Soft tissue infections with S. Lugdunensis. Presentation of 2 cases and general review]

When perfusion pressure to the kidney falls, e.g., as a result of dehydration or mechanical hindrance to the renal arterial blood flow, the release of renin, hence angiotensin (Ang), surges. This feedback regulation is geared to preservation of renal hemodynamic environment by raising systemic blood pressure. We are aware that a surge of renin-angiotensin release also occurs when there is a mechanical hindrance to urine outflow. This phenomenon of ureteral pressure-sensitive activation of renin-angiotensin has been heretofore viewed as an error of nature. We have obtained evidence which challenges this traditional view when we examined strains of mutant mice which are completely devoid of either angiotensin type 1 (AT1) receptor gene (Agtr1-) or angiotensin type 2 (AT2) receptor gene (Agtr2-) as a result of genetic manipulation of these animals. These strains of mice display varying degrees of urinary tract obstruction. In Agtr2- mice obstructions develop during early kidney ontogenesis in ureto, and, in Agtr1- mice, during late ontogenesis ex utero. One may recall that, throughout its normal ontogenesis, the kidney is twice at risk for obstruction of urine outflow. Thus, in utero the ureter is transiently obliterated. This transient obliteration is believed to protect the kidney from the high pressure from the cloaca when urine is not yet formed. During this period, the ureter is surrounded by dense layers of undifferentiated mesenchymal cells. Subsequent expansive growth that the ureter must achieve, therefore, in concert with a timely disappearance of the surrounding mesenchymal cells. The study in Agtr2- embryos indicated that Ang, through the Agtr2 receptor, promotes disappearance of these mesenchymal cells, and that inactivation of this receptor results in congenital obstructive nephropathy. Our additional studies in human specimens indeed indicate that many infants with congenital anomalies of the kidney and urinary tract have a significant mutation within the AT2 gene. Once animals are born, the kidney comes to be of primary importance for preservation of body fluid homeostasis, and urinary output increases dramatically. The large volume of urine predisposes the kidney to obstructive nephropathy due to the high resistance offered to the urine by the downstream ureter. Normally, a special device develops within the urinary tract in a timely fashion, which enables the kidney to collect a bulk of urine, and then to expel it downward periodically without imposing positive pressure upon the renal parenchyma. This special device is the renal pelvis. In the studies on Agtr1 null mutant mice, we learned that Ang, through the AT1 receptor, promotes development of the pelvis shortly after birth, so that inactivation of this receptor in Agtr1- mice leads to absence of development of the pelvis, hence to obstructive nephropathy. Collectively, Agtr1 or Agtr2 null mutant mice suffer from urinary tract obstruction. Given that urinary tract obstruction per se is a potent stimulus for Ang generation, Ang is essential for the kidney to escape from obstructive injury.     

Rhabdomyosarcoma. Presentation of 67 cases

Two cases of herpes zoster ophthalmicus with dendritic keratitis are reported. Virological studies confirmed the double infection with herpes simplex type 1 virus in the corneal lesions and herpes zoster virus in the cutaneous lesions. We suggest the use of the immunoperoxidase test to identify the viral agent mainly because of its rapid and specific results. We are against the use of local steroids in dendritic keratitis unless the etiological agent is proved to be herpes zoster virus and not herpes simplex virus.     

Sneddon syndrome. Presentation of 2 cases

Sneddon syndrome is a systemic non inflammatory arteriopathy characterized by the association of livedo reticularis, thrombotic cerebrovascular disease, coronary artery disease and hypertension. Middle age females are usually affected. It should be considered in the differential diagnosis of acute ischemic attacks in younger patients. It has been related to the antiphospholipid antibody syndrome. Treatment is based on control of hypertension and cardiovascular risk factors along with antiplatelet agents. Two cases meeting the clinical criteria outlined above are reported.     

Presentation of intestinal malrotation syndromes in older children and adults: report of three cases

Malrotation syndromes are typically presented during the first few months of life but may sometimes appear later in life, causing difficulties and mistakes in diagnosis. We had 40 cases of malrotation, 3 of them with atypical and delayed presentation. Two of the three cases had a history of abdominal disorders that lasted for several years. Severe dehydration was a significant symptom in one of them. Diagnosis was delayed because respective symptoms were not adequately considered in older children and adults.     

Active transport mechanisms in the intestinal mucosa of the small intestine and their functional disorders

The efficacy of an anion-exchange gel, Secholex, as a hypocholesterolemic agent was assessed in 46 patients in 4 different studies and the effects were compared with those of cholestyramine. All patients had severe Type II-a or II-b hyperlipoproteinemia. In short-term metabolic studies Secholex (15 g/day) and cholestyramine (16 g/day) decreased serum cholesterol levels and increased total fecal sterol output and serum methyl sterol concentration to a similar extent, but cholestyramine was more effective than Secholex in increasing fecal bile acid excretion. In crossover studies, the two drugs appeared to be equally effective in lowing serum cholesterol levels but the patients mostly preferred Secholex. Twenty patients were treated with Secholex over a two-year period. The average decrease in serum cholesterol levels from the mean pretreatment value of 406 mg/100 ml was 15% during the first year, and 13% during the second year. In 5 patients the serum cholesterol was permanently lowered by more than 20% (good responders), while in 7 patients the average reduction of serum cholesterol level during Secholex administration was less than 10% (non-responders). The serum triglyceride level was slightly decreased by Secholex in Type II-b patients but was unaltered in Type II-a patients. At the end of the treatment period, serum iron and vitamin B12 levels were normal but the serum folic acid concentration was reduced in eight of 20 patients. A dose--response study indicated that a similar cholesterol-lowering effect was obtained with daily doses of 9 and 15 g of Secholex. It is concluded that Secholex is a relatively safe drug which effectively reduces serum cholesterol levels in two-thirds of patients with severe hypercholesterolemia.     

Recurrent parotitis in children and HIV infection. Apropos of 4 cases]

Over a 2-year period at our institution, 6 patients underwent metallic stent treatment, 5 for malignant conditions and 1 for a benign condition of the esophagus. The use of expandable metallic stents for benign strictures has paralleled malignant indications but is limited and less understood from a clinical standpoint. A review of current literature in the treatment of benign strictures is presented. Treatment of benign strictures is associated with high morbidity and mortality as demonstrated by the cumulative experience of 21 patients. Migration, hyperplastic tissue obstruction at the terminal ends, reflux, and complications of perforation occur at a prohibitive rate. We conclude that expandable metallic stents should be reserved for palliative treatment of esophageal malignant obstructions and tracheoesophageal fistulas. Pharmacological management, necessary dilatations and operative corrections (antireflux procedures, esophagectomy) are recommended treatments for benign strictures.     

Colonic metastasis from kidney cancer. Presentation of 2 cases

Preliminary results of an observational study are described in 50 unselected diabetic patients treated with insulin pens. The study was conducted to detect the presence of unexpected material in needles and cartridges after a single insulin injection. The injection was done by a trained nurse with the patient's usual pen and insulin cartridge. Cytopathological examination was performed on the material obtained from the needles and found in cartridges after centrifugation. Non-inert material was found in 28% of needles and 58% of cartridges, including squama (18 and 50% respectively) and epithelial cells (20 and 42% respectively). These data, which suggest a non-passive capture of biological material into the delivery system after injection, emphasise the rule of strictly individual use of insulin delivery systems, including cartridges. The precise impact of self-injection of this non-inert material on individuals during repeated pen injections remains uncertain.     

Diagnosis of 4 cases of intestinal microsporidiosis in AIDS patients

Because of its excellent soft tissue contrast and ability to demonstrate soft tissue structures, magnetic resonance imaging is ideally suited to the evaluation of the soft tissues surrounding the ankle, including the lateral collateral ligaments. This study was undertaken to compare the clinical evaluation of 15 patients who suffered inversion injuries of the ankle with the results found on magnetic resonance imaging within 48 hours of the injury. Physical examination was found to be 100% accurate in the diagnosis of grade III ligament injuries but only 25% accurate in the diagnosis of grade II injuries. Clinicians most often underestimate the damage with a grade II ligament tear. Furthermore, other associated injuries, such as significant capsule ruptures and tendon damage, were often overlooked at physical examination.     

Sweet's syndrome. Presentation of six cases and review of the literature

The acute febrile neutrophilic dermatosis or Sweet syndrome, initially described in 1964 by Robert Sweet (1). It is characterized fever, neutrophilic leucocytosis, abrupt appearance of erythematous, painful, cutaneous plaquets and dense dermal infiltrate consisting of mature neutrophils without vasculitis sings. Malignancy has been described in the 10-15% of the reported cases. We report our series of 6 patients diagnosticated of this illness in our department. One of this patients has Sweet syndrome associated with a malignancy disorder. All of them had diagnostic criteria of the described disease and had good response to corticotherapy. We also report a bibliographic review of this infrequent syndrome.     

Fahr's disease and hypocalcemic syndromes. Presentation of a clinical case]

A clinical case of a man with calcification of basal ganglions (CBG) is presented. The first manifestations of this syndrome were loss of consciousness and convulsions. The potential causes of his hypocalcemia, Fahr's syndrome, myocardiopathy of hypoparathyroidism and hypocalcemia are reviewed and a study oriented to autoimmune polyendocrinopathy is performed.     

Mood disorders. Prevalence and course of unspecified functional disorders from the epidemiologic and psychosomatic viewpoint

Subjective complaints or somatoform symptoms beyond the case threshold (ICD-diagnoses) occur in 12% of the normal population. In recent studies prevalence is at least 17% in primary care. Somatoform complaints (e.g. headache with 38.7%) or non-specific common symptoms (e.g. feeling of inner restlessness with 41.3%) are much more widespread. Mostly, several symptoms together are forming a multiple somatoform syndrome. As well known from other psychogenic disorders, spontaneous long-term course of somatoform symptoms is variable due to the psychic co-morbidity (in particular anxiety and depression) and a strong tendency to symptomatic shift. The long-term course of total impairment by additional psychogenic symptoms is rather bad in somatoform disorders. Clinically significant personality traits and traumatic influences during early childhood development are correlated with somatoform disorders. Within the traditional role patterns of the relation between physician and patient, somatoform complaints often communicate or indicate a psychodynamic conflict. In this case, a psychosomatic/psychotherapeutic approach in primary care or a specialized psychotherapy is indicated.     

Acute intestinal obstruction and pregnancy. Apropos of 3 cases

The axillary artery has been successfully cannulated in critically ill adult and paediatric patients. There is little information about experience with this technique in neonates. We report the use of axillary cannulation in 62 mechanically ventilated neonates with birth weight from 750 to 3800 g (mean 1950 g). The axillary artery was catheterized with 24 or 22 gauge teflon catheters by means of the catheter-over-a-needle technique. Arterial access was used for blood pressure monitoring, blood sampling and in seven cases for blood removal during exchange transfusions. Cannulae were removed when the fraction of inspired oxygen (FIO2) was less than 0.3. During cannulation capillary refill, radial artery pulse and neurological status of the arm were checked daily. The mean period of cannulation was 4.1 days (1-10 days). During cannulation and after catheter removal there were no complications related to the chosen vessel e.g. no change in the skin colour, skin warmth, capillary refill and the quality of the radial pulse. No changes in the motor activity of the limb on the cannulated side were observed. CONCLUSION: Axillary artery cannulation is a useful alternative for establishing an arterial access in ventilated neonates. Further studies are needed to evaluate the long-term consequences of this technique.     

Histological and functional studies of small intestinal mucosa in intestinal tuberculosis

Twelve cases of peptic ulcer with diabetes mellitus were found in 165 hospitalized diabetics. All of them had gastric ulcer and no duodenal ulcers were found. The incidence of peptic ulcer in diabetics was comparatively higher than the previously reported series. But there was nosignificant correlation between the duration of diabetes and the onset of gastric ulcer. The gastric ulcer with poorly controlled diabetes showed more intractability than those without triopathy and well-controlled diabetes.     

Varicella pneumonia in adults infected by HIV-1. Presentation of 2 cases

BACKGROUND: Infection by the varicella-zoster virus (VZV) is frequent in patients infected by the HIV-1. Nonetheless, visceral involvement in addition to that of pneumonia is rare, despite the important immune dysfunction found among these patients. METHODS: Varicella pneumonia was diagnosed in 2 patients with HIV-1 infection who presented cough with high fever and a characteristic rash in addition to respiratory failure and a micronodular pattern on chest radiography. The medical literature is reviewed (MEDLINE). RESULTS: An excellent clinical response was achieved with endovenous acyclovir treatment. CONCLUSIONS: The authors underline how rare is varicella pneumonia in patients with HIV-1 infection. The appearance of a pustulous vesicular rash in the context of a febrile episode leads to suspicion of this diagnosis. The treatment of choice is endovenous acyclovir (5 mg/kg/8 h). Varicella pneumonia has also been described in children with HIV-1 infection. The possible increase in patients with varicella pneumonia with be assessed, due to the immunosuppressive state of these patients. Patients not having been in contact with the varicella-zoster virus are particularly susceptible to presenting primoinfection by this virus.     

Necrotizing fasciitis of the head and neck. Report of 4 cases of cervical necrotizing fasciitis]

Necrotizing fasciitis is a severe polybacteria infection characterised by necrosis of the fascial and adjacent soft tissues with rapid expansion of the infection along fascial planes. It may originate potentially fatal complications and often is accompanied by systemic toxicity. It is not a frequent entity in the head and neck, but early diagnosis is very important because early treatment based on intravenous antibiotherapy and aggressive surgical debridement can prevent complications that often cause the death of the patient. Pour reports of necrotizing fasciitis are presented, one of them with fatal outcome, which leads us to emphasize the importance of an early diagnosis.     

Hemostatic disorders in septicemia. Apropos of 65 cases

In the course of a restrospective study, some hemostatic parameters were studied in connection with 65 cases of septicaemia. From this study, it follows that coagulation troubles are more frequent in septicaemiae induced by negative Gram germs, but that this frequency is actually linked with circulatory troubles. Besides, as for the biological diagnosis of the disseminated intravascular coagulation syndrome in this instance, it is not possible to take strictly into account the fibrinogen values or the rate of thrombocytes.     

Black widow spider (Latrodectus tredecimguttatus) bite. Presentation of 12 cases

The most severe cases of arachnidism are those due to Latrodectus tredecimguttatus spider-bite. The Mediterranean area is the habitat of the L. tredecimguttatus species. In the last few years no series of patients with latrodectism has been reported in Spain. A retrospective study of the patients admitted for L. tredecimguttatus spider bite in the Torrecárdenas Hospital in Almeria, Spain from 1984 to 1994 was performed. Twelve patients were diagnosed with latrodectism. Eleven were bitten while carrying out agricultural tasks, 8 of which were performed in greenhouses. The mean time between the bite and the appearance of the general symptoms was 40 minutes (20-120 minutes), with the most common signs and symptoms being: pain and abdominal stiffness (10 cases), erythema (10 cases) or pain (8 cases) at the site of the bite, thoracic pain, pain in extremities and contractures and psychomotor alterations (6 cases). Laboratory findings were limited to leukocytosis (4 cases), increase in creatinphosphokinase count (4 cases) and proteinuria (3 cases). All the patients received analgesics, 6 were administered myorelaxants and calcium gluconate was given in 6 cases. The evolution was good without complications in all of the patients. Latrodectism is a rare phenomenon Spain. The diagnosis is difficult when there is absence of a clear history of spider bite and due to the lack of knowledge as to its semiology. Antivenom serum is not usually required.     

Perceptual style and behavioral pattern of individuals with functional gastrointestinal disorders.

The present research examined the perceptual style and coping pattern characterizing individuals with functional gastrointestinal disorders. A matched case–control design was adopted to compare differences among the target group of individuals with functional gastrointestinal disorders (n?=?40), a pain control group of individuals with rheumatism (n?=?40), and the community control group of healthy individuals (n?=?40). Perceptual style was measured by both monitoring and blunting responses to hypothetical stressful situations, and coping pattern was measured by the use of coping strategies in real-life stressful events. Results revealed that participants with functional gastrointestinal disorders differed from their healthy and rheumatic counterparts in having higher monitoring and lower blunting scores and using action-oriented coping strategies regardless of the controllability of stressful situations. (PsycINFO Database Record (c) 2010 APA, all rights reserved)