Whipple's disease in Spain: a clinical review of 91 patients diagnosed between 1947 and 2001.

BACKGROUND: To determine the epidemiological, clinical, diagnostic and therapeutic characteristics of Whipple s disease in Spain. PATIENTS AND METHOD: Cases of Whipple s disease reported in the Spanish literature between 1947 and 2001 which meet histological or PCR criteria are reviewed. RESULTS: 91 cases were included, 87.5% of which were male. The maximum incidence was between 40 and 60 years of age (68%). There was no family clustering or susceptibility by profession or surroundings. The most common symptoms and signs were: weight loss (80%), diarrhoea (63%), adenopathies (35%), skin problems (32%), abdominal pain (27%), fever (23%), joint problems (20%) and neurological problems (16%). Arthralgias, diarrhoea and fever were noted prior to diagnosis in 58, 18 and 13% of patients, respectively. Diagnosis was histological in all cases except two, which were diagnosed by PCR. Intestinal biopsy was positive in 94%. Adenopathic biopsies (mesenteric or peripheral) were suggestive in 13% of cases, and treatment was effective in 89%. There were nine relapses, four of which were neurological, although all occurred before the introduction of cotrimoxazole. CONCLUSIONS: Whipple s disease is not uncommon, although it requires a high degree of suspicion to be diagnosed in the absence of digestive symptoms. The most common and most sensitive diagnostic method is duodenal biopsy. PCR is beginning to be introduced to confirm the diagnosis and as a therapeutic control. Initial antibiotic treatment with drugs that cross the blood-brain barrier, such as cotrimoxazole and ceftriaxone, is key to achieving a cure and avoiding relapses.

[Validation of a Spanish version of the Child Abuse Potential Inventory administered in Spain]. / Validación de una versión española del child abuse potential inventory para su uso en España.

A translation into Spanish of the Child Abuse Potential Inventory was administered to a group of perpetrators of maltreatment and physical abuse (n = 66) and to a demographically representative sample (n = 829) of the general population of the País Vasco (Spain). Results were studied with item analysis, regression, factorial analysis with the total sample so as to determine the descriptive characteristic of the Spanish version. Since this inventory is designed specifically for the detection of physical maltreatment, similar analyses were carried out with a subgroup of physical child abuse perpetrators (n = 24) and with a similar comparison group (n = 156). For the total number of perpetrators and the representative comparative group a differential analysis indicated that 91.7% had correct classification. For the group of physical child abuse perpetrators and the similar comparative group, the percentage was 98.3%. For these two comparative groups, the variance for the total of items in the abuse scale was 64.8%. Factorial analysis revealed that both English and Spanish versions of this inventory have a similar factorial structure. This preliminary data sustained the idea of working in the development and validation of a Spanish version of this inventory for the detection of physical maltreatment.

[Incidence and clinical features of splenic abscesses, with special reference to tuberculous etiology in a general hospital]. / Incidencia y características clínicas de los abscesos esplénicos, con especial referencia a los de etiología tuberculosa, en un hospital general.

BACKGROUND: The aim of this revision is to know the incidence of splenic abscess (SA) in our hospital, its etiology, with special reference to tuberculosis, and clinical characteristics. PATIENTS AND METHODS: Abdominal CT-scan performed during the period 1987-1997, with the diagnosis of splenic abscess were reviewed. Etiologic diagnosis standed on blood or sputum cultures, PAAF and/or histologic study of lymph nodes. RESULTS: Seventeen cases of SA were obtained, 12 males and 5 females. Limits of age: 13 and 77 years. The causal microorganisms were: M. tuberculosis (7), Mycobacterium aviumintracellulare (1), S. aureus (2), S. anginosus (1), S. milleri (1), E. coli (1), C. albicans (1), T. biguelle (1) and polymicrobian flora (1). One case was of unknown etiology. Underlying illnesses were: AIDS (7), malignant neoplasms (3), diabetes (2), endocarditis (2), Sjögren syndrome (1) and complications of abdominal surgery (2). Clinical presentation in nontuberculous splenic abscess was fever and upper-left abdominal pain. Predominant symptoms in tuberculous splenic abscess were fever and weight loss. Blood cultures were positive in 80% of non tuberculous splenic abscess. Specific treatment for tuberculosis improved all patients with tuberculous splenic abscess, without needing surgery or corticosteroids. CONCLUSIONS: From the total of splenic abscess, 41.1% were tuberculous, six with AIDS and one with Sjögren syndrome. Diabetes and malignant neoplasms were the commonest underlying illnesses in the non-tuberculous. In these, clinical presentation consisted in fever and upper-left abdominal pain. In patients with tuberculous splenic abscess, the main complaint was weight loss. A prompt treatment is generally succesful.

Enfermedad deWhipple en España. Revisión clínica de 91 pacientes diagnosticados durante 1947-2001 / Whipple’s disease in Spain: a clinical review of 91 patients diagnosed between 1947 and 2001

Fundamento: conocer las características epidemiológicas, clínicas,diagnósticas y terapéuticas de la enfermedad de Whipple enEspaña.Pacientes y método: se revisan los casos de enfermedad deWhipple de la literatura española que cumplen criterios histológicoso de PCR desde 1947 hasta 2001.Resultados: se incluyeron 91 casos. El 87,5% eran hombres.La incidencia máxima fue entre los 40 y 60 años de edad (68%).No hubo agregación familiar ni preferencia por profesión o entornoambiental. Los síntomas y signos más habituales fueron: adelgazamiento(80%), diarrea (63%), adenopatías (35%), cutáneos(32%), dolor abdominal (27%), fiebre (23%), articulares (20%) yneurológicos (16%). Artralgias, diarrea y fiebre se referían previamenteal diagnóstico en el 58, 18 y 13% de los enfermos, respectivamente.El diagnóstico fue histológico en todos salvo en dosque se diagnosticaron por PCR. La biopsia intestinal fue positivaen el 94%. Las biopsias de adenopatías (mesentéricas o periféricas)fueron orientadoras en un 13%. El tratamiento fue eficaz enel 89%. Hubo 9 recidivas, 4 neurológicas, estas antes de la introduccióndel cotrimoxazol.Conclusiones: la enfermedad de Whipple no es tan infrecuente.Se precisa un alto índice de sospecha para diagnosticarlaen ausencia de síntomas digestivos. El método diagnóstico másempleado y más sensible es la biopsia duodenal. Se empieza a introducirla técnica de PCR para confirmar el diagnóstico y comocontrol terapéutico. El tratamiento antibiótico inicial con antibióticosque pasan la barrera hematoencefálica como cotrimoxazol yceftriaxona es determinante para la curación de los pacientes yevitar las recidivas (AU)

Background: to determine the epidemiological, clinical, diagnosticand therapeutic characteristics of Whipple’s disease in Spain.Patients and method: cases of Whipple’s disease reportedin the Spanish literature between 1947 and 2001 which meet histologicalor PCR criteria are reviewed.Results: 91 cases were included, 87.5% of which were male.The maximum incidence was between 40 and 60 years of age(68%). There was no family clustering or susceptibility by professionor surroundings. The most common symptoms and signswere: weight loss (80%), diarrhoea (63%), adenopathies (35%),skin problems (32%), abdominal pain (27%), fever (23%), jointproblems (20%) and neurological problems (16%). Arthralgias, diarrhoeaand fever were noted prior to diagnosis in 58, 18 and13% of patients, respectively. Diagnosis was histological in all casesexcept two, which were diagnosed by PCR. Intestinal biopsywas positive in 94%. Adenopathic biopsies (mesenteric or peripheral)were suggestive in 13% of cases, and treatment was effectivein 89%. There were nine relapses, four of which were neurological,although all occurred before the introduction of cotrimoxazole.Conclusions: Whipple’s disease is not uncommon, althoughit requires a high degree of suspicion to be diagnosed in the absenceof digestive symptoms. The most common and most sensitivediagnostic method is duodenal biopsy. PCR is beginning to beintroduced to confirm the diagnosis and as a therapeutic control.Initial antibiotic treatment with drugs that cross the blood-brainbarrier, such as cotrimoxazole and ceftriaxone, is key to achievinga cure and avoiding relapses (AU)