Entheseal morphologic abnormalities, PD signal, and bursitis were US abnormalities that were responsive to anti-TNF therapy in SpA. PDUS can be a reproducible method for multicenter monitoring of therapeutic response in enthesitis of SpA.

A prospective study of the clinical characteristics and evolutionary patterns of 59 cases of late prosthetic valve endocarditis (LPVE) that occurred between January 1975 and December 1994 was performed. Of these 59 cases of LPVE, 48 involved mechanical valves and 11 involved biological valves. Etiologies were as follows: streptococci, 41% of cases; staphylococci, 25%; enterococci, 13%; and miscellaneous, 21%. Echocardiography documented vegetations in 21 patients, paravalvular abscesses in 10, and prosthetic leaks in 34. Emboli occurred in 22 patients, and heart failure in 19 patients. Forty-two patients received medical treatment alone, and 17 received medical treatment and underwent valve replacement surgery. The in-hospital mortality rate was 25%; staphylococcal infection caused 67% of deaths, streptococcal infection caused 5%, and other etiologies caused 23% (P = .0004). After adjustment for age and type of prosthesis, multiple logistic regression revealed an odds ratio for death due to nonstreptococcal infections of 9.67. The overall survival rate was 59% at 5 years and 52% at 10 years. During follow-up, 17 patients needed new valves. At the end of follow-up, only 13 patients remained alive and had the same prosthesis that they had at the time of the diagnosis of LPVE.

♦ Background: We undertook a cost-effectiveness analysis of the Spanish Renal Replacement Therapy (RRT) program for end-stage renal disease patients from a societal perspective. The current Spanish situation was compared with several hypothetical scenarios. ♦ Methods: A Markov chain model was used as a foundation for simulations of the Spanish RRT program in three temporal horizons (5, 10, and 15 years). The current situation (scenario 1) was compared with three different scenarios: increased proportion of overall scheduled (planned) incident patients (scenario 2); constant proportion of overall scheduled incident patients, but increased proportion of scheduled incident patients on peritoneal dialysis (PD), resulting in a lower proportion of scheduled incident patients on hemodialysis (HD) (scenario 3); and increased overall proportion of scheduled incident patients together with increased scheduled incidence of patients on PD (scenario 4). ♦ Results: The incremental cost-effectiveness ratios (ICERs) of scenarios 2, 3, and 4, when compared with scenario 1, were estimated to be, respectively, -€83 150, -€354 977, and -€235 886 per incremental qualityadjusted life year (ΔQALY), evidencing both moderate cost savings and slight effectiveness gains. The net health benefits that would accrue to society were estimated to be, respectively, 0.0045, 0.0211, and 0.0219 ΔQALYs considering a willingness-to-pay threshold of €35 000/ΔQALY. ♦ Conclusions: Scenario 1, the current Spanish situation, was dominated by all the proposed scenarios. Interestingly, scenarios 3 and 4 showed the best results in terms of cost-effectiveness. From a cost-effectiveness perspective, an increase in the overall scheduled incidence of RRT, and particularly that of PD, should be promoted.

Aims To evaluate the burden of tricuspid regurgitation (TR) in a large cohort, determine the right ventricle involvement of patients with TR and determine the characteristics of isolated TR. Methods and results Prospective study where consecutive patients undergoing an echocardiographic study in 10 centres were included. All studies with significant TR (at least moderate) were selected. We considered that patients with one of pulmonary systolic hypertension >50 mmHg, left ventricular ejection fraction <35%, New York Heart Association III–IV, or older than 85 years, had a high surgical risk. A total of 35 088 echocardiograms were performed. Significant TR was detected in 6% of studies. Moderate TR was found in 69.6%, severe in 25.5%, massive in 3.9%, and torrential in 1.0% of patients. Right ventricle was dilated in 81.7% of patients with massive/torrential TR, in 55.9% with severe TR, and in 29.3% with moderate TR (P < 0.001). Primary TR was present in 7.4% of patients whereas secondary TR was present in 92.6%. Mitral or aortic valve disease was the most common aetiology (54.6%), following by isolated TR (16%). Up to 51.9% of patients with severe, massive, or torrential primary TR and 57% of patients with severe, massive, or torrential secondary TR had a high surgical risk. Conclusion Significant TR is a prevalent condition and a high proportion of these patients have an indication for valve intervention. More than a half of patients with severe, massive, or torrential TR had a high surgical risk. Massive/torrential TR may have implications regarding selection and monitoring patients for percutaneous treatment.

We present a case report of a 30-year-old female presenting a progressive painless swelling in the malar and zygomatic regions. CT scan demonstrated a right zygomatic lesion that extended into the orbital floor and lateral orbital wall, affecting also the zygomatic arch. The biopsy revealed an intraosseous hemangioma. Treatment was performed including an en bloc resection with healthy bony margins and primary reconstruction with calvarian bone graft in association with galea-pericranium flap.