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The aim of this work was to evaluate how the use of mixed cultures of Saccharomyces cerevisiae and Lachancea thermotolerans indigenous yeast strains influences the volatile composition of wine. Multivariate curve resolution (MCR) method has been applied to data analysis. Five fermentation trials were carried out: three co-inoculated with L. thermotolerans:S. cerevisiae, at the ratio of 50:1, 20:1 and 5:1 respectively, and two with a pure culture of each strain. A must from sun-dried Pedro Ximénez grapes was employed. Volatile composition was determined by dual sequential stir bar sorptive extraction, followed by GC-MS analysis. MCR provided 171 peaks. Results in co-inoculation fermentations revealed that the majority compounds obtained in each case followed the same trend as that observed for the pure culture of the strain that was present in a higher proportion. Finally, 50:1 and 20:1 seemed to be the best proportions to obtain a wine with a quality volatile profile.

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Currently, there is a growing interest in the use of non-Saccharomyces yeast to enhance the aromatic quality of wine, with pure or mixed cultures, as well as sequential inoculation. Volatile components of wines were closely related to their sensory quality. Hence, to study the evolution of volatile compounds during fermentation was of great interest. For this, sampling methods that did not alter the volume of fermentation media were the most suitable. This work reports the usefulness of headspace sorptive extraction as non-invasive method to monitor the changes in volatile compounds during fermentation. This method allowed monitoring of 141 compounds throughout the process of fermentation by Saccharomyces cerevisiae and Lachancea thermotolerans strains. Both strains showed a similar ability to ferment a must with high sugar content. The S. cerevisiae strain produced higher amount of volatile compounds especially esters that constitutes fruity aroma than L. thermotorelans.

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OBJECTIVE: We aimed to evaluate the clinical efficacy of ciprofloxacin plus fluocinolone acetonide (antibiotic plus corticosteroid) ear drops compared to ciprofloxacin (antibiotic) ear drops in diffuse otitis externa. METHODS: This was a multicentre, randomised, parallel-group, double-blind study involving 590 patients of both sexes aged 7 years or older. RESULTS: The rate of clinical cure was higher (p = 0.01) with ciprofloxacin plus fluocinolone acetonide than with ciprofloxacin alone. The mean total symptom score was lower with ciprofloxacin plus fluocinolone acetonide (p = 0.005). No differences were found in the percentage of patients reporting resolution of otalgia between patients receiving ciprofloxacin plus fluocinolone acetonide and patients receiving only ciprofloxacin. Resolution of oedema and otorrhoea (p = 0.003 and p = 0.002, respectively) was higher with ciprofloxacin plus fluocinolone acetonide, as was eradication or presumed eradication (p = 0.003). There were eight mild adverse events, three with the ciprofloxacin plus fluocinolone acetonide combination (not related to the treatment) and five when ciprofloxacin was administered alone (directly related to the treatment). CONCLUSIONS: Ciprofloxacin plus fluocinolone acetonide is a more effective treatment for diffuse otitis externa than ciprofloxacin alone. The ciprofloxacin plus fluocinolone acetonide combination also has an excellent safety profile.

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BACKGROUND: Multiple sclerosis (MS) has a unique geographical distribution that reflects both genetic and environmental factors. Many studies have shown a positive correlation between MS frequency and latitude across both large and small geographical regions. However, scarce data have been published on the epidemiology of MS in Latin America and no study has evaluated latitudinal variation. OBJECTIVE: To evaluate the effect of latitude on MS prevalence in Latin America. METHODS: We conducted a systematic review of MS prevalence during January 2011. Prevalence rates were collected from eligible publications. The effect of latitude on prevalence was analyzed using linear regression. RESULTS: A total of ten studies were eligible for analysis, corresponding to six countries, spanning from Panama to Argentina. The crude prevalence of MS ranged from 0.75 to 21.5 per 100,000. We found a strong and significant association between prevalence and latitude (r(2) 0.8; p < 0.001) and determined an increase in prevalence of 0.33 per 100,000 per degree latitude. CONCLUSION: Our findings suggest a latitudinal prevalence gradient of MS in Latin American countries between Panama and Argentina.

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Generally, the need for information about varicella-zoster virus (VVZ) infection in cardiac transplantation (CT) is greater than that for other organ transplants. All cases of VVZ infection among the 175 CT patients included herpes zoster as the clinical syndrome in all 11 cases (men, 90.9%; mean age, 50.3+/-5 years; incidence, 6.3%). The infection was limited to one dermatome in seven patients (63.6%: thoracic, 6%; ophthalmic, 1), or two contiguous dermatomes in four patients (36.4%). The infection onset was after the first semester in seven patients (63.6%). All patients received three drug immunosuppressive therapy. Cardiac rejection during the three previous months occurred in one patient (3A grade). Previous CMV disease was observed in three patients (27.3%: range, 7-14 months). Intravenous acyclovir was administered to five patients (ophthalmic and several dermatome forms), and oral therapy for the rest. All the patients recovered; there were no complications or postherpetic neuralgia (mean follow-up: 16.5 months). VVZ infection, a frequent late infection among CT recipients, presents as a clinical syndrome of herpes zoster, frequently in patients with previous CMV infection. In CT, herpes zoster frequently affects two dermatomes, but the clinical courses and responses to treatment are favorable. There was no postherpetic neuralgia.

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El ecocardiograma de estrés con dobutamina (ESD) es una técnica de uso cada vez más rutinario en el diagnóstico de la enfermedad coronaria. La aparición de alteraciones en el electrocardiograma durante la prueba corresponde habitualmente a una depresión del segmento ST y en raras ocasiones a una elevación del ST, relacionándose con lesiones coronarias graves o infarto agudo de miocardio (IAM) previo. La elevación del ST, en ausencia de lesiones coronarias significativas, es muy infrecuente y se supone relacionada con un mecanismo vasoespástico. Presentamos el caso de un varón joven y con factores de riesgo cardiovascular, ingresado para estudio de dolor torácico y con ergometría negativa, que durante la prueba de dobutamina presenta positividad clínica, eléctrica en forma de ascenso del ST y alteraciones segmentarias de la contractilidad. Coronariografía sin lesiones coronarias significativas. Se comenta el caso y se revisa la literatura. (AU)

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The present study examined the differences between anesthesia care team (ACT) and non-ACT practice types. Six practice variables were analyzed. We prepared and distributed a 13-item questionnaire to 1,000 practicing Certified Registered Nurse Anesthetists (CRNAs) with a 44.4% response rate. Data analysis revealed that nurse anesthetists in ACT practices had fewer years of experience and were younger than non-ACT nurse anesthetists (alpha = 0.05). Also, a significantly greater percentage of ACT nurse anesthetists were female, held master-level degrees, and practiced in urban and metropolitan locations. This also was true for placement of laryngeal mask airways and arterial lines, and in providing anesthesia for cardiopulmonary bypass, pediatric, intracranial, and trauma cases. However, a significantly greater percentage of non-ACT nurse anesthetists placed epidurals and central lines and were involved in pain management and critical care consultations. Income was significantly greater for non-ACT nurse anesthetists as well, but they worked more hours per week on average. Lastly, evaluation of employment arrangements showed that more than 91% (n = 361) of ACT nurse anesthetists were employees, and only 4% (n = 17) were self-employed. However, only 49% (n = 24) of non-ACT nurse anesthetists were employees, and almost 43% (n = 21) were self-employed. The present study demonstrates that significant differences exist between the 2 nurse anesthesia practice types examined. As nurse anesthesia practice arrangements continue to change and fewer CRNAs are hospital employed, each nurse anesthetist must be aware of current practice trends and understand the alternatives.

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Actynomicosis of the submaxillary gland is a very uncommon infectious disease. In this article one case of submaxillary sialolithiasis by actynomices israelii in a young girl is presented. We discuss several aspects of its diagnosis and therapeutic possibilities and review the literature on the subject. We emphasize the interest and value of performing a microbacteriological, mineralogical and pathological study of the calculi.

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OBJECTIVE/DESIGN: This study aimed to examine and describe three siblings with alacrima, the eldest of whom had associated achalasia and adrenocortical insufficiency. PARTICIPANTS: Three affected siblings and four age-matched control subjects participated. INTERVENTION/MAIN OUTCOME MEASURES: The three children underwent complete ophthalmologic examinations; computed tomographic scanning of brain, orbit, chest, and abdomen; and measurement of serum cortisol. All three were subjected to a short synacthen challenge. Lacrimal gland biopsies were performed on the two younger subjects, and specimens were studied by light and electron microscopy. RESULTS: All three children showed virtually absent tear secretion as tested by the Schirmer test. The resulting keratopathy was most severe in the oldest child, who developed bilateral corneal melting. The two younger children showed interpalpebral corneal staining with rose bengal. All three children improved after punctal occlusion. Addison's disease was present in the oldest child. Computed tomographic scanning showed absent lacrimal and shrunken adrenal glands in association with achalasia of the cardia in the oldest child. The lacrimal glands were found to be reduced in size in the next eldest child. When evaluated by electron microscopy, the lacrimal gland biopsy specimens from the two younger children showed neuronal degeneration associated with depletion of secretory granules in the acinar cells. CONCLUSION: In this disease, radiologic evidence of reducing lacrimal gland size with increasing age could represent a degenerative process. This may be paralleled by other signs and the possibility of adrenocortical insufficiency and achalasia of the cardia should be investigated in all children presenting with dry eyes. These children appear to have a progressive neuronal disease.

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OBJECTIVE: To attempt to identify common events or factors in four cases of endophthalmitis that developed after penetrating keratoplasty performed within a 1-week interval. DESIGN: Case series. SETTING: Tertiary care eye hospital in Riyadh, Saudi Arabia. PATIENTS: Four patients in whom endophthalmitis developed after penetrating keratoplasty performed in May 1993. OUTCOME MEASURES: Source of donor tissue, transportation of corneas, handling of corneas at the eye hospital, and causative organism and sensitivity profile. RESULTS: The donor tissue in all four cases originated from the same eye bank. Organisms were cultured from 10 of the 11 donor rims from eye bank A tissue used during the week in question. The causative organisms were Enterococcus faecalis in three patients and Torulopsis glabrata in one patient. In each case the same organism was cultured from the recipient eye and the corresponding donor rim. Two of the four patients had a favourable outcome. CONCLUSIONS: Donor rim culture is essential if the cause of endophthalmitis after penetrating keratoplasty is to be determined. Close communication between eye bank personnel, the microbiology laboratory and the operating surgeon is important as it may influence early detection, choice of treatment and outcome of endophthalmitis after penetrating keratoplasty. Epidemiologic studies from both the source eye bank and the recipient facility are required to fully investigate the cause of a cluster of endophthalmitis cases from contaminated donor tissue following penetrating keratoplasty.

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Megadolichobasilar is a vascular anomaly consisting of widening and elongation of the basilar artery. It is rare and may produce otoneurological manifestations such as vertigo, sudden deafness, trigeminal neuralgia, and facial spasm or palsy. Six cases of megadolichobasilar diagnosed by magnetic resonance angiography are reported and their pathogenesis is discussed.

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This article deals with an investigative work done by the AA. with the aim of determine the final cause of sudden sensorial deafness. Three causes are accepted as source of sudden deafness: viral infections, the tear away of labyrinthine membranes and the vascular theory. An increase in antibody titer suggest a viral origin. The labyrinthine membranes split has been observed at times when performing an exploratory tympanotomy. But circulatory troubles are hardly diagnosed, even with histopathological evidences of vascular upsets in temporal bones belonging to patients who suffered from an auditory stroke, because there are no diagnostic tests for "in vivo" control. Our intend is to investigate on the physiopathology of unforeseen deafness and also try to know the possible mechanisms of reversion of this calamitous pathology. We use, as investigative method of actual vascular changes in sudden deafness, the following; the speed analysis of the blood flow furnished by the A. labyrinthi through echography Doppler color transcranialis and angiography and magnetic resonance (Angio-MR). Both procedures are non invasive and harmless. We comment the findings of 13 patients. And find out, in 4 cases, an important trouble of the arterial vertebrobasilaris flow. The A. labyrinthi, a branch of the A. cerebelli inferior anterior (ACIA) and/or A. basilaris--rarely from the A. cerebelli inferior posterior (ACIP)--showed a heavy hypoplasy of these vessels, stenosis or complete blockage. In 2 of cases, 4 months later, a new exploration of the Doppler flow and angio-MR, was performed, and detected an improvement of the vertebrobasilar flow, in both instances. In those patients with an evident recovery of the hearing, it was attributed to these two compensatory mechanisms: 1) reversal of the flow at the level of cicle of Willis, at the expense of development of A. communicans posterior, and 2) cessation of the vertebral A. spasm and decrease of the vessel's tortuosity so improving the blood flow.

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Bone SPECT in cholesteatoma assessment. Single photon emission computed tomography (SPECT) is a procedure in nuclear medicine which enables bone lesions to be better assessed. Twenty patients with cholesteatoma were studied to assess the efficiency of SPECT in bone lesions produced by cholesteatoma. Every patient also had a middle ear computed tomography (CT) and underwent surgery and anatomopathologic examination. Results obtained by SPECT are compared to CT results. SPECT was positive in 15 cases of which 2 of them with a negative CT for bone erosion. Five cases were false negative, but 2 of them had contralateral ear pathology and in one case bone erosion was not found. We conclude that in some patients SPECT can be a complementary diagnostic procedure in cholesteatomatous bone lesions.

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BACKGROUND: Twenty-three eyes of 22 patients remained undercorrected 5 to 49 months after radial keratotomy, either alone or in combination with transverse keratotomy. METHOD: We attempted to correct the residual myopia ranging from -1.25 to -5.75 diopters (D) (with astigmatism of 0 to 1.25 D) with photorefractive keratectomy. The mean age of patients was 26 years (range 22 to 40 years). RESULTS: After photorefractive keratectomy (follow-up 6 to 17 months) uncorrected visual acuity was equal to or better than 20/20 in 39% (9 eyes), better than 20/25 in 65% (15 eyes), and better than 20/40 in 74% (17 eyes). Spectacle-corrected visual acuity was equal or better than 20/40 in all eyes; one eye (4%) lost two lines of spectacle-corrected visual acuity. Refractive error was within +/- 0.50 D in 48% (11 eyes) and within +/- 1.00 D in 65% (15 eyes). Undercorrections of more than 1.00 D occurred in 22% (5 eyes) and overcorrections of more than 1.00 D occurred in 13% (3 eyes). No or minimal haze was present in 57% (13 eyes), mild haze in 39% (9 eyes) and moderate haze in 4% (1 eye). Final uncorrected visual acuity was better (p = 0.0002) and haze was less (p = 0.003) in the group with less than -3.00 D than in the group with greater than or equal to -3.00 D. CONCLUSION: Photorefractive keratectomy after radial keratotomy is safe but less effective and less predictable in eyes with greater than or equal to -3.00 D compared to those with less than -3.00 D.

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Many cases of hearing impairment are of genetic origin. Non-syndromic recessive transmission is the most frequent form. A genetic study was made of cases of non-syndromic familial hearing impairment seen in our service. The pattern of Mendelian inheritance was studied in the disorders associated with deafness. Four families had non-syndromic deafness and autosomal inheritance (3 dominant and one recessive) and one had a probable sex-linked inheritance. Genetic counseling was given and guidelines were created after reviewing the literature.

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BACKGROUND: Three children, ranging in age from 2 to 6 months, had diffuse and homogeneously opaque corneas, clinically consistent with congenital hereditary endothelial dystrophy. Bilateral elevated intraocular pressure (IOP) was a feature in all three children. METHODS: Initially, all patients underwent glaucoma surgery to reduce IOP. Subsequently, a penetrating keratoplasty was performed in one eye of each patient to clear the visual axis. The excised corneal button was examined by light microscopy and by transmission and scanning electron microscopy. RESULTS: Postoperatively, all patients maintained clear corneal grafts. Results of histopathologic examination showed an absence of the endothelial cell layer in all patients. The presence of a variably thick collagenous layer posterior to the anterior banded zone of Descemet's membrane and the absence of endothelial cells were noted on transmission electron microscopy. Scanning electron microscopy confirmed absent, or scanty, and abnormal endothelial cells. CONCLUSION: The authors describe three patients with a clear association between congenital glaucoma and congenital hereditary endothelial dystrophy. This combination should be suspected where persistent and total corneal opacification fails to resolve after normalization of IOP.

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