Association between distance to tertiary hospital and cardiovascular outcomes in coronary artery disease patients

Background

The impact of distance from residence to Tertiary Referral Hospital and cardiovascular (CV) outcomes in patients with coronary artery disease (CAD) is unknow. Despite longer travel distances hinder access to healthcare and may worsen CV outcomes, we hypothesize that Mediterranean lifestyle and behaviors in distant rural areas may be associated with a reduced risk of CV death and events.

Purpose

To investigate the association between travel distance to Tertiary Hospital and mid-term cardiovascular outcomes in a population of CAD patients in Southern Spain.

Methods

Retrospective study including all patients discharged after percutaneous coronary intervention (PCI) at a high-volume center in Southern Spain during 2018. Those belonging to another healthcare area were excluded. One-way driving distances from residence to hospital were computed using Google Maps Distance Matrix API with R package “gmapsdistance”. Patients were stratified into tertiles according to travel distance (short, STD; intermediate, ITD; and long, LTD). Kaplan-Meier (KM) and Multivariable Cox regression (adjusted for age, sex, atrial fibrillation, cancer history, prior revascularization and clinical presentation) were used to assess the impact of travel distance on CV death and a composite outcome of MACE (Myocardial Infarction, unplanned PCI and CV death).

Results

Of 1005 patients discharged after PCI during the study period, 966 met the selection criteria. Flowchart and baseline characteristics by distance groups are presented in Figure 1. Median travel distance tertiles were 6.1 (STD), 41.7 (ITD) and 78.4 (LTD). During a median follow-up of 31 (IQR 28–35) months, 50 cardiovascular deaths [STD 27 (8.4%), ITD 13 (4%), LTD 10 (3.1%), p=0.006)] and 63 MACE occurred [STD 45 (13.9%), ITD 37 (11.5%), LTD 26 (8.1%), p=0.060)]. KM curves for the three distance groups are shown in Figure 2. In univariable and multivariable Cox models, longer travel distances were associated with better outcomes, as for every 10 Km increase, there was a 11% and 7% decrease in the hazards of CV death (HR adj: 0.89, CI 0.82–0.98, p=0.029) and of MACE (HR adj: 0.93, CI 0.87–0.99, p=0.025), respectively.

Conclusion

Travel distance was inversely associated with CV events in a population of CAD patients in Southern Spain. Patients in the first tertile of distance had a higher rate of CV death. Multicenter studies involving other Mediterranean regions are needed to confirm these findings and to look for explanations.

Funding Acknowledgement

Type of funding sources: None. Flowchart and baseline characteristicsSurvival curves by distance groups

Long-term outcomes among a cohort of 4296 implantable cardioverter-defibrillator patients: insights from the UMBRELLA study

Background

Large observational real-world studies describing modern implantable cardioverter-defibrillator (ICD) populations with long-term follow-up are lacking.

Purpose

To assess the incidence of arrhythmias in a cohort of contemporary patients undergoing ICD implant from 2005 and 2017 and to analyze the arrhythmic risk and mortality according to their clinical profiles.

Methods

UMBRELLA (NTC01561144) is a prospective, multicentre, nationwide study of ICD patients followed by remote monitoring. All device information was automatically stored through the remote monitoring system and a blinded review of all the stored arrhythmic episodes was performed. The study outcomes were first appropriate ICD therapy and all-cause death.

Results

The study population consisted of 4296 patients (61.9±12.9 years, ischaemic cardiomyopathy (ICM): n=2150, dilated cardiomyopathy (DCM): n=1166, valvular heart disease (VHD): n=119, hypertrophic cardiomyopathy (HCM): n=294, arrhythmogenic right ventricular cardiomyopathy (ARVC): n=71, Brugada syndrome (BS): n=143, long QT syndrome (LQTS): n=43, and adult congenital heart disease (ACHD): n=60)). Primary prevention (PP) was the main indication (n=2758).

During a mean follow-up of 46.6±27.3 months, 16,067 episodes of sustained ventricular arrhythmia (SVA) occurred in 1344 patients. Appropriate ICD therapy was delivered to 85.7% (n=13,767) episodes of SVA in 1173 patients (27.3% of population). A higher risk of first appropriate ICD therapy was observed in VHD (HR: 1.94, 95% CI: 1.43–2.62), ARVC (HR: 1.84, 95% CI: 1.28–2.66), ICM (HR: 1.51, 95% CI: 1.29–1.78), and DCM (HR: 1.28, 95% CI: 1.07–1.53) whereas patients with HCM (HR: 0.72, 95% CI: 0.54–0.96) and BS (HR: 0.25, 95% CI: 0.14–0.45) were at significantly lower risk (Figure 1A). In multivariate analysis (Table 1), age, gender, atrial fibrillation (AF), secondary prevention, LVEF ≤35%, and QRS width emerged as clinical predictors of appropriate ICD therapy, whereas CRT-D correlated with lower risk. An independently higher risk was found in DCM, VHD, and ARVC, and a lower risk in BS patients.

At follow-up, 590 deaths (13.4% of population) were reported. Patients with ICM (HR 3.90, 95% CI: 2.58–5.90), DCM (HR 3.33, CI 95%: 2.18–5.10), and VHD (HR 3.97, CI 95%: 2.25–6.99) had worse prognoses and it was significantly better in BS patients (HR 0.11, 95% CI: 0.01–0.67, p=0.017) (Figure 1B). In multivariate analysis, age, gender, AF, renal failure, diabetes and reduced LVEF, emerged as independent predictors of all-cause death (Table 1).

Conclusions

Irrespective of the aetiology, contemporary ICD patients with an arrhythmic substrate derived from left ventricular systolic dysfunction had a similar risk of ICD life-saving interventions and death.

Funding Acknowledgement

Type of funding sources: None. Table 1Figure 1

Instantaneous wave-free ratio for the assessment of nonculprit lesions in patients with acute coronary syndrome

Background

A physiological assessment with the fractional flow reserve (FFR) or instantaneous wave-free ratio (iFR) is strongly recommended by the European Guidelines of Revascularization to guide percutaneous coronary intervention (PCI) decision making in intermediate coronary stenosis. However, data supporting its use in the pro-inflammatory setting of ACS is weak.

Purpose

To analyze the usefulness of a physiological coronary evaluation with iFR of nonculprit lesions in patients with ACS.

Methods

Retrospective multicenter study including patients with ACS and underwent successful revascularization of the culprit vessel and had other nonculpritlesions physiologically evaluated with the iFR between January 2017 and December 2019. The primary endpoint was a composite of cardiac death, nonfatal myocardial infarction, stent thrombosis and new revascularization (MACEs).

Results

A total of 356 patients with 472 nonculprit lesions were included. The mean age was 66±11 years. The clinical presentation was non-ST-segment elevation myocardial infarction (NSTEMI) in 235 patients and ST-segment elevation myocardial infarction (STEMI) in 121 patients. After a mean follow-up period of 22±10 months, the primary endpoint occurred in 32 patients (9%). There were no differences in outcomes regarding iFR induced treatment strategy (patients with all lesions revascularized vs. patients with at least one lesion deferred for revascularization, 10.5 vs 8.4%, p=0.476).

Conclusion

The use of the iFR to guide percutaneous coronary intervention decision making in nonculprit lesions seems to be safe, with an acceptable percentage of MACEs at the mid-term follow-up.

Funding Acknowledgement

Type of funding sources: None. FlowchartSurvival curves by iFR and ACS group

Phytophthora infestans Mating Types on Tomato (Solanum lycopersicum) in Southern Spain

During 2004, an unusual spread of Phytophthora infestans on tomato plants in greenhouses located in Almería and Granada provinces, southern Spain, was observed. Infected plants had water-soaked, brown spots on leaves and stems and necrotic areas with white mold on the surface of fruits. Three isolates were obtained by plating diseased tissue on V8 juice agar medium and maintained on rye agar at 18°C. These isolates were analyzed for the mating type. Crosses were carried out using V8 juice agar and rye agar. The two parental isolates US1 (A1) and US8 (A2) were both provided by W. E. Fry, Cornell University, Ithaca, NY. Two of the Spanish isolates were homothallic and the other isolate belonged to the uncommon mating type A1A2. To confirm the occurrence of the two mating types, 43 single-sporangium progeny were produced and analyzed from the A1A2 mating type. Thirty eight isolates were A1, two were A2, one was A1A2 mating type, and two were sterile. Assessment of five single-sporangium progeny from the homothallic type resulted in two A1, two homothallic, and one sterile isolate. A1A2 isolates produced oospores when crossed with either A1 or A2, but not when self-crossed. Previously, the A1A2 mating type has been found in Israel in the field and was obtained from oospores produced on tomato seeds (2,3). Since 2003, mating types of P. infestans isolates recovered from potato (60) and tomato (8) in southern Spain have been characterized. Seventy-five percent of the isolates recovered from potato were A1 and 25% were A2 mating types. Isolates recovered from tomato were 50% A1 and 50% A2 (1). To our knowledge, this is the first report of the occurrence of the A1A2 mating type and homothallic P. infestans isolates on tomato in Spain. References: (1) E. Andujar et al. Congr. Sociedad Española de Fitopatol. 12:244, 2004. (2) E. Rubin and Y. Cohen. Phytoparasitica 32:237, 2004. (3) E. Rubin and Y. Cohen. Plant Dis. 90:741, 2006.

Visualizing odorant receptor trafficking in living cells down to the single-molecule level

Despite the importance of trafficking for regulating G protein-coupled receptor signaling, for many members of the seven transmembrane helix protein family, such as odorant receptors, little is known about this process in live cells. Here, the complete life cycle of the human odorant receptor OR17-40 was directly monitored in living cells by ensemble and single-molecule imaging, using a double-labeling strategy. While the overall, intracellular trafficking of the receptor was visualized continuously by using a GFP tag, selective imaging of cell surface receptors was achieved by pulse-labeling an acyl carrier protein tag. We found that OR17-40 efficiently translocated to the plasma membrane only at low expression, whereas at higher biosynthesis the receptor accumulated in intracellular compartments. Receptors in the plasma membrane showed high turnover resulting from constitutive internalization along the clathrin pathway, even in the absence of ligand. Single-molecule microscopy allowed monitoring of the early, dynamic processes in odorant receptor signaling. Although mobile receptors initially diffused either freely or within domains of various sizes, binding of an agonist or an antagonist increased partitioning of receptors into small domains of approximately 190 nm, which likely are precursors of clathrin-coated pits. The binding of a ligand, therefore, resulted in modulation of the continuous, constitutive internalization. After endocytosis, receptors were directed to early endosomes for recycling. This unique mechanism of continuous internalization and recycling of OR17-40 might be instrumental in allowing rapid recovery of odor perception.

Diffuse cavernous hemangioma of the rectum: an atypical cause of rectal bleeding

OBJECTIVE

cavernous hemangioma of the rectosigmoid colon is a rare disease, with no more than 200 cases reported in the literature. The rectosigmoid is the most common site of this disease in the gastrointestinal tract.

CASE REPORT

we report the case of a 31-year-old male with recurrent episodes of rectal bleeding, who was finally diagnosed of diffuse cavernous hemangioma of the rectum. The tumor, of 12 x 10 x 9 cm in size, occupied the rectum to the margin of the anal sphincter. A surgical procedure was ruled out because of the inability to carry out a safe anastomosis while preserving anal sphincters.

DISCUSSION

rectal hemangiomas are less frequent vascular malformations. The clinical presentation of a cavernous hemangioma of the rectum is usually acute, recurrent or chronic rectal bleeding. Other symptoms stem from the possible compression or invasion of adjacent structures, such as lumbar or perianal pain, metrorrhage, hematuria, etc. This diagnosis is commonly made in younger patients. Colonoscopy is without doubt the diagnostic technique of choice, and it allows to establish the localization, morphology, and total extension of the lesion; its characteristic image is a red-purplish nodule with great vascular congestion. According to the opinion of most authors, biopsy is not advisable during colonoscopy, since imaging techniques are sufficient for an accurate diagnosis, and the risk of bleeding while manipulating this lesion is not negligible. Computed tomography and particularly magnetic resonance imaging, given their high precision to delimit the lesion and its relations to adjacent structures, are imaging studies that are mandatory before surgical treatment. Other techniques such as selective angiography, barium enema, gastrointestinal transit, and upper-tract endoscopy may be supplementary and help locate more lesions along the gastrointestinal tract. Failure to recognize the exact diagnosis and extent of diffuse cavernous hemangioma may lead to failed surgical treatment and severe complications. Complete surgical excision of the lesion with a sphincter-saving procedure is the primary mode of treatment: conservative proctectomy with coloanal anastomosis.

[Interferon, ribavirin and amantadine in prior nonresponders to interferon and ribavirin therapy with chronic hepatitis C (genotype 1)]

OBJECTIVE

Despite advances in the treatment of chronic hepatitis C virus (HCV), the disease persists after treatment with interferon and ribavirin in a large percentage of patients and other therapeutic options are lacking. We investigated the efficacy of retreatment with antiviral therapy including amantadine.

EXPERIMENTAL DESIGN

prospective and open pilot study.

PATIENTS

Thirty-nine patients with chronic HCV, genotype 1, who were nonresponders to interferon and ribavirin were included. The patients were given repeat treatment with interferon-alpha 2A (9 MU/week), ribavirin (1,000-1,200 mg/day) and amantadine (200 mg/day) for 48 weeks.

RESULTS

HCV-RNA was undetectable in 5 patients in week 48 (12.8%) and in only 2 patients after 24 weeks of follow-up (5.1% of sustained responses). In patients with basal viremia of < 8 105 U/ml the probability of response at the end of treatment and of sustained response was 26.3 and 10.5%, respectively; in patients with elevated viremias response was 0%.

CONCLUSIONS

In patients with chronic HCV genotype 1 without response to interferon and ribavirin, triple antiviral therapy with interferon, ribavirin and amantadine is not useful.

A randomized controlled trial comparing three invitation strategies in a breast cancer screening program

BACKGROUND

The objective of this study was to compare the response received by a population-based breast cancer screening program, according to three different invitation strategies: letters sent by mail from the program (program group), letters sent by mail from the Primary Health Care Team (PHT group), and direct contact through a trained professional (direct contact group).

METHODS

We used a cluster-randomized controlled trial with assignment to invitation group using home address. Nine hundred eighty-six women of Barcelona (Spain), ages 50 to 64 years, were invited to participate in the program. The main outcome used was the response rate after the first invitation.

RESULTS

Five hundred sixty-four women accepted the invitation (57.2%). The highest response rate was achieved in the direct contact group (63.5%), followed by the PHT group (55.6%), the program group being the one that attained the lowest response rate (52.1%). The direct contact group had a higher probability of participating than the PHT group (RR = 1.14, P = 0.037) or the program group (RR = 1.22, P = 0.003). The response rate in the direct contact group was 72.1% when the letter was received by the subject herself. The increase in response occurred particularly among women of lower educational level.

CONCLUSIONS

Inviting women to participate in a breast cancer screening program through direct contact by trained personnel increased participation rate compared with mailed-letter methods. The positive effect appeared restricted to women with lower educational levels.

In vitro T-cell responses to beta-lactam drugs in immediate and nonimmediate allergic reactions

BACKGROUND

beta-Lactam drugs may induce both cellular and humoral allergic reactions, and there is evidence that T cells play an important role in the pathogenesis of these reactions. The aim of this work was to assess the sensitivity and specificity of the lymphocyte transformation test (LTT) as an in vitro diagnostic tool, in patients with either an immediate or a nonimmediate reaction to penicillin G and/or amoxicillin.

METHODS

Fifty patients with a well-documented history of allergic reactions to beta-lactams (31 immediate and 19 nonimmediate) were studied by means of skin tests (prick and intradermal), radioallergosorbent test (RAST), and, when necessary, controlled administration of the drug. Twenty-eight healthy subjects with good tolerance to penicillins served as controls. LTT was performed in all subjects.

RESULTS

Skin tests were positive in 77.4% of the patients with immediate reactions and in 36.8% of those with nonimmediate reactions. The overall sensitivity of LTT in the allergic patients was 62%, but, when analyzed separately, sensitivity was 64.5% for the immediate group and 57.9% for the nonimmediate group. The LTT specificity was 92.8%.

CONCLUSION

The LTT should be considered a useful in vitro diagnostic tool to identify subjects allergic to penicillins, especially patients with nonimmediate reactions where the LTT has a better diagnostic value than skin tests. Interestingly, positive T-cell proliferative responses can be observed 10 or more years after the occurrence of the reaction without further exposure to the drug.

Antioxidant activity levels and oxidative stress as blood markers of allergic response to drugs

Antioxidant enzymes work together in human blood cells against toxic reactive oxygen species. Although their relationship with several pathophysiologic processes has been stated, not much is known about the connection between antioxidant defence and allergy. This study was designed to determine the enzymatic activities and the oxidative indices in the blood and serum proteins in patients suffering from allergy to drugs. We hypothesize that serum and blood reactions may serve as useful clinical marker for the allergic state. We used enzymatic antioxidant activities, thiobarbituric acid reactive substances, and carbonyl contents of proteins as suitable markers. We determined superoxide dismutases, glutathione peroxidase and catalase activities in each cell type. After antihistaminics plus steroids were given as part of a protocol treatment, enzymatic antioxidant activities, thiobarbituric acid reactive substance levels, and carbonyl contents were used as recovering markers for the disease. We found a relationship between antioxidant enzymatic activities, thiobarbituric acid reactive substance levels, and carbonyl contents for allergic reactions belonging to several type I and type IV allergies, as well as cross-reactive intolerance to nonsteroidal anti-inflammatory drugs and an anaphylactoid reaction to a radiocontrast media. A similar pattern also exists for analogous allergic manifestations and disease-like status.

Utilization of screening mammography as a preventive practice prior to initiating a population-based breast cancer screening program

Factors associated with the level of utilization of screening mammography as a preventive practice were analyzed prior to initiating a population-based breast cancer screening program. A questionnaire was used to collect information about screening mammography utilization during the last 4 years among women invited to enroll in the program. Sociodemographic and health factors, and health services utilization were studied. A screening mammography in the last 4 years had been performed on 59.3% of the 8867 women interviewed. The utilization of mammography was higher among women who were younger, had a higher education level, or had previous visits to a physician (P < 0.001). The variables more strongly associated with use of screening mammography were: visit to a gynecologist and performance of a pap smear. Also associated with the utilization of screening mammography were: personal history of breast pathology, family history of breast cancer, breast self-examination, and recent visit to a general practitioner. Self-perceived health presented an inverse relation with screening mammography use (P < 0.001). The use of screening mammography appears to have increased in recent years, although inequalities persist which the breast cancer screening programs help to modulate. Mammographic frequency only would be deemed appropriate by the European guidelines in fewer than one-half of the cases.

Allergy to drugs: antioxidant enzymic activities, lipid peroxidation and protein oxidative damage in human blood

Reactive oxygen species lead to lipid peroxidation and specific oxidation of some specific enzymes, proteins and other macromolecules, thus affecting many intra- and intercellular systems. Recently, antioxidant functions have been linked to anti-inflammatory properties. Cell defences against toxic oxygen include antioxidant enzymes. We studied the enzymic antioxidant capacity in human blood of both erythrocytes and mononuclear cells from patients suffering from an allergic reaction to different drugs. We determined superoxide dismutases (SODs), glutathione peroxidase (GSHPx) and catalase (CAT) activities in each cell type. We also determined the extent of thiobarbituric acid reactive substances (TBARS) and the oxidative damage to proteins, in order to study the correlation between the cellular enzymic activities, the oxidative status and the allergic reaction. In mononuclear cells from allergic patients, SODs and CAT activities were enhanced compared with controls. Conversely, a decrease in GSHPx activity was found. In erythrocytes, higher values for CAT, GSHPx and SODs activities were found in allergic patients. TBARS were also enhanced in both types of cells, and the carbonyl content of serum was equally increased. The respective enzymic imbalances in mononuclear cells and erythrocytes, namely, GSHPx/SOD and CAT/SOD, and their consequences are discussed. To our knowledge, this is the first global study of antioxidant enzyme determinations, including TBARS level and carbonyl content, in patients suffering from allergies to drugs.

Hydrogastric sonography in the preoperative staging of gastric cancer

PURPOSE

Depth of wall invasion is the main prognostic factor in gastric cancer. We studied the utility of hydrogastric sonography in the evaluation of transmural infiltration by gastric cancer.

METHODS

Thirty-seven patients with gastric adenocarcinoma were examined before surgery with a 5-MHz probe after the ingestion of 100-400 ml of water (mean, 330 ml). Sonographic results were compared with pathologic classifications obtained after surgery.

RESULTS

Of the 37 tumors, 15 were found at surgery to be in the antrum, 10 were in the gastric body, 5 were proximal, and 7 were diffuse. After surgery, tumors were classified as follows: 2 (5%) T1, 4 (11%) T2, 15 (41%) T3, and 16 (43%) T4. Hydrogastric sonography correctly classified 30 (81%) of the 37 tumors. Sonography was correct for 2 (100%) of the 2 T1 tumors, 2 (50%) of the 4 T2 tumors, 13 (87%) of the 15 T3 tumors, and 13 (81%) of the 16 T4 tumors. Five sonographic errors were due to understaging and 4 to overstaging. With regard to tumor site, sonographic results were correct for 4 (57%) of the 7 diffuse tumors, 3 (60%) of the 5 proximal tumors, 9 (90%) of the 10 gastric body tumors, and 14 (93%) of the 15 antral tumors.

CONCLUSIONS

Hydrogastric sonography is useful for preoperative evaluation of transmural infiltration by gastric cancers, particularly tumors in the antrum or gastric body.

Antioxidant enzymatic activities in human blood cells after an allergic reaction to pollen or house dust mite

Several diseases have been related to oxidative stress. Recently, antioxidant functions have also been linked to anti-inflammatory properties. Cell defenses against reactive oxygen species include antioxidant enzymes. We studied the enzymatic antioxidant capacity in human blood of both red blood and mononuclear cells from patients suffering from an allergic reaction to pollen or house dust mite. We determined superoxide dismutases (SODs), glutathione peroxidase (GSHPx) and catalase (CAT) activities in each cell type. We also determined the extent of thiobarbituric acid reactive substances (TBARS), in order to study the correlation between the cellular enzymatic activities, the redox status and the disease. In mononuclear cells from allergic patients, SODs and CAT activities were enhanced compared to controls. Conversely, a decrease in GSHPx activity was found. In erythrocytes, higher values for GSHPx and SODs and similar CAT activities were found in allergic patients and controls. Interestingly, CuZnSOD and MnSOD activities were enhanced in the same proportion for both, erythrocytes and mononuclear cells. TBARS were also enhanced in both types of cells. The respective enzymatic imbalances in mononuclear cells and erythrocytes, namely, GSHPx/SOD and CAT/SOD, and their consequences are discussed. To our knowledge, this is the first global study of antioxidant enzymes, including TBARS level determinations, in allergy.

Hidrocolonic ultrasonography in the detection of tumoral processes in the inferior gastrointestinal tract

OBJECTIVES

To determine the value of hidrocolonic ultrasound in the detection of proliferative lesions in the colon and to compare it with other techniques of already proven value.

MATERIAL AND METHODS

We performed a prospective blinded trial including 155 patients (82 males and 73 females) with ages ranging from 33 to 94 years (average of 58) and clinical and analytical criteria suggesting the existence of colonic proliferative lesions. Patients with rectal mass or those with deficient bowel preparation were excluded. Ultrasound findings were compared to those obtained by colonoscopy (133 cases) and by Barium RX studies (22 cases) and all diagnoses were always confirmed by histologic exams.

RESULTS

155 patients were studied. 50 of them had cancer and 46 of these 50 were diagnosed by Hidrocolonic Ultrasound (92%); 19 had polyps > 7 mm. and 15 of these (78.9%) were diagnosed by Hidrocolonic Ultrasound. Hidrocolonic Ultrasound failed to detect all the polyps < 7 mm. The overall sensitivity, specificity, positive predictive value and negative predictive value for identifying colon carcinoma were 92%, 98%, 95.8% and 96.2% respectively and for polyps > 7 mm were 78.9%, 100%, 100% and 97.1%, respectively. The mean time for examination was 14 minutes. Tolerance was good in 114 patients (73.5%), 29 showed a slight discomfort (18.7%) and 12 (7.7%) showed a great discomfort. There were no complications.

CONCLUSIONS

Hidrocolonic ultrasound is an innocuous, fast, well tolerated technique for detecting colonic proliferative lesions > 7 mm H.U. can be considered as a useful complementary technique to other more expensive and invasive ones, such as barium RX studies and Colonoscopy.

[Usefulness of abdominal echography in the diagnosis of active Crohn's disease]

OBJECTIVE

The aim of this study was to evaluate the relevance of the ultrasonography in assessing activity in a series of patients with Crohn's disease.

PATIENTS AND METHODS

A series of 24 patients with active (Crohn's disease activity index > 150) ileal or ileocolonic Crohn disease underwent abdominal ultrasonography.

RESULTS

There was a significant correlation between bowel wall thickening and the Crohn's disease activity index: the higher the bowel wall thickening was the higher were the values of Crohn's disease activity index. Two or more ultrasound studies were performed in 10 patients with bowel wall > 4 mm during treatment, and a progressive normalization of bowel wall size was observed with new thickening when recurrence occurred.

CONCLUSIONS

A bowel wall thickening (> or = 4 mm) was found in patients with active Crohn's disease. A patient with bowel wall thickness > 6 mm should make us suspect the presence of stenosis. Abdominal ultrasonography is an accurate method in the first assessment of Crohn's disease because its high correlation with the Crohn's disease activity index.

[Abdominal echography in patients with human immunodeficiency virus (HIV) infection. Diagnostic usefulness in the evaluation of associated medico-surgical pathology]

BASIS

The abdominal manifestations in the patient with HIV infection are increasingly frequent. We have conducted the present study in order to determine the diagnostic usefulness of the abdominal echography in the clinical assessment of the patient.

MATERIALS AND METHODS

We review the echographic findings of 112 patients carrying the HIV with or without the Acquired Immunodeficiency Syndrome (AIDS). Seventy eight patients were men and 34, women, with an average age of 30 years. The main risk group was parenterally drug addiction (72%). The stage of the HIV infection was IVC1 in 41% of the cases, II in 23%, III in 13% and IVC2 in 13%. The echographic exploration was performed using a real-time echography, with a probe of 3.5 Mhz, assessing according to conventional criteria the abdominal organs and their pathology, masses and free intraabdominal fluid. The echographic characteristics were first broadly assessed in the patients from the series and later on, according to the patient's pathology. (Infectious, acute abdominal, hepatic biochemical disorders, HIV carrier-associated pathology).

RESULTS

In 33% of the cases, the echography was normal. Hepatomegaly was the most frequent echographic sign: 56 patients (50%), followed by splenomegaly in 43 patients (38.3%), standing out the affection of the biliary and/or vesicular ductus in 7 patients (6.2%). The echographic findings were not related to the HIV infection stage, nor with the presence of hepatic biochemical disorders. However, the presence of organomegaly (hepatosplenomegaly associated or not to retroperitoneal adenopathies) were more frequent in the group with infectious complication, 33.3% vs 19.6% (p < 0.01), that in the patients without associated infectious processes. In patients with medical or surgical acute abdominal pathology, the echography was diagnostic in 9 out of 10 patients.

CONCLUSION

In the HIV patient, the echography allows an specific initial diagnostic assessment, being able in most of the patients with abdominal manifestations to diagnose the causal pathology.

[Diagnosis of choledocholithiasis and residual lithiasis. Ultrasonic postcholecystectomy]

246 patients with proven common bile duct stones at surgery were studied in order to establish the accuracy of ultrasound scanning in detecting choledocholithiasis and to compare the sensitivity of real-time examinations with those performed by a static scanner. The detection of choledocholithiasis by real-time ultrasound was 45.6% compared to 26.3% for the examinations performed with a static scanner. A dilated common bile duct was detected in 83.6% using real-time scanning compared to 70.3% using a static scanner. When the common bile duct was not dilated ultrasound was unable to detect the stones. Real-time ultrasound detected 66.6% of the patients with residual choledocholithiasis compared to 23.5% of patients examined by a static scanner. Our results show that real-time ultrasound scanning is a very useful screening method in detecting choledocholithiasis and residual lithiasis.