines recommend only a minority of tumor markers for routine use, such as the study of fecal occult blood, CEA determination in the postoperative followup, microsatellite instability to identify people susceptible to hereditary nonpolyposis colorectal cáncer, and mutation of APC in the diagnosis of familial adenomatous polyposis.

Síndrome de apneas-hipopneas durante el sueño / Obstructive sleep apnoea síndrome

Introducción: El síndrome de apneas-hipopneas del sueño (SAHS) es altamente prevalente en la edad pediátrica y un problema importante de salud pública. Se pretende conocer la presentación clínica y polisomnográfica del SAHS infantil en nuestro medio. Pacientes y métodos: Estudio descriptivo retrospectivo de los estudios del sueño realizados a menores de 14 años desde 1999 hasta 2012 en la Unidad del Sueño del Complejo Hospitalario Universitario de Albacete. Se recogen edad, sexo, datos antropométricos, clínicos, indicación y variables del estudio del sueño, tratamiento y evolución. Resultados: Doscientos treinta y cuatro niños. SAHS el 71,8%: moderado 42,3% y grave 44,6%. 60,7% varones y mediana de edad 5 años; el 78% en edad preescolar o escolar. Presentaban sobrepeso/obesidad 44%, ronquidos 93,4%, apneas 84,5% y somnolencia diurna 5,4%; 23 polisomnografías y 145 poligrafías: mediana de índice de apneas-hipopneas (IAH) 10, de SatO2 mínima 84% y de índice de desaturaciones 8, y media de sueño en supino 53,65% y de eventos en supino 57,61%. El tratamiento fue medidas higiénico-dietéticas en el 29,2%, CPAP el 6% y cirugía el 42,9%. Mejoraron los ronquidos y/o apneas el 69,4% y el peso el 32,4% de los niños con sobrepeso/obesidad. Conclusiones: La mayoría de los niños estudiados tenían un IAH patológico. Casi la mitad presentaban sobrepeso/obesidad y un alto porcentaje tenía SAHS moderado-grave. El tratamiento más indicado fue la cirugía. La evolución clínica fue favorable en casi el 70%. Menos de un tercio con SAHS y sobrepeso/obesidad mejoraron el peso

Introduction: Obstructive sleep apnoea (OSA) is highly prevalent in children and a major public health problem. An attempt is made to determine the clinical and polysomnographic presentation of paediatric OSA in our area. Patients and methods: Retrospective descriptive study of sleep tests conducted on children up to 14 years-old from 1999 to 2012 in the Sleep Unit of the University Hospital of Albacete. Age, gender, anthropometric, clinical data, indication and variables of sleep study, treatment, and outcomes were collected. Results: The study included 234 children. OSA was found in 71.8%, with 42.3% moderate and 44.6% severe. The majority were male (60.7%) and the mean age 5 was years, of whom 78% were pre-school or school age. There was overweight/obesity in 44%, with 93.4% snoring, apnoea 84.5%, and 5.4% daytime sleepiness. There were 23 polysomnographies and 145 polygraphies, with a median apnoea/hypopnoea index (AHI) of 10, Sat.O2 minimum 84%, desaturation index 8, and mean sleep supine 53.65% and supine events 57.61%. Treatment was lifestyle modifications 29.2%, CPAP 6%, and surgery 42.9%. Improved snoring and/or apnoea 69.4%, and weight 32.4% of overweight/obesity children. Conclusions: Most of the studied children had a pathological AHI. Almost half were overweight/obese, and a high percentage had moderate-severe OSA. Most frequent treatment was surgery. The clinical outcome was favourable in almost 70%. Less than a third with OSA and overweight/obesity improved weight