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Síndromes Paraneoplásicos/diagnóstico , Pénfigo/diagnóstico , Anciano , Anciano de 80 o más Años , Humanos , Masculino , HermanosRESUMEN
PROBLEM: Syphilis is a sexually-transmitted disease caused by the spirochete Treponema pallidum, and is transmitted either through sexual contact or vertically across the placenta. Rates of infection were at a low point in the early 1990s. Since then, increasing numbers of new cases of infections have been observed in all Western countries. AIM: Presentation of three patients with syphilis who presented within a short period of time in an ENT outpatient clinic. CONCLUSIONS: One must be aware of the increasing incidence of syphilis, even in head and neck disciplines. Typical symptoms of an early infection are an ulcerous lesion in the mouth, with or without cervical lymphadenopathy. The main therapy is high doses of penicillin G administered intramuscularly. Other simultaneous sexually-transmitted diseases, especially HIV infection, must be excluded. Unnoticed and untreated patients may develop late and life-threatening complications.
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Infecciones por VIH/epidemiología , Homosexualidad Masculina , Sífilis/epidemiología , Adulto , Antibacterianos/administración & dosificación , Chancro/diagnóstico , Chancro/epidemiología , Doxiciclina/uso terapéutico , Humanos , Masculino , Penicilina G/administración & dosificación , Enfermedades del Pene/microbiología , Factores de Riesgo , Serodiagnóstico de la Sífilis , Enfermedades de la Lengua/microbiologíaAsunto(s)
Anemia Hemolítica Autoinmune/cirugía , Trasplante de Células Madre de Sangre del Cordón Umbilical/métodos , Angioedema Hereditario Tipos I y II/cirugía , Trombocitopenia/cirugía , Anemia Hemolítica Autoinmune/complicaciones , Niño , Angioedema Hereditario Tipos I y II/complicaciones , Humanos , Masculino , Trombocitopenia/complicaciones , Trasplante HomólogoRESUMEN
Early diagnosis and prompt initiation of adequate treatment are essential for clinical outcome in ISCA. We report a case in which DWI provided a more specific diagnosis than conventional MR imaging and allowed differentiation of a ring-enhancing lesion from intramedullary tumor. Diagnosis was proved by PCR from CSF (Streptococcus intermedius). Adequate antibiotic treatment was immediately initiated, and the patient recovered completely.
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Imagen de Difusión por Resonancia Magnética/métodos , Absceso Epidural/patología , Médula Espinal/patología , Anciano de 80 o más Años , Femenino , HumanosRESUMEN
PURPOSE: To determine whether CTCA supplemented with CT flow measurements can be used to demonstrate and semiquantitatively evaluate poststenotic coronary blood flow in a porcine model. MATERIALS AND METHODS: In 10 thoracotomized pigs, transit time flow meter probes were attached to the aorta and left anterior descending artery (LAD) for real-time blood flow volumetry. A vascular silicone occluder was deployed around the LAD proximal to the probe to create medium-grade (MGS) and high-grade stenoses (HGS). The blood flow was measured by CT without vessel occlusion and distal to the stenoses. Time-density curves were generated from CT data. The curves were evaluated by calculating and cross-plotting the variables "slope of the density increase", "peak density" and "slope of the post-peak density decrease" from the LAD and aortic CT data. RESULTS: The flow in the LAD dropped to 41 % +/- 9 % (mean +/- SD) for MGS and 12 % +/- 6 % for HGS of the baseline. Coronary time-density curves plateaued proportional to luminal narrowing. Unimpaired flow could be differentiated statistically significant from poststenotic flow adjacent to MGS and HGS (p < 0.000 and p < 0.002, respectively). Flow adjacent to MGS and HGS was successfully differentiated for "slope of the density increase" and "slope of the post-peak density decrease" (p < 0.003 and p < 0.030, respectively). CONCLUSION: CT measurements allow semiquantitative evaluation of poststenotic coronary blood flow.
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Angiografía Coronaria/métodos , Circulación Coronaria/fisiología , Procesamiento de Imagen Asistido por Computador/métodos , Modelos Cardiovasculares , Tomografía Computarizada Espiral/métodos , Animales , Velocidad del Flujo Sanguíneo/fisiología , Volumen Sanguíneo/fisiología , Medios de Contraste , Angiografía Coronaria/instrumentación , Estenosis Coronaria/diagnóstico por imagen , Estenosis Coronaria/fisiopatología , Diseño de Equipo , Flujómetros , Yopamidol/análogos & derivados , Sensibilidad y Especificidad , Porcinos , Tomografía Computarizada Espiral/instrumentaciónRESUMEN
BACKGROUND: Cross-reactivity is a widespread phenomenon in patients who develop cutaneous delayed-type hypersensitivity (DTH) reactions to low molecular weight heparins (LMWHs). As molecular weight is believed to be a key determinant of sensitization to heparins, the recently developed LMWH bemiparin, with the lowest molecular weight of all LMWHs, appeared to be a significant improvement. OBJECTIVES: To evaluate cross-reactivity between bemiparin and several other LMWHs and heparinoids by means of subcutaneous testing. Methods Test doses of bemiparin and several other LMWHs/heparinoids were given to eight patients with a history of local eczematous reactions after subcutaneous injection of enoxaparin. RESULTS: Seven of eight patients showed cross-reactivity following subcutaneous injection of bemiparin. In addition, nearly all tested substances caused local eczematous reactions in at least some patients, with the exception of fondaparinux, which was well tolerated by all patients. Of all substances tested, bemiparin had the highest cross-reactivity with enoxaparin. Substances with a lower molecular weight did not cross-react less frequently than the others. CONCLUSIONS: No significant correlation was found between the molecular weight of the tested substances and the frequency of DTH reactions. In patients with DTH to enoxaparin, the LMWH bemiparin is not a suitable alternative.
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Anticoagulantes/efectos adversos , Erupciones por Medicamentos/etiología , Heparina de Bajo-Peso-Molecular/efectos adversos , Heparinoides/efectos adversos , Hipersensibilidad Tardía/inducido químicamente , Anciano , Anticoagulantes/química , Anticoagulantes/inmunología , Reacciones Cruzadas/inmunología , Erupciones por Medicamentos/inmunología , Femenino , Heparina de Bajo-Peso-Molecular/administración & dosificación , Heparina de Bajo-Peso-Molecular/inmunología , Heparinoides/química , Heparinoides/inmunología , Humanos , Hipersensibilidad Tardía/inmunología , Masculino , Persona de Mediana Edad , Peso Molecular , Pruebas CutáneasRESUMEN
Because of increasing waiting times for adjuvant radiation in the province of Ontario, patients from one Canadian centre were referred to two centres in the United States. This situation provided an opportunity to compare radiation practices.We performed a retrospective review of radiation prescribed to patients following breast-conserving surgery for invasive breast cancer. Patients with positive margins, 4 or more positive lymph nodes, recurrent disease, or large tumours (>5 cm) were excluded. For comparison, we reviewed a random sample of similar patients treated at the Canadian centre during the same period. A total of 120 referred and 217 non-referred patients were eligible for comparison. The analysis included 98 pairs of patients (N = 196), fully matched on age, nodal status, T stage, grade, and estrogen receptor (er) status.Mean patient age was 60.7 years. The median total dose and number of fractions differed between centres [6040 cGy in 32 fractions (United States) vs. 4250 cGy in 16 fractions (Canadian), both p < 0.001). Boost was used more often in the United States (97% vs. 9%, p < 0.001). Variation in prescribing patterns was seen. In the United States, seven different schedules for whole-breast irradiation were used; at the Canadian centre, two schedules were prescribed. Predicted radiobiologic effects of these schedules were calculated to be similar.Differences in fractionation patterns were observed between and within U.S. and Canadian centres. Such variability is likely to affect patient convenience and resource utilization. Although patient selection, referring surgeon, and change in policies may account for some of the observed differences, further research is necessary to better understand the causes.
RESUMEN
The detection rate of liver lesions using ultrasonography is 53-77%, rendering this method inferior to CT and MRI. Despite well-known limitations, development of stable second-generation contrast agents in conjunction with new techniques of contrast display has led to increased diagnostic accuracy. Characterization of focal liver lesions with ultrasound contrast agents follows known features of iodine- and gadolinium-containing contrast agents, but compared to CT and MRI sensitive visualization of intratumoral vessels takes place in real time. In addition to very high diagnostic accuracy in differentiating benign from malignant lesions, detectability of tumors of nonhepatocellular origin is increased significantly and direct assessment of treatment success with minimally invasive tumor ablative interventions in the liver is possible. The active principle of ultrasound contrast agents, examination technique as well as distinguishing features and appearance of various, frequently observed focal liver lesions are illustrated by cases from our department.
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Carcinoma Hepatocelular/diagnóstico por imagen , Medios de Contraste/administración & dosificación , Aumento de la Imagen , Hepatopatías/diagnóstico por imagen , Neoplasias Hepáticas/diagnóstico por imagen , Neoplasias Hepáticas/secundario , Carcinoma Hepatocelular/irrigación sanguínea , Carcinoma Hepatocelular/cirugía , Medios de Contraste/farmacocinética , Quistes/diagnóstico por imagen , Diagnóstico Diferencial , Hiperplasia Nodular Focal/diagnóstico por imagen , Semivida , Hemangioma/diagnóstico por imagen , Venas Hepáticas/diagnóstico por imagen , Humanos , Hígado/irrigación sanguínea , Hígado/diagnóstico por imagen , Hepatopatías/cirugía , Neoplasias Hepáticas/irrigación sanguínea , Neoplasias Hepáticas/cirugía , Microburbujas , Neovascularización Patológica/diagnóstico por imagen , Fosfolípidos/farmacocinética , Polisacáridos/farmacocinética , Sensibilidad y Especificidad , Hexafluoruro de Azufre/farmacocinética , Ultrasonografía IntervencionalRESUMEN
The paper describes an approach to monitor a person's ECG and activity continuously with functional clothing. A belt with integrated electronics has been developed and has proven long-term robustness of all electrical components. A low-power module measures the ECG signal as well as the acceleration (2-axis) and stores data continuously up to two days. A user test has been performed to evaluate the belt according to system performance at different daily-life activities like sleeping, walking and so on. System parameters are ECG-signal quality, system up-time, and ECG-signal coverage during a day.
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HISTORY AND ADMISSION FINDINGS: A 21-year-old woman with known endocardial fibroelastosis diagnosed when aged 3 months was admitted because of progressive dyspnoea. The physical examination revealed symptoms of heart failure, with pulmonary rales, mild hepatomegaly, and tachyarrhythmia. INVESTIGATIONS: The electrocardiogram showed atrial fibrillation, complete right bundle branch block and right ventricular hypertrophy. Echocardiography indicated hypertrophy and dilatation of the right ventricle (61 mm) with tricuspid regurgitation and hypoplasia of the left ventricle. Heart catheterization confirmed pulmonary hypertension (60/46 mmHg) as well as dilatation and hypokinesia of the right ventricle. Right ventricular biopsy showed severe myocardial hypertrophy resulting from secondary pulmonary hypertension, while no evidence of myocarditis or idiopathic dilated cardiomyopathy was found. TREATMENT AND COURSE: Symptoms of heart failure improved under medical treatment with digitalis, angiotensin-converting enzyme inhibitor and diuretics. CONCLUSION: Primary endocardial fibroelastosis of the contracted type must be included in the differential diagnosis of heart failure occurring in young adults.
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Fibroelastosis Endocárdica/complicaciones , Fibroelastosis Endocárdica/diagnóstico , Insuficiencia Cardíaca/etiología , Adulto , Inhibidores de la Enzima Convertidora de Angiotensina/uso terapéutico , Fibrilación Atrial/complicaciones , Cateterismo Cardíaco , Diagnóstico Diferencial , Digitalis/uso terapéutico , Diuréticos/uso terapéutico , Disnea , Ecocardiografía , Electrocardiografía , Fibroelastosis Endocárdica/fisiopatología , Femenino , Insuficiencia Cardíaca/diagnóstico , Insuficiencia Cardíaca/tratamiento farmacológico , Humanos , Fitoterapia , Plantas Medicinales , Plantas TóxicasRESUMEN
The measurement of cortisol and 17-hydroxyprogesterone (17-OHP) in saliva has become a reliable tool for both the scientist and the clinician for studying adrenal cortical function in the adult and the older child. We have now established in parallel normative data for salivary cortisol and 17-OHP levels in healthy neonates. We have asked whether or not there is a circadian rhythm of cortisol and 17-OHP saliva levels in neonates. Furthermore, we have asked whether salivary hormone levels correlated with auxologic and clinical data and time of sampling. Cortisol and 17-OHP levels in saliva samples from 119 healthy neonates (55 girls, 64 boys) were measured using in-house time-resolved fluorescent immunoassays. Saliva samples were obtained using a saliva collecting tube three times a day on the first or second day of life. Gender and gestational age did not influence salivary cortisol and 17-OHP levels. No significant circadian rhythm of salivary hormone levels was detected in this group of newborns. However, body mass index, arterial cord blood pH and time of saliva sampling significantly influenced salivary hormone levels. In conclusion, measurement of cortisol and 17-OHP in saliva is feasible in healthy neonates. The existence of normative data forms the basis for future studies on pathophysiologic states in the newborn period.
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17-alfa-Hidroxiprogesterona/análisis , Hidrocortisona/análisis , Saliva/química , Antropometría , Ritmo Circadiano , Edad Gestacional , Humanos , Recién Nacido , Valores de ReferenciaRESUMEN
Between September 1996 and February 2000 five female and 62 male patients with an abdominal aortic aneurysm, requiring therapy, underwent endoluminal treatment. Their age ranged from 51 to 81 years (mean 72 years). Preoperative evaluation was done with spiral computed tomography (CT) and angiography. All procedures were performed under general anesthesia in a radiologically adapted operating room. Postoperative complications occurred in 28.4%. The total conversion rate was 13.4%, the 30-day lethality rate was 1.4%. During the mean follow-up of 15.1 months 19 secondary interventions were necessary in 13 patients. The results presented in this study do not justify the wide use of this method and indicate a stricter form of patient selection.
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Aneurisma de la Aorta Abdominal/cirugía , Implantación de Prótesis Vascular/métodos , Endoscopía/métodos , Stents , Anciano , Anciano de 80 o más Años , Angiografía , Aneurisma de la Aorta Abdominal/diagnóstico , Aneurisma de la Aorta Abdominal/mortalidad , Implantación de Prótesis Vascular/efectos adversos , Endoscopía/efectos adversos , Femenino , Estudios de Seguimiento , Humanos , Masculino , Persona de Mediana Edad , Estudios Retrospectivos , Análisis de Supervivencia , Tomografía Computarizada por Rayos X , Resultado del Tratamiento , Procedimientos Quirúrgicos Vasculares/efectos adversos , Procedimientos Quirúrgicos Vasculares/métodosRESUMEN
A 64-year-old woman presented with extensive erythematous papulosquamous lesions along the lines of Blaschko on the right half of the trunk and the right leg. The clinical and histological features led to the diagnosis of lichen striatus, a dermatosis which usually appears during childhood. Treatment with acitretin led to marked improvement. Lichen striatus and its differential diagnoses--particularly "blaschkitis of adulthood" as first described in 1990--are discussed.
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Eritema/diagnóstico , Erupciones Liquenoides/diagnóstico , Enfermedades Cutáneas Papuloescamosas/diagnóstico , Biopsia , Diagnóstico Diferencial , Eritema/patología , Femenino , Humanos , Erupciones Liquenoides/patología , Persona de Mediana Edad , Piel/patología , Enfermedades Cutáneas Papuloescamosas/patologíaRESUMEN
BACKGROUND: There still is a controversy as to the neonatal outcome of small for gestational age (SGA) infants compared to a appropriate for gestational age (AGA) preterm infants. As a part of a randomized multicenter trial on timing of bovine surfactant therapy, we aimed at investigating short-term outcome variables in SGA-infants compared with AGA-infants. METHODS: SGA-infants were classified weighing below the 10th percentile at birth and were compared to AGA-infants in terms of prenatal and neonatal characteristics and neonatal outcome. RESULTS: A total of 317 infants were enrolled, 59 SGA- and 258 AGA-infants. Both groups did not differ in gestational age, however, SGA-infants had a lower birth weight. Preterm premature rupture of fetal membranes was observed more frequently in AGA-, preeclampsia in SGA-infants. The rate of intubation, severity of RDS, rate of surfactant administration, pulmonary airleaks and days on the ventilator did not differ between both groups. However prolonged nasal CPAP, supplemental oxygen therapy and chronic lung disease at 28 days and 36 weeks was diagnosed more often in SGA-infants. Furthermore mortality was significantly higher in SGA-infants as well as total NICU and total hospital days. CONCLUSION: As SGA-infants have an increased mortality rate and an increased risk for developing chronic lung disease, further studies should focus on prevention of intrauterine growth restriction and its complications.
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Recién Nacido Pequeño para la Edad Gestacional , Femenino , Retardo del Crecimiento Fetal/complicaciones , Rotura Prematura de Membranas Fetales/complicaciones , Edad Gestacional , Humanos , Recién Nacido , Cuidado Intensivo Neonatal , Masculino , Oxígeno/administración & dosificación , Preeclampsia/complicaciones , Embarazo , Complicaciones del Embarazo , Pronóstico , Estudios Prospectivos , Surfactantes Pulmonares/uso terapéutico , Síndrome de Dificultad Respiratoria del Recién Nacido/mortalidad , Síndrome de Dificultad Respiratoria del Recién Nacido/terapiaRESUMEN
In this study, the regulation of mitochondrial Ca2+ transport by polyamines structurally related to spermine and by analogous polycationic compounds was characterized. Similar to spermine, a number of amino groups containing cationic compounds exerted a dual effect on Ca2+ transport of isolated rat liver mitochondria: a decrease in Ca2+ uptake velocity and an enhancement of Ca2+ accumulation. In contrast to the effects of spermine and other aliphatic polyamines, however, the accumulation-enhancing effect of aminoglucosides, basic polypeptides, and metal-amine complexes turned into an inhibition of Ca2+ accumulation at higher concentrations. Within groups of structurally related compounds, the potency to decrease Ca2+ uptake velocity and to enhance Ca2+ accumulation correlated with the number of cationic charges. The presence of multiple, distributed cationic charges was a necessary, but not sufficient criterion for effects on mitochondrial Ca2+ transport, because cationic polyamines and basic oligopeptides which did not enhance mitochondrial Ca2+ accumulation could be identified. Spermine was not able to antagonize the blocking of Ca2+ uptake by ruthenium red, but rather showed an apparent synergism, which can be explained as a displacement of membrane-bound Ca2+ by spermine. The aminoglucosides, gentamicin and neomycin, but not the inactive polyamine bis(hexamethylene)-triamine, inhibited the binding of spermine to intact mitochondria. Apparently, the binding of spermine, gentamicin, and a number of polyamine analogues to low-affinity binding sites at mitochondria, which have low, but distinct structural requirements and which may correspond to phospholipid headgroups, indirectly influences the activity state of the mitochondrial Ca2+ uniporter. The ability of aminoglucosides to displace spermine from the mitochondria and to inhibit mitochondrial Ca2+ accumulation may contribute to the mitochondrial lesions, which are known to occur early in the course of aminoglucoside-induced nephrotoxicity.
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Poliaminas Biogénicas/farmacología , Calcio/farmacocinética , Mitocondrias Hepáticas/efectos de los fármacos , Espermina/farmacología , Aminoglicósidos/farmacología , Análisis de Varianza , Animales , Transporte Biológico/efectos de los fármacos , Colorantes , Depresión Química , Sinergismo Farmacológico , Técnicas In Vitro , Mitocondrias Hepáticas/metabolismo , Ratas , Rojo de Rutenio , Estimulación QuímicaRESUMEN
In this study, the effects of polyamines and analogous compounds on mitochondrial permeability transition were characterized to distinguish between these effects and those on mitochondrial Ca2+ uptake, which are described in an accompanying report (Rustenbeck et al., Biochem Pharmacol 8: 977-985, 1998). When a transitional Ca2+ release from Ca2+-loaded mitochondria was induced by an acute increase in Ca2+ concentration in a cytosol-adapted incubation medium (Ca2+ pulse), this process was inhibited, but not abolished by spermine in the concentration range of 0.4 to 20 mM. The aminoglucoside, gentamicin, and the basic polypeptide, poly-L-lysine, which like spermine are able to enhance mitochondrial Ca2+ accumulation (preceding paper), had no or only a minimal inhibitory effect, while the aliphatic polyamine, bis(hexamethylene)triamine, which is unable to enhance mitochondrial Ca2+ accumulation, achieved a complete inhibition at 4 mM. The conclusion that the Ca2+ efflux was due to opening of the permeability transition pore was supported by measurements of mitochondrial membrane potential, ATP production, and oxygen consumption. Mg2+, a known inhibitor of mitochondrial membrane permeability transition, did not mimic the effects of spermine on mitochondrial Ca2+ accumulation, while ADP, the main endogenous inhibitor, showed both effects. However, a combination of spermine and ADP was significantly more effective than ADP alone in restoring low Ca2+ concentrations after a Ca2+ pulse. Two different groups of spermine binding sites were found at intact liver mitochondria, characterized by dissociation constants of 0.5 or 4.7 mM and maximal binding capacities of 4.6 or 19.7 nmol/mg of protein, respectively. In contrast to aminoglucosides, the aliphatic polyamine bis(hexamethylene)triamine did not displace spermine from mitochondrial binding sites. The total intracellular concentration of spermine in hepatocytes was measured to be ca. 450 microM and the free cytoplasmic concentration was estimated to be in the range of 10-100 microM. In conclusion, the enhancement of mitochondrial Ca2+ uptake by spermine is not an epiphenomenon of the inhibition of permeability transition. The physiological role of spermine appears to be that of an enhancer of mitochondrial Ca2+ accumulation rather than an inhibitor of permeability transition.