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BACKGROUND: The European registry for minimally invasive pancreatic surgery (E-MIPS) collects data on laparoscopic and robotic MIPS in low- and high-volume centers across Europe.METHODS: Analysis of the first year (2019) of the E-MIPS registry, including minimally invasive distal pancreatectomy (MIDP) and minimally invasive pancreatoduodenectomy (MIPD). Primary outcome was 90-day mortality.RESULTS: Overall, 959 patients from 54 centers in 15 countries were included, 558 patients underwent MIDP and 401 patients MIPD. Median volume of MIDP was 10 (7-20) and 9 (2-20) for MIPD. Median use of MIDP was 56.0% (IQR 39.0-77.3%) and median use of MIPD 27.7% (IQR 9.7-45.3%). MIDP was mostly performed laparoscopic (401/558, 71.9%) and MIPD mostly robotic (234/401, 58.3%). MIPD was performed in 50/54 (89.3%) centers, of which 15/50 (30.0%) performed ≥20 MIPD annually. This was 30/54 (55.6%) centers and 13/30 (43%) centers for MIPD respectively. Conversion rate was 10.9% for MIDP and 8.4% for MIPD. Overall 90 day mortality was 1.1% (n = 6) for MIDP and 3.7% (n = 15) for MIPD.CONCLUSION: Within the E-MIPS registry, MIDP is performed in about half of all patients, mostly using laparoscopy. MIPD is performed in about a quarter of patients, slightly more often using the robotic approach. A minority of centers met the Miami guideline volume criteria for MIPD.

Resumen La Seccion de Via Aerea de la Sociedad Catalana de Anestesiologia, Reanimacion y Terapeutica del Dolor (SCARTD) presenta la actualizacion de las recomendaciones para la evaluacion y manejo de la via aerea dificil con el fin de incorporar los avances tecnicos y los cambios observados en la practica clinica desde la publicacion de la primera edicion en 2008. La metodologia elegida fue la adaptacion de 5 guias internacionales recientemente publicadas, cuyo contenido fue previamente analizado y comparado de forma estructurada, y el consenso de expertos de los 19 centros participantes. El documento final fue sometido a la valoracion de los miembros de la SCARTD y a la revision por parte de 11 expertos independientes. Estas recomendaciones estan pues sustentadas en la evidencia cientifica actualmente disponible y en un amplio acuerdo de los profesionales de su ambito de aplicacion. En esta edicion se amplia la definicion de via aerea dificil, abarcando todas las tecnicas de manejo, y se hace mayor hincapie en la valoracion de la via aerea y en la clasificacion en 3 categorias segun el potencial grado de dificultad y las consideraciones de seguridad adicionales, que guiaran la planificacion de la estrategia a seguir. La preparacion previa al manejo de la via aerea, no solo relativa al paciente y al material, sino tambien a la comunicacion e interaccion entre todos los agentes implicados, ocupa un lugar destacado en todos los escenarios incluidos en el presente documento. El texto refleja el aumento progresivo del uso de los videolaringoscopios y de los dispositivos de segunda generacion en nuestro entorno y promueve tanto su uso electivo como el uso precoz en la via aerea no prevista. Tambien recoge la creciente utilizacion de la ecografia como herramienta de apoyo en la exploracion y toma de decisiones. Se han abordado nuevos escenarios como el riesgo de broncoaspiracion y la extubacion considerada dificil. Finalmente, se trazan las lineas maestras de los programas de entrenamiento y formacion continuada en via aerea necesarios para garantizar la implementacion efectiva y segura de las recomendaciones.

The Airway Division of the Catalan Society of Anaesthesiology, Intensive Care and Pain Management (SCARTD) presents its latest guidelines for the evaluation and management of the difficult airway. This update includes the technical advances and changes observed in clinical practice since publication of the first edition of the guidelines in 2008. The recommendations were defined by a consensus of experts from the 19 participating hospitals, and were adapted from 5 recently published international guidelines following an in-depth analysis and systematic comparison of their recommendations. The final document was sent to the members of SCARTD for evaluation, and was reviewed by 11 independent experts. The recommendations, therefore, are supported by the latest scientific evidence and endorsed by professionals in the field. This edition develops the definition of the difficult airway, including all airway management techniques, and places emphasis on evaluating and classifying the airway into 3 categories according to the anticipated degree of difficulty and additional safety considerations in order to plan the management strategy. Pre-management planning, in terms of preparing patients and resources and optimising communication and interaction between all professionals involved, plays a pivotal role in all the scenarios addressed. The guidelines reflect the increased presence of video laryngoscopes and second-generation devices in our setting, and promotes their routine use in intubation and their prompt use in cases of unanticipated difficult airway. They also address the increased use of ultrasound imaging as an aid to evaluation and decision-making. New scenarios have also been included, such as the risk of bronchoaspiration and difficult extubation Finally, the document outlines the training and continuing professional development programmes required to guarantee effective and safe implementation of the guidelines.

Immune modulation is a key therapeutic approach for allergic diseases, asthma and autoimmunity. It can be achieved in an antigen-specific manner via allergen immunotherapy (AIT) or in an endotype-driven approach using biologicals that target the major pathways of the type 2 (T2) immune response: immunoglobulin (Ig)E, interleukin (IL)-5 and IL-4/IL-13 or non-type 2 response: anti-cytokine antibodies and B-cell depletion via anti-CD20. Coronavirus disease 2019 (COVID-19) vaccination provides an excellent opportunity to tackle the global pandemics and is currently being applied in an accelerated rhythm worldwide. The vaccine exerts its effects through immune modulation, induces and amplifies the response against the severe acute respiratory syndrome coronavirus (SARS-CoV-2). Thus, as there may be a discernible interference between these treatment modalities, recommendations on how they should be applied in sequence are expected. The European Academy of Allergy and Clinical Immunology (EAACI) assembled an expert panel under its Research and Outreach Committee (ROC). This expert panel evaluated the evidence and have formulated recommendations on the administration of COVID-19 vaccine in patients with allergic diseases and asthma receiving AIT or biologicals. The panel also formulated recommendations for COVID-19 vaccine in association with biologicals targeting the type 1 or type 3 immune response. In formulating recommendations, the panel evaluated the mechanisms of COVID-19 infection, of COVID-19 vaccine, of AIT and of biologicals and considered the data published for other anti-infectious vaccines administered concurrently with AIT or biologicals. © 2022 European Academy of Allergy and Clinical Immunology and John Wiley & Sons Ltd.

We describe a novel algorithm for the robust approximation of elastic, inelastic, and frictional contact problems in explicit computations. The method is based on a master-slave concept and a predictor/corrector split of the dynamic update. In the predictor step, the bodies move ignoring all contact interactions; in the correction, the nodes that have penetrated a body are pushed back while correcting their velocities to preserve linear momentum and balance the kinetic energy. In contrast with existing predictor/corrector contact algorithms, no iterations nor global computations are required in the correction step. Moreover, thanks to the geometrical basis of the method, the choice of an artificial penalty parameter is avoided. The contact algorithm does not require the computation of the normal vectors at the contacting surfaces, making it especially useful for simulations that employ finite element and certain meshfree discretizations, and for the simulation of contact among bodies with non-smooth boundaries.

In this work, we describe in detail a model for small strain elasto-visco-plasticity with convex, non-smooth, yield functions and associative nonlinear kinetic laws, restricted to linear hardening. Using concepts of non-smooth convex geometry, numerical methods are developed to integrate the evolution equations of the model. These algorithms are analyzed and shown to inherit a discrete dissipation inequality, irrespective of the smoothness of the yield function. The results are applied to models based on Tresca’s and Drucker–Prager’s yield criteria, which include all possible types of non-smoothness. Numerical examples are shown to illustrate the performance of the methods.

Background and aims Total knee arthroplasty (TKA) is a painful procedure. In our hospital the worst pain appears in postoperative day one, which could be related to the use of an effective but short analgesic intraoperative technique: a periarticular local analgesic infiltration associated with NSAIDs and rescue opioids. The aim of this study is to assess if adductor canal block (ACB) performed the day after TKA improves analgesia without motor blockade and impairment of ambulation ability. Methods The trial is registered at http://www.clinicaltrials.gov (NCT03915522) and approved by the Regional Ethics Committee. This is a prospective, double-blinded study that includes patients ASA I-III, aged 18–85 years, admitted for TKA. Exclusion criteria are daily intake of strong opioids, allergy to drugs used and surgery performed under general anesthesia. Patients are transferred the day after the surgery to postoperative resuscitation unit. A sterile dressing of the extremity is performed, and after the adductor canal is identified with ultrasound, a puncture is done with or without doing the ACB. After all patients have a sterile apposite on the puncture site. Outcome measures are postoperative pain score measured with a numerical rating scale, knee extensor and adductor muscle strength measured using a hand-held dynamometer, ability to walk with ten meter walk test, rate of opioid side effects, rate of adductor canal block complications and length of hospital stay. Results The study is in recruiting status. The estimated number of patients enrolled is 140 and the estimated primary completion date September 2019. Conclusions In TKA it is essential to treat pain without motor leg impairment.

This paper presents the effect of the laser-polishing process applied to a milled and EDMed surface of DIN 1.2379 tool steel commonly used in the die and mold industry. The martensitic structure of this type of steel (showing hardness values up to 62 HRC) makes the polishing operation extremely difficult. At present polishing must be carried out manually by skilled workers, and this entails an expensive and prolonged process. An alternative to automation of the polishing process is a laser-polishing process, based on tightly controlled melting of a micro-layer of surface material which flows into and fills topographic valleys for a smoothed surface topography. Thus the main process parameters have been identified and optimized using two different types of industrial laser: a CO2 laser and a high-power diode laser (HPDL), obtaining up to 90% roughness reduction with mean roughness values (Ra) below 0.5 μm. Moreover, in order to secure a complete study of the process in accordance with the energy radiated, three-dimensional topographic surfaces were measured and a metallurgical study performed to determine the effect of laser radiation on the structure of the material.

In this work a methodological scheme for a reduction of both the try-out and lead-time of complex dies is presented. The finite element simulation of the system press/tool behaviour along the stamping process results in criteria for the best design of high-cost dies/punches. Modifications of the main geometry, components and functional parameters are so recommended. Die deflection during the pressing process is in this work investigated. With the proposed methodology die manufacturers are able to avoid errors coming from die deformation due to their asymmetrical shape. At the same time, time of manual adjustment and polishing is reduced in a 30%. Examples are deeply explained as well as experimental evidences.

A laser polishing method applied on metallic surfaces is presented in this work. One of the most important applications of this technique is the small-medium injection mould polishing manufactured by rapid manufacturing processes (RM) such as selective laser sintering. The polishing method has been applied to different surfaces including a laser-sintered part. Topography and roughness parameters measurements show that laser polishing can achieve surface improvements up to three times in mean roughness parameter with no macro-geometric deviations.

This article presents the optimum cutting conditions for advanced high-strength steel (AHSS) laser cutting. Different series of AHSSs, used in the automotive industry at present, have been tested with different laser cutting parameters. The influence of laser cutting in the material and the changes in metallurgical characteristics have been studied. The results, as expected, demonstrate very different behaviours as a function of sheet thickness, while the variation in cutting parameters due to the influence of the material is less important. The results have been divided into two large groups with thicknesses of more than 1 mm and less than 1 mm. Parameter variation inside each group mainly depends on sheet material coating. The optimum cutting areas and the quality of the cut evaluated with different criteria are presented. Finally, the best position for the laser beam has been observed to be underneath the sheet.

This article demonstrates the optimum working areas and cutting conditions for the laser cutting of a series of advanced high strength steels (AHSS). The parameters that most influence the cutting of sheet metal have been studied and the results have been divided into two large groups with thickness of more and less than 1 mm. The influence of the material and, more important, the effect of coating have been taken into account. The results, have demonstrate very different behaviours between the thinnest and thickest sheets, whilst the variation of the cutting parameters due to the influence of the material is less relevant. The optimum cutting areas and the quality of the cut evaluated with different criteria are presented. Finally, the best position for the laser beam has been observed to be underneath the sheet.

Patients suffering anaphylactic reactions after parasitized fish consumption have been reported in Spain in recent years. This reaction is different from the well-known acute or chronic anisakiasis and causes intolerance to parasitized fish ingestion, even after appropriate cooking. High specific IgE values are usually found in these subjects. IgE immunoblotting is now needed to confirm the presence of specific IgE directed to several parasite antigens in order to exclude cross-reactions. Positive specific IgG4 by immunoblotting was found in 60% of the patients, as well as in patients with anisakiasis, and probably reflected recent contact with the parasite proteins. The most specific response of IgE antibodies was directed to low-molecular-mass antigens of the parasite. Therefore, recombinant or purified antigens for in vivo and in vitro use will in future overcome some of the problems found in the diagnosis of sensitized patients.

Background: The fish parasite Anisakis simplex is the etiologic agent of anisakiasis and induces IgE-mediated reactions. Skin prick tests (SPTs) and the measurement of specific IgE to A. simplex were, in our experience, not valid tools with which to discriminate between allergic and nonallergic patients because many control subjects also had positive results. Objective: The study was carried out to assess the usefulness of IgE immunoblotting in the diagnosis of allergy to A. simplex. Methods: We have studied 61 patients with acute symptoms of urticaria, angioedema, or anaphylaxis and positive specific IgE to A. simplex . According to the anamnesis, time interval between ingestion of fish and clinical onset of symptoms, and exclusion of other causes of allergy, three different groups of patients were established: group A (allergic), group NA (nonallergic), and group D (doubtful). Fifty-one healthy donors were included as control subjects (group C). IgE immunoblotting with A. simplex whole-body extract was performed in all patients and control subjects. Results: Four patterns of immunoblotting were observed: type 1, with a group of several bands of medium molecular weight and others of low molecular weight; type 2, two or more bands of medium molecular weight; type 3, only one band of medium molecular weight; type 4, without any band. There was a significant predominance of blotting type 1 in group A and type 4 in group C. Conclusion: These data suggest that IgE immunoblotting is the most useful approach to A. simplex allergy diagnosis. (J Allergy Clin Immunol 1997;99:497-501.)

A 40-year-oldman underwent endoscopic ultrasound (EUS) because of suspected submucosal gastric tumor diagnosed after an episode of severe bleeding (●" Fig.1). EUS revealed a well-delineated, 18-mm hypoechogenic lesion in the submucosa with a calcified area inside it (●" Fig.2, ●" Video1). Three lymph nodes near the celiac trunk showed the same characteristics of the gastric lesion: well-delineated and hypoechogenic, with central calcification (●" Fig.3, ●" Video1). A fine-needle aspiration (FNA) biopsy of the largest lymph node (14mm) was carried out using a 22-G needle, and histological examination revealed reactive lymphadenitis. The patient was referred for surgery, which showed an ulcerated submucosal tumor in the anterior gastric wall with pathological lymph nodes in the coronary gastric chain. The finding of the intraoperative study was a neuroendocrine gastric tumor (●" Fig.4) with nodal neuroendocrine metastasis. All the regional lymph nodes were removed and a total gastrectomy was carried out. An intraoperative ultrasound examination was done to rule out any pancreatic or duodenal lesions. Microscopically, the tumor consisted of uniform, small cells with round or oval nuclei and moderate atypia, lying in nests and within the bone trabeculae. The number of mitoses was 4 per 10 high power field (HPF). Extensive stromal bone formation was seen within the tumor (●" Fig.5). The tumor cells stained positive for cytokeratin, chromogranin A (●" Fig.6), synaptophysin, enolase, and CD56, and the index of tumoral proliferation was 15%. Final histopathologic diagnosis was neuroendocrine tumor G2 (World Health Organization [WHO] classification, 2010). Most gastric neuroendocrine tumors are multiple and associated with hypergastrinemia. Solitary tumors have a poor prognosis [1]. To our knowledge, there are only four reports of gastric carcinoid tumors with ossification [2–5]. We report a case of a type 3 (G2) neuroendocrine gastric tumor with lymph node metastases with ossification diagnosed with EUS.

Background and study aims Endoscopic ultrasound (EUS) is a commonly used and fairly sensitive method of assessing changes of chronic pancreatitis (CP) when routine noninvasive imaging has not shown overt features of CP. The aim of this study is to evaluate the interobserver agreement (IOA) for the classic (MSC) and the Rosemont (RC) criteria for the diagnosis of chronic pancreatitis on the basis of clinical practice. Patients and methods Two experienced endosonographers evaluated on the same day patients referred for EUS in a blinded fashion. Data from the sonographic criteria of both MSC and RC were collected. Agreement was calculated using k statistics. Results A total of 69 patients were evaluated. The study population included mainly patients without pancreatic diseases, resulting in a low number of sonographic findings. Agreement for the final diagnosis was moderate for both classification systems of chronic pancreatitis ( k = 0.53 for conventional and k = 0.46 for Rosemont). Conclusions The IOA of EUS in the diagnosis of CP is moderate. The concordance values obtained in clinical practice are similar to those obtained in multicenter studies. The RC does not seem to improve the IOA of MSC.

Objectives: Evaluation of the impact of EUS in clinical practice. Methods: All exploration performed during the first 18 months of implementation of the technique were analyzed. Agreement was assessed by radiographic techniques or surgical specimens in those cases allowed. Results: 277 exploration were performed. There have been only 2 complications and they were related to sedation in both cases. The demand increased gradually, reaching 70 scans per 100,000 inhabitants. Main indications were bile (34.3%) and pancreatic processes. No pathology was found in 10% of cases; 29 cases had choledocholithiasis (93% confirmed and treated endoscopically). Chronic pancreatitis was diagnosed in 19 cases (only 15.78% of the cases were diagnosed by computed tomography). 32 patients with idiopathic acute pancreatitis were evaluated: 20 of them had evidence of microlithiasis (80% cholecystectomized and asymptomatic after a mean follow-up of 21.5 months), two cases of choledocholithiasis, 1 with chronic pancreatitis and 9 cases remained free of filial etiology. We performed 56 punctures: 39 samples of pancreas in 33 patients (81.1% of the samples were diagnostic; adenocarcinoma and serous cystadenoma were the most common diagnoses), 13 enlarged nodes and 4 abdominal masses. Conclusions: EUS is a growing demand technique that has low risks and leads to better decision-making in a significant number of patients with different diseases. Therefore, its inclusion in routine clinical practice must be considered.

Resumen . Presentamos el caso de una mujer de 44 anos remitida a nuestra consulta por cuadro de ictericia, coluria y acolia. Al revisar la historia clinica de la paciente se comprobo que el IgM frente al virus de la hepatitis A (VHA) era positivo 4 y 2 anos antes, asi como en el momento de ser visitada por nosotros. Usando el sistema de puntuacion del Grupo Internacional para el Estudio de la Hepatitis Autoinmune, la paciente presentaba una puntuacion de 16 sin tener en cuenta el marcador de la hepatitis VHA y de 13 si este se tenia en cuenta. Probablemente la persistencia de este marcador viral a lo largo de tantos anos se relaciona con la hipergammaglobulinemia policlonal existente en estos enfermos, por lo que pensamos que la inclusion de este anticuerpo como dato negativo en el diagnostico de la hepatitis autoinmune debe realizarse con precaucion.

[Background]: Systemic mast cell activation disorders (MCADs) are characterized by severe and systemic mast cell (MC) mediators-related symptoms frequently associated with increased serum baseline tryptase (sBt). [Objective]: To analyze the clinical, biological, and molecular characteristics of adult patients presenting with systemic MC activation symptoms/anaphylaxis in the absence of skin mastocytosis who showed clonal (c) versus nonclonal (nc) MCs and to provide indication criteria for bone marrow (BM) studies. [Methods]: Eighty-three patients were studied. Patients showing clonal BM MCs were grouped into indolent systemic mastocytosis without skin lesions (ISMs-; n = 48) and other c-MCADs (n = 3)-both with CD25++ BM MCs and either positive mast/stem cell growth factor receptor gene (KIT) mutation or clonal human androgen receptor assay (HUMARA) tests-and nc-MCAD (CD25-negative BM MCs in the absence of KIT mutation; n = 32) and compared for their clinical, biological, and molecular characteristics. [Results]: Most clonal patients (48/51; 94%) met the World Health Organization criteria for systemic mastocytosis and were classified as ISMs-, whereas the other 3 c-MCAD and all nc-MCAD patients did not. In addition, although both patients with ISMs- and patients with nc-MCAD presented with idiopathic and allergen-induced anaphylaxis, the former showed a higher frequency of men, cardiovascular symptoms, and insect bite as a trigger, together with greater sBt. Based on a multivariate analysis, a highly efficient model to predict clonality before BM sampling was built that includes male sex (P = .01), presyncopal and/or syncopal episodes (P = .009) in the absence of urticaria and angioedema (P = .003), and sBt >25 μg/L (P = .006) as independent predictive factors. [Conclusions]: Patients with c-MCAD and ISMs- display unique clinical and laboratory features different from nc-MCAD patients. A significant percentage of c-MCAD patients can be considered as true ISMs- diagnosed at early phases of the disease. © 2010 American Academy of Allergy, Asthma and Immunology., Supported by grants from the Ministerio de Sanidad y Consumo, Instituto de Salud Carlos III (FIS060529, FIS061377, PS09/00032, FIS09/90871, and RETICS RD06/0020/0035-FEDER); Junta de Castilla y León (Grant SAN196/SA10/07 and SAN/1778/ 2009); Junta de Comunidades de Castilla La Mancha (FISCAM 2007/36 and FISCAM 2008/46), and Fundación MMA. A.G.-M. is supported by a grant from FIS/ FEDER (CP03/00035) and C.T. from the FCT of Portugal (SFRH/BD/17545/2004).

La colitis colagena es una enfermedad cuya frecuencia ha aumentado progresivamente en los ultimos anos debido fundamentalmente a la toma rutinaria de biopsias en el estudio de pacientes con diarrea cronica. Se han comunicado buenas respuestas con numerosos tratamientos, aunque hay pocos ensayos clinicos realizados por el escaso numero de pacientes con esta patologia. Presentamos dos casos de colitis colagena cuyo interes reside en su manejo terapeutico, revisando las distintas alternativas existentes en el tratamiento de esta entidad de creciente importancia en la practica clinica diaria.

Although rare, anaphylactic reactions induced by proton pump inhibitors have been reported. The presence of cross-reactivity between different members of the group is not clear. We studied 9 patients with adverse reactions to omeprazole. Clinical symptoms appeared immediately in 8 patients and after 4 hours in 1. Symptoms ranged from urticaria/angioedema in 7 cases to anaphylaxis in 2 cases. Skin prick tests and oral controlled challenge tests with omeprazole, lansoprazole, and pantoprazole were performed. Skin prick or intradermal tests with omeprazole were positive in 8 patients. Four were also positive to pantoprazole. Prick tests with lansoprazole were always negative. Lansoprazole was administered to all 9 patients, with good tolerance in 8. Only 3 patients were challenged with pantoprazole and developed widespread urticaria. We present 9 patients with immunoglobulin E-mediated allergy to omeprazole. In most of our cases, lansoprazole proved to be a good alternative treatment.

Polishing operation of die and molds represents up to 30% of the total manufacturing cost, since it is a high added value operation that is necessary carried out manually by qualified personnel. There are several alternatives to hand operations, such as abrasive automated methods operated by robots, ball burnishing or laser polishing process in order to reduce operation time and costs. The presented article proposes a laser based polishing operation which consists in the application of a laser beam in a very controlled way. The radiated energy melts a microscopic layer which flows and re‐solidifies smoothing the topographic irregularities of the surface resulting in a reduction of the initial roughness. The article presents, in addition to some experimental results of laser polishing process, a thermal model developed based on the finite difference method. The model is able to take into account different types of lasers; in particular, simulations for a CO2 laser and a high power diode laser have been carried out. As the model gets the full map of temperatures in 3D, it is possible to predict the melted material layer thickness, which is a crucial parameter in the laser polishing process. Finally, two types of validation tests are presented: First, some tests measured by pyrometers on the test part surface. Secondly, the comparison of a series of metallographic analysis on W.‐Nr.1.2379 tool steel, where the metallurgical changes caused by the laser radiation can be observed with the thermal field estimated by the model.

Contradictory reports of the sensitivity of skin tests in quinolone allergy have been reported. Our objectives were to describe the outcome of quinolone skin and challenge tests in patients consulting because of a history of adverse reaction to quinolone and to compare the outcome of quinolone skin tests and challenge tests in the subsample of patients who had undergone both tests.We reviewed skin and challenge test results of all patients who consulted at our allergy service over the last 5 years because of a history of quinolone adverse reaction in the form of urticaria or anaphylaxis within 1 hour of drug intake (group 1), urticaria or maculopapular eruption between 1 and 24 hours after intake (group 2) or after 24 hours had passed (group 3), or atypical symptoms (group 4).A total of 71 cases were identified: 27, 8, 24 and 12 in groups 1 through 4, respectively. Skin tests were performed in all patients, with positive results in 31 patients. In group 1, 62.9 % of these patients showed positive skin tests and 22.2% showed positive challenge tests, whereas in the other 3 groups, about 30% of patients had positive skin tests and a variable percentage (from 0% to 4.1% depending on the group) had positive challenge tests. Quinolone challenge tests were performed in 10 patients with positive skin tests (5 of them with positive results) and in 34 patients with negative skin tests (2 of them with positive results).A highly suggestive history of quinolone allergy is more frequently associated with positive skin tests and positive challenge tests. Therefore, skin tests help to predict the result of the challenge test.

Intermolecular copigmentation is one of the mechanisms of stabilization of anthocyanins in nature and is also responsible for the characteristic color and stability of aged red wines. In the present study, the effect of polyphenol oxidase (PPO) activity on phytochemical stability of an ascorbic acid-fortified muscadine grape juice following high hydrostatic pressure (HHP) processing (400 and 550 MPa for 15 min) and after 21 d of storage at 25 degrees C was investigated. Addition of rosemary and thyme polyphenolic extracts (copigmentation) was evaluated as a means to stabilize anthocyanins and ascorbic acid during pressurization and subsequent storage. Polyphenolic extracts were partially purified in order to reduce their content of PPO substrates, and improve their stabilization properties within juice matrix. Overall PPO activity increased (3- and 2.5-fold) following HHP at 400 and 550 MPa, respectively, although it was significantly lower in copigmented treatments. Higher anthocyanin losses occurred at 400 (approximately 70%) than at 550 MPa (approximately 46%), which were correlated to antioxidant losses (r = 0.89). Similarly, greater ascorbic acid losses were observed at 400 (84%) than at 550 MPa (18%). Copigmentation increased anthocyanin retention in reference to pressurized controls (3- and 3.2-fold for rosemary and thyme treatments, respectively) and decreased ascorbic degradation (20 to 32%). In stored samples, higher anthocyanin content (>2-fold) and antioxidant capacity (>1.5-fold) was observed for copigmented treatments when compared to control juices. Addition of partially purified copigments increased muscadine grape juice color, antioxidant activity and also reduced phytochemical losses during HHP processing and storage.

In comparison with the extremely frequent use of corticosteroids in different diseases, immediate allergic reactions remain uncommon. In addition to the steroid molecule, the causative agent of these reactions can be an excipient.We report seven cases of immediate reactions induced by different preparations of corticosteroids. Skin tests with the suspected steroid and excipients were carried out. In patients with negative skin tests, oral or parenteral challenges were performed with the drug and the excipients involved. Challenge tests with at least two other corticosteroids belonging to another or even the same group of the Coopman classification were carried out.Of the 7 patients, six had positive skin tests with the suspected preparation of corticoid: three cases with methylprednisolone acetate, two cases with carboxymethylcellulose and one case with the complete triamcinolone preparation. Only in one case did we have to challenge with the suspected steroid preparation to confirm the diagnosis. All challenge tests with other corticosteroids belonging to another or to the same group of the Coopman classification were negative.The reactions were caused by the steroid molecule (Triamcinolone or methylprednisolone succinate) in four patients, by an excipient (carboxymethylcellulose) in another two patients and we could not identify the sensitized molecule in one patient. We did not demonstrate cross-reactivity between different corticosteroids.

The commercial growing of white mushroom (Agaricus bisporus) is a frequent activity in certain Spain regions as La Rioja. We report two cases of white mushroom workers suffering from asthma caused by hypersensitivity to basidiocarp and spores of white mushroom.

Immediate hypersensitivity reactions to quinolones are rare. Moxifloxacin is an quinolone chemically different from other fluoroquinolones. We report 6 patients diagnosed with hypersensitivity to different fluoroquinolones in whom the response to moxifloxacin and cross-reactivity with other quinolones was studied.An allergenic study was made by prick and intradermal test with different fluoroquinolones, in all the patients. Single blind oral challenge tests were performed with moxifloxacin in all the patients, with ciprofloxacin in five patients, with levofloxacin in three patients and with ofloxacin in one patient.The skin test performed with moxifloxacin was positive in five patients, and the oral challenge test was positive in all six patients. All the patients had at least one positive skin test with some of the other fluoroquinolones.The skin test with different quinolones seems to be sensitive at showing group hypersensitivity, but not at predicting specific tolerance of each drug. We found a high degree of cross-reactivity among fluoroquinolones, so we currently recommend to avoid the group. We did not find that moxifloxacin differed from other fluoroquinolones so we cannot recommend it as a valid therapeutic alternative in patients sensitized to other quinolones.

We are discussing two patients, with clinically compatible reactions, who display an immediate hypersensitive mechanism following the administration of oxaliplatin, confirmed by the performance of cutaneous tests.

I. BACKGROUND The consumption of raw or undercooked fish may lead to infection with any of several helminths, the most important being species of the cestode genus Diphyllobothrium, the digenean families Heterophyidae (Heterophyes spp. and Metagonimus yokogawai) and Opisthorchiidae (Clonorchis sinensis and Opisthorchis spp.), and the nematode genera Anisakis and Pseudoterranova of the family Anisakidae (1). As will be reviewed in Sec IV, the anisakid species most commonly involved in human infections are Anisakis simplex and less frequently Pseudoterranova decipiens. Infection with A. physeteris and Contracaecum spp. has only been reported in a very few cases (2-5). At one time, the anisakid species Hysterothylacium aduncum was considered a possible human parasite (6,7), but this hypothesis was later discarded in view of experimental evidence indicating that it is unable to penetrate the gastric mucosa of laboratory animals and it cannot survive at temperatures close to 37°C (8,9). However, it has recently been demonstrated that larvae of some species of this genus are capable of invading the gastrointestinal tract of primates (10), and therefore the possibility of human infection should not be ruled out completely.

We present the case of a 44-year-old woman who was referred to us for jaundice, choluria and acholia. Review of the patient's clinical history revealed that tests for hepatitis A virus (HAV) IgM antibody had been positive 4 and 2 years previously and continued to be so. The patient showed a score of 16 in the International Autoimmune Hepatitis Group's system when the HAV marker was not taken into account and a score of 13 when this marker was taken into account. The persistence of this viral marker for so many years in such patients is probably associated with polyclonal hypergammaglobulinemia. Consequently, we believe that the inclusion of this antibody as a negative datum in the diagnosis of autoimmune virus should be viewed with caution.

Collagenous colitis is a disorder which has been diagnosed with increasing frequency in the last few years, probably due to the routine obtention of colon biopsy specimens in the study of patients with chronic diarrhoea. Good responses have been reported with a number of therapies, although only a scarce number of clinical trials have been performed, partly because of the small number of patients studied. Two cases of collagenous colitis with different therapeutic approaches are here reported. All medical therapy options for this interesting disorder are reviewed.

Rendu-Osler-Weber syndrome, or hereditary hemorrhagic telangiectasia, is characterized by vascular alterations that tend to hemorrhage. We present a 56-year-old woman, with a diagnosis of chronic liver disease of unknown origin 15 years earlier, who came to our hospital as a liver transplantation candidate following hemorrhage due to esophageal varices. Rendu-Osler-Weber syndrome can affect the liver in several ways although vascular alterations can be distinguished from those produced in the liver parenchyma. The different types of vascular alterations in the liver may manifest as as telangiectasias, angiomas, aneurysms of the hepatic artery and fistulae between different vessels. This syndrome may also produce alterations in the liver parenchyma although the exact pathogenic mechanisms are unknown. There are three main forms of treatment: embolization of the branches of the hepatic artery, ligature of the hepatic artery and liver transplantation.