Enfermedad discal intervertebral (I): anatomía,fisiopatología y signos clínicos

La enfermedad discal intervertebral es una patología habitual en la especie canina y menos común en la felina. La presentación clínica puede variar desde leve molestia espinal hasta severa disfunción motora y retención urinaria. La prevalencia de la enfermedad discal intervertebral en perros es del 2%, mientras que en gatos representa el 0,12%. Durante los últimos años, la investigación de esta patología se ha centrado en describir y entender los mecanismos que la originan, así como en mejorar las técnicas de diagnóstico y el tratamiento de los pacientes

Efficacy of rifabutin-based triple therapy as second-line treatment to eradicate helicobacter pylori infection

<p>Abstract</p> <p>Background</p> <p>Rifabutin has been found to be effective in multi-resistant patients after various treatment cycles for Helicobacter pylori (HP) infection, but it has not been analysed as a second-line treatment. Therefore, we seek to compare the effectiveness of a treatment regimen including rifabutin versus conventional quadruple therapy (QT).</p> <p>Methods</p> <p>Open clinical trial, randomised and multi-centre, of two treatment protocols: A) Conventional regime -QT- (omeprazole 20 mg bid, bismuth citrate 120 mg qid, tetracycline 500 mg qid and metronidazole 500 mg tid); B) Experimental one -OAR- (omeprazole 20 mg bid, amoxicillin 1 gr bid, and rifabutin 150 mg bid), both taken orally for 7 days, in patients with HP infection for whom first-line treatment had failed. Eradication was determined by Urea Breath Test (UBT). Safety was determined by the adverse events.</p> <p>Results</p> <p>99 patients were randomised, QT, n = 54; OAR, n = 45. The two groups were homogeneous. In 8 cases, treatment was suspended (6 in QT and 2 in OAR). The eradication achieved, analysed by ITT, was for QT, 38 cases (70.4%), and for OAR, 20 cases (44.4%); p = 0.009, OR = 1.58. Of the cases analysed PP, QT were 77.1%; OAR, 46.5%; p = 0.002. Adverse effects were described in 64% of the QT patients and in 44% of the OAR patients (p = 0.04).</p> <p>Conclusion</p> <p>A 7-day rifabutin-based triple therapy associated to amoxicillin and omeprazole at standard dose was not found to be effective as a second-line rescue therapy. The problem with quadruple therapy lies in the adverse side effects it provokes. We believe the search should continue for alternatives that are more comfortably administered and that are at least as effective, but with fewer adverse side effects.</p> <p>Trial Registration</p> <p>Current Controlled Trials ISRCTN81058036</p

Indications of EUS FNA in lymph nodes

La PAF-EE est une technique sensible et précise pour l'évaluation tissulaire diagnostique de lésions péri-luminales (ganglions lymphatiques) quand les autres techniques font défaut ou ne sont pas réalisables. La sécurité de la technique se concentre sur l'emploi d'un échoendoscope à balayage linéaire avec une aiguille de petit calibre pour biopsier les lésions solides. Les limitations majeures dans l'élargissement des applications de la PAF-EE sont les coûts élevés de l'équipement et la pénurie de praticiens capables de réaliser cette procédure. Toutefois, la PAF-EE fait désormais partie intégrante de l'algorithme de stadification préopératoire de différentes tumeurs (oesophagiennes, pulmonaires, etc.)

Regression of gastric high grade mucosa associated lymphoid tissue (MALT) lymphoma after Helicobacter pylori eradication

BACKGROUND—Most low grade gastric lymphomas arising from the mucosa associated lymphoid tissue (MALT) are related to Helicobacter pylori colonisation. Cases with disease limited to the stomach can be cured after H pylori eradication and remain in remission for years. In contrast, high grade lymphomas of the stomach, although also related to H pylori, do not usually respond to eradication treatment.
CASE REPORT—A 36 year old patient was referred from another hospital with a diagnosis of a low grade gastric MALT lymphoma associated with H pylori. The patient was in stage I and while waiting for the biopsies to be reviewed H pylori eradication therapy was given as the first step of treatment. Review of the biopsies showed a high grade immunoblastic lymphoma with areas of low grade gastric MALT lymphoma (high grade gastric MALT lymphoma or diffuse large B cell lymphoma with areas of MALT type lymphoma of the WHO classification). The patient received no further treatment but has been closely followed up for 32 months with sequential endoscopies to obtain biopsies for histological studies, H pylori cultures, and polymerase chain reaction analysis of the IgH gene.
RESULTS—After H pylori eradication the patient had a complete histological response that has been maintained for 32 months. Monoclonal IgH gene rearrangement persisted for 32( )months.
CONCLUSION—The response of this patient indicates the possibility that some cases of high grade gastric MALT lymphoma (possibly patients in stage I with a superficial or limited disease) may still be responsive to H pylori antigenic drive and may be cured with eradication therapy. Prospective studies should be performed to identify patients with high grade gastric MALT lymphomas that may respond to eradication therapy and be spared of other more aggressive treatments.


Keywords: mucosa associated lymphoid tissue; lymphoma; gastric lymphoma; immunoblastic lymphoma; Helicobacter pylor