Hospital General Universitario Research Articles

Lupus nephritis flare in young patients: relapse or nonadherence to treatment?

PurposeAdherence is a challenging issue in the treatment of systemic lupus erythematosus. Nonadherence has been widely addressed in patients with lupus and must be detected quickly to prevent severe complications. The cases we present illustrate the importance of adherence in young adults.Case 1A 23-year-old Spanish woman diagnosed with severe lupus nephritis 8 years previously achieved renal remission after immunosuppressive treatment with corticosteroids and cyclophosphamide. Three years later, she developed a renal flare. Her treatment was intensified, and rituximab and mycophenolate mofetil were added. One year later, she was readmitted for a new renal flare. A blood test revealed no detectable levels of mycophenolic acid, and the patient admitted she had not taken her treatment correctly. Treatment was resumed. Four years later, the patient remains in remission.Case 2A 19-year-old Spanish woman was diagnosed with nephrotic syndrome due to lupus nephritis. She achieved complete remission after treatment with corticosteroids and cyclophosphamide followed by mycophenolate mofetil. Two years later, she developed a severe renal relapse that was treated with corticosteroids, cyclophosphamide, and rituximab. The response to treatment was good. Mycophenolic acid was undetectable in blood. The patient admitted that she had often missed doses before this relapse. The renal response has been maintained since she resumed her previous medications 2 years ago.ConclusionWe conclude that the frequent and severe relapses of lupus nephritis observed in young patients may actually be due to nonadherence rather than to refractory disease. Our cases are typical examples of nonadherence that were discovered after a detailed interview with the patients and their families. We emphasize the need for clinical suspicion of nonadherence when caring for young adults with lupus.

Dermatofibroma of the Face: A Clinicopathologic Study of 20 Cases

IntroductionDermatofibroma is one of the most common benign skin tumors. It typically develops on the lower limbs between the third and fifth decade of life and is more common in women. Clinical diagnosis is often straightforward. Dermatofibromas are associated with a very low rate of local recurrence following excision. ObjectivesTo describe the clinical and histologic features of dermatofibroma of the face based on our experience. Materials and methodsDescriptive retrospective study of the clinicopathologic features of dermatofibromas of the face diagnosed at the dermatology department of Hospital General Universitario de Valencia between 1990 and 2012. ResultsTwenty cases of dermatofibroma of the face (1.11% of all dermatofibromas diagnosed) were studied. The age at onset varied widely, from 28 to 84 years. The mean age at onset was 57.15 years and the median was 54 years. There were 11 women and 9 men. Mean follow-up was 83 months and there were no local recurrences. All the tumors were confined to the papillary and reticular dermis and the storiform pattern was the most common growth pattern observed. ConclusionsThis study of facial dermatofibromas diagnosed at our hospital over a period of 22 years suggests that the face is an uncommon site but that dermatofibromas in this location behave similarly to those occurring elsewhere on the body.

Applicability of the Epworth Sleepiness Scale to fibromyalgic women with sleep apnea–hypopnea syndrome

Introduction Sleep apnea–hypopnea syndrome (SAHS) and fibromyalgia (FM) are two diseases of unknown etiology that share a distinctive feature: the great importance of subjective symptoms when it comes to establishing their seriousness. Even though they are prevalent entities in Spain, as in the rest of Western civilization, there are few cases described in which these syndromes concur; likewise, differentiating elements which can influence in diagnosis and therapeutic management have not been established. Tools used in the study of SAHS are frequently used even though they have not been completely validated for all groups of patients, especially for the female population. This happens when applying the Epworth Sleepiness Scale (ESS), used to measure pathological daytime hypersomnia. Materials and methods For this analysis we have featured 11 incidental cases of women diagnosed with FM among all the 2824 patients that were diagnosed with SAHS by the Pneumology Service of the Hospital General Universitario de Alicante (HGUA) between the dates of January 1998 and December 2008 by polysomnographic or polygraphic study. It has been researched the relationship between self-referred somnolescence and the scores obtained via the ESS. Both sets of data were complimented and were registered according to the protocol used when facing any case of suspected SAHS at the HGUA. For statistical treatment, the ESS has been stratified into two levels: from 12 to 24 points and less than 12 points – in keeping with the limit established between pathological hypersomnia and non-pathological somnolence. Results The validity values of the ESS have been calculated in base to a receiver operating characteristic (ROC) curve analysis: area under the curve (AUC) of 0.70 (p-value > 0.005, asymptotic 95% confidence interval [lower bound: 0, upper bound: 1]) with 40% sensitivity and 100% specificity. Conclusion In conlusion, there is not enough evidence to state that the Epworth Questionnaire is useful for establishing the presence of daytime somnolence in this group of fibromyalgic women with sleep apnea–hypopnea syndrome, but it could be more utile for controlling the evolution of patients under treatment. However, this tendency would need to be confirmed by wider range studies.

Human papillomavirus genotypes in human immunodeficiency virus-positive patients with anal pathology in Madrid, Spain.

BackgroundWe studied anal specimens to determine the distribution of human papillomavirus (HPV) genotypes and co-infection occurrence. This information will contribute to the knowledge of HPV genotype distributions and provide an estimate of the prevalence of different oncogenic HPV genotypes found in patients in Madrid (Spain).MethodsWe studied a total of 82 anal biopsies from the Hospital General Universitario Gregorio Marañón of Madrid. These included 4 specimens with benign lesions, 52 specimens with low-grade anal squamous intraepithelial lesion, 24 specimens with high-grade anal squamous intraepithelial lesions and 2 specimens with invasive anal carcinoma. HPV genotyping was performed with PCR amplification and reverse dot blot hybridization.ResultsWe detected 33 different HPV genotypes, including 16 HPVs associated with a high risk of carcinogenesis, 3 HPVs associated with a highly likely risk of carcinogenesis and 14 HPVs associated with a low-risk of carcinogenesis. In two specimens, an uncharacterized HPV genotype was detected. The most frequent HPV genotypes found were HPV-16 (10.3%; 95% CI: 6.6%-15.1%), HPV-52 (8.5%; 95% CI: 5.2%-13%) and HPV-43/44 (7.6%; 95% CI: 4.5%-11.9%). HPV-18 was only detected in 0.9% (95% CI: 0.1%-3.2%) of the total viruses detected in all lesions. HPV co-infections were found in 83.9% of all types of lesions. The majority of cases (90.2%) were concomitantly infected with the human immunodeficiency virus (HIV).ConclusionThe prevalence of high-risk carcinogenic genotypes in anal pathological samples was remarkable. Therefore, further studies that include a greater number of samples, particularly invasive carcinoma cases are needed to evaluate the potential influence of these HPV genotypes in the appearance of anal carcinomas. Also, the influence of other accompanying infections should be evaluated clarify the appearance of this type of carcinoma.Virtual slidesThe virtual slide(s) for this article can be found here: http://www.diagnosticpathology.diagnomx.eu/vs/2075238024106058.

Multinational Gout Recommendations Released

Multinational Gout Recommendations Released

Dermatofibromas faciales: estudio clínico-patológico de 20 casos

IntroductionDermatofibroma is one of the most common benign skin tumors. It typically develops on the lower limbs between the third and fifth decade of life and is more common in women. Clinical diagnosis is often straightforward. Dermatofibromas are associated with a very low rate of local recurrence following excision. ObjectivesTo describe the clinical and histologic features of dermatofibroma of the face based on our experience. Materials and methodsDescriptive retrospective study of the clinicopathologic features of dermatofibromas of the face diagnosed at the dermatology department of Hospital General Universitario de Valencia between 1990 and 2012. ResultsTwenty cases of dermatofibroma of the face (1.11% of all dermatofibromas diagnosed) were studied. The age at onset varied widely, from 28 to 84 years. The mean age at onset was 57.15 years and the median was 54 years. There were 11 women and 9 men. Mean follow-up was 83 months and there were no local recurrences. All the tumors were confined to the papillary and reticular dermis and the storiform pattern was the most common growth pattern observed. ConclusionsThis study of facial dermatofibromas diagnosed at our hospital over a period of 22 years suggests that the face is an uncommon site but that dermatofibromas in this location behave similarly to those occurring elsewhere on the body.

Intraoperative radiation therapy, opportunities for clinical practice normalization: MEDTING, a scientific platform

AimTo use a platform to analyze a subgroup specialized in evaluation of patients candidates to IOERT. BackgroundMedting is a project that was initiated to support daily clinical activity, knowledge management and medical education by sharing information with other physicians. The project began at the “Hospital General Universitario Gregorio Marañón”, which has a dedicated oncology physician's multi-specialist committee. There are many scientific social networks all over the world. Medting is the only platform that specializes in healthcare and has been developed for hospital purposes. Materials and methodsMedting brings all together the relevant clinical information from electronic medical records and picture archiving about the patient to study. Subplatform Medting-IORT was created on February 2, 2012 at the Hospital General Universitario Gregorio Marañon. It has 23 members, have been registered 18 cases with 238 multimedia images. ResultsMedting started with 28 physicians and five departments. After 6 months, proof of concept period, there are 225 physicians, more than 120 medical students and 39 departments in 3 hospitals using the scientific social network. Furthermore, the project is being extended on three more hospitals in Madrid. ConclusionMedting gives the opportunity to oncology physicians to access all relevant clinical information with the ability to discuss case notes and view images at any time. The impact of the Medting platform in a subgroup working team to evaluate IOERT patients candidates is included in the analysis. The use of a constantly updated repository based on real cases and the documentation of the internal activity of the tumor committee beyond the medical record, has become an extraordinary tool for teaching, training and learning.

A phase 2, placebo-controlled, randomized, double-blind trial of tozadenant (Syn-115) in patients with Parkinson's disease with wearing-off fluctuations on levodopa

A phase 2, placebo-controlled, randomized, double-blind trial of tozadenant (Syn-115) in patients with Parkinson's disease with wearing-off fluctuations on levodopa

Labor asistencial del equipo de guardia de neurología en un hospital terciario de Madrid: análisis prospectivo durante un año

IntroductionPopulation ageing, the rising demand for healthcare, and the establishment of acute stroke treatment programs have given rise to increases in the number and complexity of neurological emergency cases. Nevertheless, many centres in Spain still lack on-call emergency neurologists. MethodsWe conducted a retrospective study to describe the role of on-call neurologists at Hospital General Universitario Gregorio Marañón, a tertiary care centre in Madrid, Spain. Sociodemographic characteristics, most common pathologies, diagnostic tests, and destination of the patients attended were recorded daily using a computer database. Results were compared with the general care data from the emergency department. ResultsThe team attended 3234 patients (3.48% of the emergency department total). The mean number of patients seen per day was 11.15. The most frequent pathologies were stroke (34%), epilepsy (16%) and headache (8%). The mean stay in the emergency department was 7.17hours. Hospital admission rate was 40% (7.38% of emergency hospital admissions). The main destinations for admitted patients were the stroke unit (39.5%) and the neurology department (33%). Endovascular or thrombolytic therapies were performed on 76 occasions. Doctors attended 70% of the patients during on-call hours. ConclusionsEmergency neurological care is varied, complex, and frequently necessary. Neurological cases account for a sizeable percentage of both patient visits to the emergency room and the total number of emergency admissions. The current data confirm that on-call neurologists available on a 24-hour basis are needed in emergency departments.

Validation of the Determinant-based Classification and Revision of the Atlanta Classification Systems for Acute Pancreatitis

Two new classification systems for the severity of acute pancreatitis (AP) have been proposed, the determinant-based classification (DBC) and a revision of the Atlanta classification (RAC). Our aim was to validate and compare these classification systems. We analyzed data from adult patients with AP (543 episodes of AP in 459 patients) who were admitted to Hospital General Universitario de Alicante from December 2007 to February 2013. Imaging results were reviewed, and the classification systems were validated and compared in terms of outcomes. Pancreatic necrosis was present in 66 of the patients (12%), peripancreatic necrosis in 109 (20%), walled-off necrosis in 61 (11%), acute peripancreatic fluid collections in 98 (18%), and pseudocysts in 19 (4%). Transient and persistent organ failures were present in 31 patients (6%) and 21 patients (4%), respectively. Sixteen patients (3%) died. On the basis of the DBC, 386 (71%), 131 (24%), 23 (4%), and 3 (0.6%) patients were determined to have mild, moderate, severe, or critical AP, respectively. On the basis of the RAC, 363 patients (67%), 160 patients (30%), and 20 patients (4%) were determined to have mild, moderately severe, or severe AP, respectively. The different categories of severity for each classification system were associated with statistically significant and clinically relevant differences in length of hospital stay, need for admission to the intensive care unit, nutritional support, invasive treatment, and in-hospital mortality. In comparing similar categories between the classification systems, no significant differences were found. The DBC and the RAC accurately classify the severity of AP in subgroups of patients.

Back Pain Due to Lumbar Gouty Flare — A Prospective Diagnosis

To the Editor: We read with interest the article by Konatalapalli, et al 1. The authors described a computed tomographic (CT) study to assess the prevalence of spinal tophi or characteristic erosions (which also result from tophi2) in patients with gout. The prevalence was rather high (around 35%), even higher than the rate previously reported by these authors in The Journal 3. As discussed, several factors may have influenced these results; the spine might be prone to monosodium urate (MSU) crystal deposition, because the spine is a common location for osteoarthritis4, and a predilection for osteoarthritic joints has been shown in gout5. Clinical presentations of gout essentially relate to joint inflammation or either palpable tophi or problems related to them in different locations6. Our knowledge about gouty spinal inflammation remains … Address correspondence to Dr. M. Andrés, Hospital General Universitario de Alicante, Seccion de Reumatologia, Pintor Baeza 12, Alicante 03010, Spain. E-mail: drmarianoandres{at}gmail.com.

Characteristics and outcome in nonagenarians admitted in general internal medicine and other specialties

SummaryTo describe the characteristics of nonagenarians admitted to the surgical and medical divisions at a tertiary hospital and compare them with nonagenarians admitted to other hospital care services. MethodsA retrospective study of all hospital discharge episodes via the registry of the Basic Minimum Data Set at the Hospital General Universitario de Alicante from January 2007 until December 2011. ResultsOf the 165,870 hospitalizations, 2461 (1.5%) were nonagenarians. The highest number of admitted nonagenarians was in the Division of General Internal Medicine (DGIM) (n=751), followed by the short stay unit (SSU) (n=633). The rate of nonagenarians per 100 admissions to the DGIM was 10.2, significantly higher than that of those admitted to the SSU (6.2) (p<0.001), the service of orthopedic and trauma surgery (2.2) (p<0.001), and other specialties. Females comprised 64.8% of the nonagenarians. Mortality was 17% for the nonagenarians admitted, while for those admitted to the DGIM it was 27.7%. Those hospitalized in the SSU had a lower risk of death during hospitalization (8.1%) (odds ratio [OR] 0.23, 95% confidence interval [CI] 0.16–0.32) and a greater risk of being admitted for diseases and disorders of the circulatory system (OR: 1.58, 95% CI: 1.22–2.05), particularly for heart failure and shock (OR: 1.82, 95% CI: 1.30–2.53), and being discharged with home hospitalization (OR: 8.05, 95% CI: 5.5–11.8). ConclusionsNonagenarian patients represent a tenth of those admitted to the DGIM. The profile of nonagenarians admitted to the DGIM is different from other hospital services. Hospital mortality for nonagenarians admitted to the DGIM is high and superior to other hospital services.

Why psychogeriatrics starts right after adolescence

The borders between pediatric and adult medical specialties are always somewhat artificial, and based on spurious considerations, such as usually attaining the age of majority, i.e., 18 years; however, the borders between socalled child and adolescent (CA and those that incubate over neurodevelopment and erupt in adolescence and young adulthood (e.g., schizophrenia, bipolar disorders). Five of Erikson’s eight stages of life occur before age 18. A substrate of biological changes runs in parallel to these psychological stages; indeed, most changes in brain development occur before the third decade of life. Absolute cortical volume peaks at 9.3 years in males, and at 8 years in females; the convex hull area rises robustly from age 3 in both sexes, reaching its peak in males at 15.2 years and in females at 11.8 years [2]. The visual, auditory, and limbic cortices, which myelinate early, show a more linear pattern of aging than the frontal and parietal neocortices, which continue myelination into adulthood. Except for the posterior temporal regions, which have a more protracted course of cortical maturation and continue to gain gray matter density up to age 30, the other regions (dorsal frontal and parietal association cortices, on both the lateral and interhemispheric surfaces) see a decline in their gray matter density between the ages of 7 and 60 [3]. Brains do not develop normally in the absence of critical genetic signaling, or in the absence of essential environmental input. The key to understanding the origins and emergence of both the brain and behavior lies in understanding how inherited and environmental factors are engaged in the dynamic and interactive processes that define and guide development of the neurobehavioral system [4]—and this knowledge is key for the work of child psychologists and psychiatrists. It is well known that chronic stress alters brain conformation. For example, animal studies show that the hippocampus, through stress-induced dendritic retraction, becomes vulnerable to neurotoxicity, even after the stress has stopped; the retraction protects the neuron from glutamate damage during the stressful situation, but this may come at the price of interfering with normal development and learning [5]. Smaller hippocampi have been associated with childhood maltreatment, as well as major depression and post-traumatic stress disorder [6, 7]. In addition to the effect on brain development of cumulative exposure to stressful situations that may exceed the brain’s buffering capacity to restore the stress system to its baseline status, exposure to stressful situations during sensitive periods of development can become embedded into regulatory physiological processes. Epigenetic changes, such as DNA M. Parellada (&) Child and Adolescent Psychiatry Department, Instituto de Investigacion Sanitaria Gregorio Maranon, IiSGM, Hospital General Universitario Gregorio Maranon, CIBERSAM, Ibiza 43, 28009 Madrid, Spain e-mail: parellada@hggm.es

Effect of necrosis status at the time of intervention on the outcome of severe acute pancreatitis

Effect of necrosis status at the time of intervention on the outcome of severe acute pancreatitis

Histerectomía periparto en el Hospital General Universitario de Elche

The aim of this study was to determine the incidence, indications, maternal outcomes and complications of peripartum hysterectomy in our environment. For this purpose we retrospectively analyzed 17 cases of peripartum hysterectomy performed at the Obstetrics and Gynecology Department of Hospital General Universitario de Elche between January 2001 and December 2005.The incidence of peripartum hysterectomy was 1.3 per 1000 deliveries. The most frequent indications for the procedure were uterine atony (53%), placenta accreta (23%) and uterine rupture (12%). There were no maternal deaths. The most common complications were hemorrhage/coagulopathy (53%) and infection (24%). More than 90% of the patients required transfusion.Peripartum hysterectomy was associated with significant morbidity. Prior identification of probable cases can improve the results by allowing adequate preparation for this procedure and the involvement of the most experienced obstetricians.

Criteria for Gout Diagnosis?

Diagnosis is the proper classification of an individual patient. Efforts to develop clinical criteria for the classification of gout, which are often used to diagnose individual patients, continue, as the article by Prowse, et al shows in this issue of The Journal 1. A proper approach to gout diagnosis implies that, if possible, (1) all patients presenting with the disease have to be properly diagnosed, and (2) in all cases the diagnosis must be correct, so gout does not go undetected and is not misclassified. Gout results from monosodium urate (MSU) crystal deposition, which is responsible for all clinical consequences of the disease. MSU crystals are large enough to be easily detected and identified by an ordinary microscope fitted with polarized filters, which clearly shows the highly birefringent MSU crystals shining on the dark microscope field. The addition of a first-order red compensator helps in definitive distinction from calcium pyrophosphate (CPP) and other crystals2. Crystals form as a result of elevated serum uric acid (SUA) levels; they slowly dissolve and finally disappear when SUA levels are brought back to normal; thus, the disease is now considered curable3. Because it is associated with an elevated cardiovascular risk4 and, when advanced, can be very disabling, gout cannot be taken as a minor disease. MSU crystals are regularly present in synovial fluid … Address correspondence to Prof. E. Pascual, Rheumatology Section, Hospital General Universitario, Maestro Alonso 109, Alicante, 03010, Spain. E-mail: pascual_eli{at}gva.es

Prenatal diagnosis of Type II single umbilical artery (persistent vitelline artery) in a normal fetus

The human umbilical cord usually develops with two arteries and one vein. However, in 0.5–1% of fetuses, one umbilical artery is either obliterated or simply does not form, giving rise to single umbilical artery (SUA) syndrome1-3. Although several mechanisms have been proposed to explain the pathogenesis of SUA, in most cases it is due to secondary atresia or atrophy of one or both previously normal umbilical arteries1. Blackburn and Cooley2 suggested four plausible types of SUA (Figure 1). Type II SUA is the second most frequent and is thought to occur secondary to fusion of the two umbilical arteries. It is normally reported in malformed fetuses with sirenomelia, or after interruption in the development of both umbilical arteries accompanied by persistent vitelline artery, which compensates for this defect2, 3. We report a favorable outcome after prenatal diagnosis of Type II SUA in a normal fetus. A 31-year-old primigravida was referred to our center at 22 weeks' gestation after a routine ultrasound scan revealed SUA and abnormal abdominal vasculature without other malformations. Umbilical arteries could not be seen in their normal position adjacent to the bladder, and a large artery was observed continuing in an anterior direction towards the umbilical cord, inferior to the celiac trunk at the position of the superior mesenteric artery (SMA) with normal blood flow indices (Figure 2). The umbilical vein appeared normal and blood flow in the abdominal aorta, renal and femoral arteries was also normal. The pregnancy was uneventful and at 40 weeks' gestation, the patient gave birth via vaginal delivery to a healthy female infant weighing 4010 g. The appearance of the placenta was normal, and the umbilical cord had a single artery with a distinct internal elastic lamina, usually absent in normal umbilical arteries on histopathological testing. Differentiation between SUA types is a prenatal diagnostic challenge, and most isolated cases are considered to be Type I. Using color Doppler ultrasound, after obtaining an axial view of the fetal ventral wall, umbilical arteries can be tracked as they divide to enclose the fetal bladder. However, in Type II SUA, both umbilical arteries are absent. The sagittal view at the abdominal–pelvic level confirms the diagnosis, because the artery observed in the umbilical cord originates directly and abnormally from the aorta, inferior to the celiac trunk and at the position of the SMA. The artery follows an abnormal course separated from the bladder (Figure 2)2, 3. Diagnosis of SUA syndrome should be followed by an exhaustive fetal morphology scan, though fetal karyotype testing is not mandatory in isolated cases4. Type II SUA can be associated with sirenomelia or defects of the viscera and/or soft tissues, or it may be present as an isolated finding1, 5. In the latter instance, clinical presentation of the neonate after birth could be normal or could be associated with acute intestinal obstruction, recurrent intestinal pain, or intra-abdominal hemorrhage. Based on surgical findings, Postoloff6 described three types of persistent vitelline artery: a persistent band between the anterior abdominal wall and the ileal mesentery, a band in association with Meckel's diverticulum, or a free-hanging cord. However in this case, neonatal outcome was favorable, and after 12 months of follow-up the infant remained asymptomatic. F. Gámez†, J. De León-Luis*†, C. Bravo†, P. Pintado†, Y. Ruiz‡, S. Palomo§, R. Pérez† and L. Ortiz-Quintana† †Fetal Medicine Unit, Department of Obstetrics and Gynecology, Hospital General Universitario Gregorio Marañón, Calle O'Donnell, 48, Planta 0, Bloque C, 28009 Madrid, Spain; ‡Department of Radiology, Hospital General Gregorio Marañón, Universidad Complutense de Madrid, Madrid, Spain; §Department of Pathology, Hospital General Gregorio Marañón, Universidad Complutense de Madrid, Madrid, Spain *Correspondence. (e-mail: [email protected]) This work was supported by Fondo de Investigaciones Sanitarias (FIS# PI081712 and BA#09/90011). We are grateful to Mr David De León for assistance with graphics and to Mr Thomas O'Boyle for editorial assistance.

Pulmonary and intracardiac cement embolism after a percutaneous vertebroplasty

A 68-year-old woman was admitted to our hospital complaining of dyspnoea and chest pain. She had neither prior cardiac history nor any other relevant medical history except from osteoporosis and Parkinson disease. She underwent percutaneous vertebroplasty for fusion of L1-S1 and fracture of L3, 2 months ago in another institution. Arthrodesis L1-S1 and laminectomy of L3 was successfully performed and she was discharged home 2 weeks later. She referred having started with chest pain and dyspnoea 2 weeks ago. On examination, she was haemodynamically stable, her blood pressure was 112/70 mmHg and her heart rate 75 bpm. Her room air oxygen saturation was 95 %. Cardiopulmonary auscultation was normal. ECG showed no relevant findings and the chest radiography only highlighted lumbar arthrodesis. A transthoracic echocardiography was performed as a first approach, followed by a transesophageal echocardiogram (Fig. 1). We found a normal ventricular ejection function of both ventricles and surprisingly we discovered a calcium density foreign body in the right atrium located in the septum, next to the the fossa ovalis. An exhaustive clinical history and physical examination were performed to rule out the possibility of a paradoxical embolism. Afterwards, a chest computed tomographic (CT) scan (Fig. 2) was performed, which confirmed the existence of several fragments of blade material, one of them, with a linear morphology, was crossing the atrial septum, located mostly in the left atrium. There were two other fragments, one located in the left lower lobe artery, at about 3.5 cm of the origin of the left main artery and the other in a subsegmental branch of the left basal segments. In this clinical context, these fragments were compatible with vertebroplasty cement fragments, which protruded into the left atrium and into the pulmonary branches. Given these findings, we decided to perform surgery. Under general anesthesia through a median sternotomy and normothermic cardiopulmonary bypass, opening of the right atrium was performed, with removal of the foreign body and closure of the oval foramen. We also carried out longitudinal opening of the left pulmonary artery from the bifurcation to the beginning of the lobar arteries, extracting the foreign body from the left lower lobe artery (Fig. 3). The patient did well and could be discharged 10 days after the surgery. Percutaneous vertebral minimally invasive procedures are becoming the standard treatment for osteoporotic vertebral fractures and osteolytic vertebral tumors (metastasis, myeloma and hemangioma) [1]. These techniques include vertebroplasty, kyphoplasty and skyphoplasty. In all of them, an injection of polymethylmethacrylate into the vertebral body is performed under fluoroscopy or computed tomographic scan guidance. In the kyphoplasty, an inflatable balloon is used to create a cavity in the vertebral body that will be filled with the cement, and a plastic tube is used in the skyphoplasty. Percutaneous vertebroplasty was the first procedure described and has been shown to improve symptoms and quality of life of patients with vertebral compression fractures [2]. The procedure requires the R. A. Llanos (&) A. Viana-Tejedor F. Fernandez-Aviles Cardiology Department, Hospital General Universitario Gregorio Maranon, Doctor Esquerdo St, 46, 28007 Madrid, Spain e-mail: rocioang1@hotmail.com

Comparison between enzyme-linked immuno-sorbent assay and multiplex assay for serological markers of Celiac Disease detection

Event Abstract Back to Event Comparison between enzyme-linked immuno-sorbent assay and multiplex assay for serological markers of Celiac Disease detection Lydia Martín-Martín1*, Laura Herráiz-Nicuesa1, Yaciris Oleo-Pérez1, Silvia Sánchez-Ramón2 and Margarita Rodriguez-Mahou1 1 Hospital General Universitario Gregorio Marañón, Spain 2 Hospital Clínico San Carlos, Spain Objective: To compare ELISA with multiplex assay for anti-deamidated gliadin peptide (anti-DGP) IgG and anti-tissue transglutaminase (anti-tTG) IgA antibodies detection in order to identify the best according to sensivity and specificity. Methods: 101 patients with suspicion or diagnostic of celiac disease (CD) were selected. Each serum was tested by ELISA (Orgentec Diagnostika) and multiplex assay (Bioplex 2200, Bio-Rad) for the anti-DGP IgG and anti-tTG IgA autoantibodies quantification. The association with clinical features was examinated by systematical review of the clinical histories. Also previous CD markers determinations, biopsy and HLA features were studied. Results: Compared to the clinical, biopsy and HLA features, the ELISA showed a sensitivity of 96.15% and a specificity of 38.09 (Positive predictive value (PPV): 79.36%; Negative predictive value (NPV): 80%), whereas multiplex assay had a sensitivity of 79.59% and a specificity of 100% (PPV: 100%; NPV: 68.75%) for anti-DGP IgG antibodies detection. Furthermore, the ELISA showed a sensitivity of 68.42% and a specificity of 100% (PPV: 100%; NPV: 93.18%), and multiplex assay had a sensitivity of 100% and a specificity of 96.34% (PPV: 86.36%; NPV: 100%) for anti-tTG IgA antibodies testing. Conclusions: Taking into consideration the previous CD markers determination and clinical, biopsy and HLA features, ELISA showed a higher sensitivity for anti-DGP IgG antibodies, but specificity was better for multiplex assay. In addition, ELISA showed a higher specificity and multiplex had a better sensitivity for anti-tTG IgA antibodies detection. Keywords: Celiac Disease, ELISA, Multiplex assay, Anti-deamidated gliadin peptide IgG antibodies, Anti-tissue transglutaminase IgA antibodies Conference: 15th International Congress of Immunology (ICI), Milan, Italy, 22 Aug - 27 Aug, 2013. Presentation Type: Abstract Topic: Immune-mediated disease pathogenesis Citation: Martín-Martín L, Herráiz-Nicuesa L, Oleo-Pérez Y, Sánchez-Ramón S and Rodriguez-Mahou M (2013). Comparison between enzyme-linked immuno-sorbent assay and multiplex assay for serological markers of Celiac Disease detection. Front. Immunol. Conference Abstract: 15th International Congress of Immunology (ICI). doi: 10.3389/conf.fimmu.2013.02.01057 Copyright: The abstracts in this collection have not been subject to any Frontiers peer review or checks, and are not endorsed by Frontiers. They are made available through the Frontiers publishing platform as a service to conference organizers and presenters. The copyright in the individual abstracts is owned by the author of each abstract or his/her employer unless otherwise stated. Each abstract, as well as the collection of abstracts, are published under a Creative Commons CC-BY 4.0 (attribution) licence (https://creativecommons.org/licenses/by/4.0/) and may thus be reproduced, translated, adapted and be the subject of derivative works provided the authors and Frontiers are attributed. For Frontiers’ terms and conditions please see https://www.frontiersin.org/legal/terms-and-conditions. Received: 10 Jul 2013; Published Online: 22 Aug 2013. * Correspondence: Miss. Lydia Martín-Martín, Hospital General Universitario Gregorio Marañón, Madrid, Spain, lydia.martin@salud.madrid.org Login Required This action requires you to be registered with Frontiers and logged in. To register or login click here. Abstract Info Abstract The Authors in Frontiers Lydia Martín-Martín Laura Herráiz-Nicuesa Yaciris Oleo-Pérez Silvia Sánchez-Ramón Margarita Rodriguez-Mahou Google Lydia Martín-Martín Laura Herráiz-Nicuesa Yaciris Oleo-Pérez Silvia Sánchez-Ramón Margarita Rodriguez-Mahou Google Scholar Lydia Martín-Martín Laura Herráiz-Nicuesa Yaciris Oleo-Pérez Silvia Sánchez-Ramón Margarita Rodriguez-Mahou PubMed Lydia Martín-Martín Laura Herráiz-Nicuesa Yaciris Oleo-Pérez Silvia Sánchez-Ramón Margarita Rodriguez-Mahou Related Article in Frontiers Google Scholar PubMed Abstract Close Back to top Javascript is disabled. Please enable Javascript in your browser settings in order to see all the content on this page.

Genotype distribution of human papillomavirus (HPV) in histological sections of cervical intraepithelial neoplasia and invasive cervical carcinoma in Madrid, Spain

BackgroundHuman Papillomavirus (HPV) genotype distribution and co-infection occurrence was studied in cervical specimens from the city of Madrid (Spain), as a contribution to the knowledge of Human Papillomavirus genotype distribution and prevalence of carcinogenic HPV types in cervical lesions in Spain.MethodsA total of 533 abnormal specimens, from the Hospital General Universitario “Gregorio Marañón” of Madrid, were studied. These included 19 benign lesions, 349 cervical intraepithelial neoplasias 1 (CIN1), 158 CIN2-3 and 7 invasive cervical carcinomas (ICC). HPV genotyping was performed using PCR and tube array hybridization.ResultsWe detected 20 different HPV types: 13 carcinogenic high-risk HPV types (HR-HPVs), 2 probably carcinogenic high-risk HPV types (PHR-HPVs) and 5 carcinogenic low-risk HPV types (LR-HPVs). The most frequent HPV genotypes found in all specimens were HPV16 (26.0%), 31 (10.7%) and 58 (8.0%). HPV 18 was only detected in 5.0%. Co-infections were found in 30.7% of CIN 1 and 18.4% cases of CIN2-3. The highest percentage of HR HPVs was found in those specimens with a CIN2-3 lesion (93.7%).ConclusionAs our study shows the current tetravalent vaccine could be effective in our geographical area for preventing all the invasive cervical carcinomas. In addition, upon the estimates of the important presence of other HR-HPV types – such as 31, 58, 33 and 52 – in different preneoplasic lesions the effectiveness of HPV vaccination in our geographical area, and others with similar genotype distribution, should be limited.