Essure® and chronic pelvic pain: a population-based cohort.

The aim of this study was to assess the incidence of chronic pelvic pain in women after placement of Essure® microinserts. This was a case series study at the hysteroscopy unit in a teaching hospital. We included 4,274 patients undergoing permanent sterilisation with Essure® microinserts from January 2005 to December 2011. Essure devices were removed in all patients reporting pelvic pain after insertion. All data were collected from the hysteroscopy unit database with later review of medical records in cases of chronic pelvic pain and a telephone survey after microinsert removal. Main outcome measures were: grade of procedure difficulty perceived by the surgeon; tolerance described by the patient after placement; the need for analgesics during or immediately after the procedure; side-effects; average time between device placement and the onset of symptoms; time between device placement and removal; technique for device removal and any symptoms thereafter. A total of seven women (0.16%) presented with chronic pelvic pain requiring microinsert removal, with four classifying the pain perceived during the procedure as medium-high. Six patients did not require analgesics after the procedure and a vasovagal syndrome requiring intravenous analgesia and monitoring occurred in only one case. Six women reported pain immediately after the procedure, with a mean time between placement and removal of 29.4 months. In all cases, the symptoms disappeared after Essure removal. We conclude that the development of chronic pelvic pain is very uncommon after placement of Essure microinserts. Removal of these devices usually improves the pain.

Eosinophilic gastroenteritis due to allergy to cow's milk.

Eosinophilic gastroenteritis is an uncommon condition that is characterized by infiltration of the gastrointestinal tract by eosinophils. We report the case of a 24-year-old woman who presented 4 episodes of eosinophilic gastroenteritis. Skin prick tests and patch tests with different allergens were all negative. The patient's eosinophil cationic protein (ECP) level was very high. Given that one of the most common causes of this condition is allergy to cow's milk, ECP levels were determined during a diet with and without cow's milk. ECP levels were considerably elevated during the diet with milk, although they returned to normal values several months after milk was withdrawn. The favorable clinical outcome and normalization of ECP levels point to a very probable association with cow's milk in the eosinophilic gastroenteritis presented by our patient.

Omalizumab as a therapeutic option for nasal polyposis in moderate-to-severe persistent allergic asthma: evidence from a prospective study in a real-world setting

No disponible

Miositis aguda benigna de la infancia secundaria a una infección por el virus influenza A subtipo H1N1 / Benign acute childhood myositis due to influenza A/H1N1 virus infection

Introducción: La miositis aguda es una complicación de la infección por el virus influenza. Clínicamente predomina el dolor en las extremidades inferiores con impotencia funcional y sin afectación de los reflejos osteotendinosos, que acompaña a los síntomas de la infección gripal. Asocia una elevación de la creatina-fosfocinasa (CPK) y otras enzimas musculares. Casos clínicos: Caso 1: Niño de 6 años de edad que acude a la consulta por presentar dolor en los miembros inferiores, con rechazo de la deambulación y fiebre. En la exploración se detecta un dolor en la zona gemelar y en el cuádriceps femoral, sin afectación articular. En la analítica al ingreso hospitalario se obtuvo una CPK de 3.614 UI/L y se detectó la presencia de hipertransaminasemia (GOT/GPT 156/42 UI/L). En el exudado nasofaríngeo se obtuvo positividad para el virus influenza A subtipo H1N1. Al quinto día, el paciente presentó leucopenia con neutropenia, con cifras de CPK de 6.529 UI/L y una elevación de las transaminasas (GOT/GPT 431/107 UI/L). Al sexto día se logró una mejoría clínica del paciente con tratamiento sintomático, y al séptimo día se produjo una normalización analítica. Caso 2: Niño de 5 años de edad que acude a la consulta por presentar fiebre y tos de 2 días de evolución. En la analítica al ingreso se obtuvieron cifras de procalcitonina de 2,94 ng/mL e índice normalizado internacional de 1,37. Se inició tratamiento con cefotaxima i.v., que se suspendió ante la positividad para el virus influenza A/H1N1 en el exudado nasofaríngeo. Al quinto día el paciente presentó mialgias en los miembros inferiores, y en la analítica se detectó leucopenia con neutropenia, cifras de CPK de 9.288 UI/L y una elevación de las transaminasas (GOT/GPT 363/95 UI/L). Se obtuvieron una mejoría clínica al sexto día y una normalización analítica al séptimo. Conclusión: La miositis aguda benigna es una entidad infradiagnosticada que debe tenerse presente en los niños con mialgias en época epidémica. Es una entidad autolimitada, con resolución espontánea, por lo que un diagnóstico adecuado evita la realización de pruebas innecesarias

Introduction: The miositis acute is a complication described of the infection by the influenza virus. Clinically it predominates muscle weakness in the lower limbs, tendon reflexes of lower limbs was normal, that accompanies to the symptoms of the infection gripal. It associates elevation of the CPK and other muscle enzymes. Clinical cases: Case 1: Boy of 6 years brought by lower limbs pain with progressive walking difficulty and fever. Exploration: Gastrocnemius-soleus muscles on both sides were soft on palpation, without joint pains. On admission laboratory tests showed a significant increase in blood levels of creatinine phosphokinase (3614 UI/L), alanine transaminase (156 U/L) and aspartate transaminase (42 UI/L). Viral tests for influenza A/H1N1 was positive. On the fifth day presents leukopenia with neutropenia, CPK 6529 UI/L and elder hypertransaminases (GOT/GPT: 431/107 UI/L). Clinical improvement on the sixth day. Laboratory tests was normal at the seventh day of admission. Case 2: Boy of 5 years brought by fever and cough since two days ago. On admission laboratory tests showed procalcitonin 2.94 ng/mL and INR of 1.37. Was started intravenous cefotaxime treatment and it is suspended after viral tests for influenza A/H1N1 was positive. On the fifth day presents lower limbs pain; in laboratory tests showed leukopenia with neutropenia, an increase in blood levels of creatinine phosphokinase (9288 UI/L), alanine transaminase (363 U/L) and aspartate transaminase (95 UI/L). Clinical improvement on the sixth day of admission and laboratory tests was normal at the seventh day. Conclusion: Benign acute childhood myositis is a rare entity and underdiagnosed, we must think in it when patient present acute onset of typical myositis clinical findings in colds months. Is a self-limiting process with a rapid clinical resolution. Recognition of this rare clinical entity is essential to prevent unnecessary invasive testing

Vitiligo induced by specific immunotherapy with grass pollen: the Koebner phenomenon

No disponible

Anaphylaxis in a child after ingestion of persimmon

No disponible