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Biocatalysis for industrial application is based on the use of enzymes to perform complex transformations. However, these systems have some disadvantage related to the costs of the biocatalyst. In this work, an alternative strategy for producing green immobilized biocatalysts based on biofilm was developed.A study of the rheological behavior of the biofilm from Bacillus sp. Mcn4, as well as the determination of its composition, was carried out. The dynamic rheological measurements, viscosity (G") and elasticity (G') module, showed that the biofilm presents appreciable elastic components, which is a recognized property for enzymes immobilization. After the partial purification, the exopolysaccharidewas identified as a levan with a non-Newtonian behavior. Extracellular DNA with fragments between 10,000 and 1000bp was detected also in the biofilm, and amyloid protein in the extracellular matrix using a fluorescence technique was identified. Bacillus sp. Mcn4 biofilms were developed on different surfaces, being the most stable those developed on hydrophilic supports. The biofilm showed lipase activity suggesting the presence of constitutive lipases entrapped into the biofilm. Indeed, two enzymes with lipase activity were identified in native PAGE. These were used as biocatalysts, whose reuse showed a residual lipase activity after more than one cycle of catalysis. The components identified in the biofilm could be the main contributors of the rheological characteristic of this material, giving an exceptional environment to the lipase enzyme. Based on these findings, the current study proposes green and natural biopolymers matrix as support for the enzyme immobilization for industrial applications.

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Quorum sensing (QS) is a cell-to-cell signaling communication system that controls the virulence behavior of a broad spectrum of bacterial pathogens, participating also in the development of biofilms, responsible of the antibiotic ineffectiveness in many infections. Therefore, QS system is an attractive target for antimicrobial therapy. In this study, we compare the effect of seven structurally related coumarins against bacterial growth, biofilm formation and elastase activity of Pseudomonas aeruginosa. In addition, the anti-pathogenic capacity of the seven coumarins was evaluated on the wild type and the biosensor strain of Chromobacterium violaceum. The comparative study of coumarins showed that molecules with hydroxyl groups on the aromatic ring displayed higher activity on the inhibition of biofilm formation of P. aeruginosa over coumarins with substituents in positions 3 and 4 or without the double 3,4-bond. These 3 or 4-hydroxylated positions caused a decrease in the anti-biofilm activity obtained for coumarin. However, the hydroxyl group in position 3 of the pyrone ring was important for the inhibition of C. violaceum QS and elastolytic activity of P. aeruginosa. The effects observed were active independently of any effect on growth. According to our results, coumarin and its hydroxylated derivatives represent an interesting group of compounds to use as anti-virulence agents against the human pathogen P. aeruginosa.

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Presentamos un caso de una mujer de 70 años con una masa mediastínica gigante. Se le practica toracotomía para resección quirúrgica con resultado anatomopatológico final de una masa tumoral de 23 x 19 x 18 cm, que pesa 2.495 g, con diagnósticos de liposarcoma de tipo mixto que respeta los bordes quirúrgicos. A los 6 meses aparece recidiva tumoral a distancia y la paciente fallece a los 11 meses de la cirugía (AU)

We present a case of a 70-year-old woman with a giant mass of mediastinum. A complete resection of the tumor from the left pleural cavity and posterior mediastinum was made through a posterior–anterior left thoracotomy. The mass weighted 2,495 g and its dimensions were 23 x 19 x 18 cm. The final diagnosis was consistent with a myxoid liposarcoma (MLS), and negative microscopic margins. 6 months after the surgical excision, the patient presented with a distal recurrence and she died after 11 months (AU)

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Different attempts have been made to improve the health status of humans and animals by increasing the intestinal production of short-chain fatty acids (SCFA) derived from non-digestible carbohydrates fermentation. In this paper we investigate the in vitro production of short-chain fatty acids (SCFA) after addition of inulin, propionibacteria or a combination of both in an experimental model of mice cecal slurries. The development of bacterial genera which are usually stimulated by inulin addition was also investigated. According to our experimental data, acetic acid and butyric acids concentrations increased after incubation in slurries that had no supplements. By contrast, butyric acid concentrations remained in the basal value when supplements were used. Fermentation of only inulin did not increase the concentration of total SCFA. Propionibacterium acidipropionici CRL1198 improved the production of propionic acid in cecal slurries when it was added alone, but the effect was more noticeable in the combination with inulin. A modulation of the global fermentative activity of the cecal microbiota was evidenced by the increase on the ratio propionic acid/SCFA in supplementations with propionibacteria. Statistical analysis of data demonstrated that samples from homogenates with propionibacteria alone or combined with inulin belong to the same cluster. The presence of propionibacteria limited the growth of Bacteroides fragilis and Clostridium hystoliticum groups in slurries with and without inulin. The growth of Bifidobacterium was not modified and the stimulating effect of inulin on lactobacilli disappeared in the presence of propionibacteria. In conclusion, dairy propionibacteria are potential candidates to develop new functional foods helpful to ensure the intestinal production of SCFA during inulin supplementation and to control the overgrowth of bacteria belonging to Bacteroides and Clostridium genera.

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OBJECTIVE: Evaluate the etiology and the most frequent funduscopic alterations of the neuroretinitis. METHODS: We present the case of a woman 24 years old with a bilateral decrease of visual sharpness (AV), painless and progressive, the funduscopic examination of which reveals a bilateral optical disc edema, with no hemorrhages or exudates, retina edema of the posterior pole and phlebitic areas. The systematic study was normal except for the hemogram (18,000/mm(3) leucocytes with 79% neutrophils) and the positive serology next to a Chlamydia. We also present the case of a 64 years old woman with a decrease of AV at the right eye of one week duration. At the back of the eye a macular star can be seen, and papilla edema. A systematic study gave normal results and positive serology at Bartonella henselae. RESULTS: The illness produced by a cat scratch is the most common cause of neuroretinitis. The customary findings are a loss of AV, discromatopsia, afferent papillary defects and abnormality on the visual field. Other frequent findings at the back of the eye are hemorrhagic nerve fibers, cotton-like exudates, papilla edema, macular star and glassy inflammation. The roll of antibiotic therapy is questionable. Oral ciprofloxacine seems to give good results.

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Objetivo: Describir la etiología y las alteraciones funduscópicas más frecuentes de las neurorretinitis.Métodos: Presentamos el caso de una mujer de 24años con disminución de la agudeza visual (AV)bilateral, indolora y progresiva cuyo examen funduscópicomostraba un edema de disco óptico bilateralsin hemorragias ni exudados, edema retinianoen polo posterior y zonas de flebitis. El estudio sistémicofue normal excepto el hemograma(18.000/mm3 leucocitos con 79% de neutrófilos) yla serología positiva frente a Chlamydia. Presentamostambién el caso de una mujer de 64 años deedad con disminución de la AV en el ojo derecho de1 semana evolución. En el fondo de ojo (FO) seaprecia una estrella macular y edema de papila.Resultó estudio sistémico normal y serología positivaa Bartonella henselae.Resultados: La enfermedad por arañazo de gato esla causa más común de neurorretinitis. Los hallazgoshabituales consisten en una pérdida de AV, discromatopsia,defecto pupilar aferente y anormalidadesen el campo visual. Otros hallazgos frecuentesen el FO son hemorragias en la capa de fibras nerviosas,exudados algodonosos, edema de papila,estrella macular e inflamación vítrea. El papel de laterapia antibiótica es cuestionable. Parece que elciprofloxacino oral tiene buenos resultados(AU)

Objective: Evaluate the etiology and the most frequentfunduscopic alterations of the neuroretinitis.Methods:We present the case of a woman 24 yearsold with a bilateral decrease of visual sharpness(AV), painless and progressive, the funduscopicexamination of which reveals a bilateral optical discedema, with no hemorrhages or exudates, retinaedema of the posterior pole and phlebitic areas. Thesystematic study was normal except for the hemogram(18,000/mm3 leucocytes with 79% neutrophils)and the positive serology next to a Chlamydia.We also present the case of a 64 years oldwoman with a decrease of AV at the right eye of oneweek duration. At the back of the eye a macular starcan be seen, and papilla edema. A systematic studygave normal results and positive serology at Bartonellahenselae.Results: The illness produced by a cat scratch is themost common cause of neuroretinitis. The customaryfindings are a loss of AV, discromatopsia,afferent papillary defects and abnormality on thevisual field. Other frequent findings at the back ofthe eye are hemorrhagic nerve fibers, cotton-likeexudates, papilla edema, macular star and glassyinflammation. The roll of antibiotic therapy is questionable.Oral ciprofloxacine seems to give goodresults(AU)

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OBJECTIVES: The overall objective of this study was to carry out a prospective investigation of the usefulness of the IMMUNOCYT commercial kit in the follow-up of patients treated for bladder cancer and to evaluate its utility as a complement to urinary cytology and a possible tool for reducing the number of follow-up cystoscopies required. SUBJECTS AND METHODS: From September 2001 to December 2002, the ImmunoCyt test and urinary cytology were performed in urine simples from a total of 136 patients (115 with a history or suspicion of bladder cancer and 21 patients with other urological pathologies). Urine simples were fixed with an equal volume of 50% alcohol. Urinary cytology and the ImmunoCyt test were interpreted by a cytopathologist unacquainted with the result of the corresponding cytology and bladder biopsy report. Samples were staged and graded using the 1997 TNM classification of the UICC and the 1998 WHO/ISUP classification. Histopathological confirmation of lesions was available for 111 patients (81.6%). RESULTS: The gender distribution was 89% men and 11% women. Mean age was 71.68 years (range 27 to 98 years). Overall sensitivity and specificity were 77.9% and 92.3% for the ImmunoCyt test and 47.9% and 100% for urinary cytology, respectively. The positive (PPV) and negative predictive values (NPV) were 96.4% and 61.7%, respectively, for the ImmunoCyt test and 100% and 36.7% for cytology. In Ta and low-grade carcinomas, the sensitivity of the ImmunoCyt test was 70% (n=20) and 76.4% (n=34) respectively, whereas it was 25% (n=28) and 29.7% (n=37), respectively, for urinary cytology. The differences observed between the sensitivities of the ImmunoCyt test and cytology were statistically significant (X2 p<0.05) overall and for Ta and low-grade carcinomas. The sensitivity and specificity of the combination of both tests were 86.8% and 96.2%, respectively. The sensitivity of the combination of both tests for Ta and low-grade carcinomas was 80% (n=20) and 82.3% (n=34), respectively. The ImmunoCyt test was diagnostic in 36.2% of tumors overall. CONCLUSIONS: In view of the results obtained, we decided to change our follow-up protocol to reduce the number of follow-up cystoscopies by 32.2% in the first 5 years of postoperative follow-up (in a cohort of 140 patients who undergo surgery annually). This benefits patients by reducing the number of urinary infections and iatrogenesis originated by follow-up cystoscopy. In addition, this 32.2% reduction in the number of cystoscopies in 5 years will yield a savings of approximately 35,560 EUR to the health care system in 5 years.

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Objectivos: El objetivo global de este trabajo es el de determinar en un estudio prospectivo la utilidad del kit comercial InmunoCyt® para el seguimiento de pacientes tratados de cáncer de vejiga y la evaluación de su utilidad como complemento de la citología urinaria y posible herramienta en la reducción del número de cistoscopias de revisión. Material y Métodos: Entre Septiembre/01 a Diciembre/02 se recogió la orina de un total de 136 pacientes (115 con antecedentes deneoplasia vesical o sospecha de la misma y 21 pacientes con otras patologías urológicas) para realizarles el test del InmunoCyt® (uCyt+) y la citología urinaria. La orina recogida era fijada con alcohol al 50% en un volumen igual. La citología urinaria y el InmunoCyt® fueron informados por un citopatólogo que desconocía tanto el resultado de su correspondiente citología como el informe de la biopsia vesical. Para el estadiaje y grado de las muestras se utilizaron la clasificación TNM de la UICC de 1997 y la de la WHO/ISUP de 1998. Se dispuso de confirmación histopatológica de las lesiones en 111 pacientes (81,6% de los pacientes). Resultados: La distribución por sexos fue del 89% para varones y del 11% mujeres. La edad media fue de 71,68 años [27-98]. La sensibilidad y especificidad globales fueron del 77,9% y 92,3% para el InmunoCyt® y del 47,9% y 100% para la citología urinaria respectivamente. Los valores predictivos positivos (VPP) y negativos (VPN) fueron del 96,4% y 61,7% respectivamente para el InmunoCyt® y del 100%y 36,7% para la citología. En los Ta y carcinomas de bajo grado la sensibilidad del InmunoCyt® fue del 70% (n=20) y 76,4% (n=34) respectivamente, mientras que para la citología urinaria fue del 25% (n=28) y 29,7% (n=37) respectivamente. Las diferencias observadas entre las sensibilidades del InmunoCyt® y de su citología fueron estadísticamente significativas (X2 p<0,05) tanto de forma global como en los Ta y en los ca. de bajo grado. La sensibilidad y especificidad conjunta de los dos test (ambos test combinados) fue del 86,8% y 96,2% respectivamente. La sensibilidad conjunta de los dos test para los Ta y bajo grado fue del 80% (n=20) y del 82,3% (n=34) respectivamente. Con el InmunoCyt® se diagnosticó de forma global un 36,2% de tumores. Conclusiones: A la vista de los resultados obtenidos decidimos cambiar nuestro protocolo de seguimiento reduciendo el número decistoscopias en las revisiones al 32,2% durante los 5 primeros años de seguimiento tras la cirugía (sobre una cohorte de 140 pacientes intervenidos anualmente). Esto supondrá un beneficio para el paciente ya que disminuirán el número de infecciones urinarias y la iatrogenia ocasionadas por la realización de las cistoscopias de seguimiento. Además, esta reducción del 32,2% del número de cistoscopias en 5 años reportará un ahorro sanitario aproximado de 35.560 € en 5 años (AU)

Objectives: The overall objective of this study was to carry out a prospective investigation of the usefulness of the IMMUNOCYT™ commercial kit in the follow-up of patients treated for bladder cancer and to evaluate its utility as a complement to urinary cytology and a possible tool for reducing the number of follow-up cystoscopies required. Subjects and methods: From September 2001 to December 2002, the ImmunoCyt™ test and urinary cytology were performed in urine simples from a total of 136 patients (115 with a history or suspicion of bladder cancer and 21 patients with other urological pathologies). Urine simples were fixed with an equal volume of 50% alcohol. Urinary cytology and the ImmunoCyt™ test were interpreted by a cytopathologist unacquainted with the result of the corresponding cytology and bladder biopsy report. Samples were staged and graded using the 1997 TNM classification of the UICC and the 1998 WHO/ISUP classification. Histopathological confirmation of lesions was available for 111 patients (81.6%). Results: The gender distribution was 89% men and 11% women. Mean age was 71.68 years (range 27 to 98 years). Overall sensitivity and specificity were 77.9% and 92.3% for the ImmunoCyt™ test and 47.9% and 100% for urinary cytology, respectively. The positive (PPV) and negative predictive values (NPV) were 96.4% and 61.7%, respectively, for the ImmunoCyt™ test and 100% and 36.7% for cytology. In Ta and low-grade carcinomas, the sensitivity of the ImmunoCyt™ test was 70% (n=20) and 76.4% (n=34) respectively, whereas it was 25% (n=28) and 29.7% (n=37), respectively, for urinary cytology. The differences observed between the sensitivities of the ImmunoCyt™ test and cytology were statistically significant (X2 p<0.05) overall and for Ta and low-grade carcinomas. The sensitivity and specificity of the combination of both tests were 86.8% and 96.2%, respectively. The sensitivity of the combination of both tests for Ta and low-grade carcinomas was 80% (n=20) and 82.3% (n=34), respectively. The ImmunoCyt™ test was diagnostic in 36.2% of tumors overall. Conclusions: In view of the results obtained, we decided to change our follow-up protocol to reduce the number of follow-up cystoscopies by 32.2% in the first 5 years of postoperative follow-up (in a cohort of 140 patients who undergo surgery annually). This benefits patients by reducing the number of urinary infections and iatrogenesis originated by follow-up cystoscopy. In addition, this 32.2% reduction in the number of cystoscopies in 5 years will yield a savings of approximately 35,560 EUR to the health care system in 5 years (AU)

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BACKGROUND: Extramammary Paget's disease of the glans penis secondary to transitional cell carcinoma (TCC) of the bladder is rare, with only a few cases reported in the literature. We report two new cases, one detected before diagnosing bladder TCC. METHODS: We describe the clinicopathologic features of two patients with intraepithelial spread of glans TCC and the histochemical and immunohistochemical features of the neoplasm. RESULTS: Light microscopy detected intraepithelial proliferation of neoplastic, large, pale cells located predominantly in the basal and parabasal layers of the epithelium. The pagetoid cells showed positive cytoplasmic staining for mucosubstances and immunoreactivity for CK20. The previously reported cases are reviewed and the differential diagnosis is discussed. CONCLUSIONS: As many benign and malignant glans lesions may be clinically similar, histologic study is necessary to correctly diagnose primary lesions and promptly detect underlying asymptomatic visceral malignancies initially presenting as Paget's disease.

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La nefroblastomatosis representa un complejo de entidades patológicas definidas por la persistencia de elementos nefrogénicos tras la nefrogénesis (más allá de la 36 semana de gestación), los cuales conservan la capacidad de evolución hacia nefroblastoma. Afortunadamente, esta transformación maligna ocurre excepcionalmete (<1 por ciento1), por lo que es considerada como una enfermedad de buen pronóstico. Los restos nefrogénicos se asocian con frecuencia al Sd. de BeckwithWiedemann, a la hemihipertrofia y la aniridia, teniendo en tales casos un riesgo mayor de desarrollar un tumor de Wilms, por lo que estos niños deben ser seguidos muy de cerca. El problema se nos plantea a la hora de decidir cuándo actuar, a qué niños tratar y qué tipo de tratamiento utilizar, pues lo poco publicado en la literatura se presta a discusión. Presentamos a continuación 2 casos de nefroblastomatosis, uno unilateral y otro bilateral que precisó de tratamiento quirúrgico al no responder a la quimioterapia (AU)

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Nephroblastomatosis is a complex of pathological conditions defined by the persistence of nephrogenic elements after the conclusion of nephrogenesis (beyond week 36 of gestation) that conserve the capacity to evolve into nephroblastoma. Luckily, this malignant transformation is exceptional (< 1%(1)), which is why the disease is considered to have a good prognosis. The nephrogenic remains are frequently associated with beckwith-Wiedemann syndrome, hemihypertrophy and aniridia, in which case there is a greater risk of the development of Wilms tumor. Consequently, these children must be followed-up closely. The difficulty lay in knowing when to act, which children should be treated, and what treatment is appropriate because what little has been published in the literature is debatable. We report the cases of two patients, one with unilateral nephroblastomatosis and the other bilateral, who required surgical treatment after not responding to chemotherapy; and we expose our therapeutic algorithm and follow-up strategy.

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The spontaneous extraperitoneal bladder rupture is an uncommon event and the diagnosis is very difficult. It is defined like the rupture of bladder wall in absence of traumatism or iatrogenic techniques. The extravasation usually is produced into the peritoneal cavity, because of the greater weakness of the vesical dome. The diagnosis is based on the retrograde cystography, being necessary the surgical treatment in the intraperitoneal rupture, while the extraperitoneal one, could be treated in a conservative way with a vesical catheter. Here we present a case of spontaneous extraperitoneal bladder rupture, with oliguria, abdominal pain and a right hypochondrius mass as clinic presentation. Due to this, the diagnosis was made by the TAC, in which it was appreciated a continuity solution in the anterior bladder wall, with a contrast extravasation through the anterior abdominal wall. The retrograde cystography confirmed the definitive diagnosis. The treatment followed was based on the keeping of the vesical catheter and antibiotherapy.

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La rotura vesical espontánea es una entidad muy poco común y de difícil sospecha diagnóstica. Se define como la rotura de la pared vesical en ausencia de traumatismos o maniobras iatrógenas. La extravasación suele producirse en la cavidad peritoneal, por la mayor debilidad de la cúpula vesical. El diagnóstico se basa en la cistografía retrógrada, siendo necesario el tratamiento quirúrgico en la rotura intraperitoneal, mientras que la extraperitoneal puede ser manejada de forma conservadora, con sondaje vesical. Presentamos un caso de rotura vesical espontánea extraperitoneal, con oliguria, dolor abdominal y masa en hipocondrio derecho como presentación clínica. Debido a ello el diagnóstico fue realizado mediante la realización de una TAC, donde se apreciaba una solución de continuidad en vertiente anterior de vejiga, distribuyéndose el extravasado por la pared abdominal anterior. La cistografía retrógrada confirmó el diagnóstico definitivo. El tratamiento aplicado se basó en el mantenimiento del sondaje vesical y antibioterapia (AU)

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The increased use of laparoscopy for treatment of reflux esophagitis has been associated with a 1-8% complication rate. Perforation of the esophagus from bougie placement, wrap breakdown or too tight a wrap are some of the complications seen from this surgery. An esophageal dilator system was developed to overcome these problems. Thirty patients had an esophageal dilator system used whereby a 48 F or 58 F dilator was placed over a 18 F orogastric tube. Intraoperative gastroscopy documented a properly created wrap. There were no esophageal perforations or morbidity associated with the dilator.

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OBJECTIVE: To establish the prevalence of psychic malaise within the population that consults the general medical clinic of our health center and the relationship between that prevalence and the frequency of consultation. DESIGN: Transversal descriptive study applying the GHQ test (28 items) to a sample obtained by mathematical sampling, using a questionnaire to collect sociodemographic data. SITE. The Health Center Segovia II (La Albuera) during November and December 1991. PATIENTS OR OTHER PARTICIPANTS: 360 patients over the age of fifteen were selected; 252 answered the test. MAIN MEASUREMENTS AND RESULTS: Considering the GHQ test as positive when score seven or more, a prevalence of psychic malaise of 33% was obtained. We found a statistically significant relationship between positive GHQ test and the frequency of consultation (p < 0.001) and female gender (p < 0.01). No statistically significant relationship was found between psychic malaise and the following variables: age, marital status, educational level and occupation. CONCLUSIONS: There is a high prevalence of psychic malaise within the population attending our general practice which can produce an increase in the demand. A biopsychosocial approach to all patients, with the aim of identifying that kind of problem and approaching it adequately, could reduce the use of health resources.

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