[Vascular adrenal cyst causing difficult to control high blood pressure]. / Hipertensión arterial mal controlada secundaria a quiste vascular suprarrenal.

Hypertension is a prevalent disease in developed countries. Adrenal masses, and especially adrenal cysts, are a rare and usually asymptomatic finding, which can go unnoticed or be detected as incidental findings in imaging tests. These circumstances make the multidisciplinary approach mandatory. The case is presented on a 72 year-old woman with uncontrolled high blood pressure referred to the Urology Department due to the incidental finding of a right retroperitoneal mass. A functional and imaging study was performed, establishing a diagnosis of adrenal cyst causing hypertensive symptoms. A literature search was performed in order to assess diagnostic and therapeutic approaches. With the diagnosis of adrenal cyst causing uncontrolled high blood pressure, a right laparoscopic adrenalectomy was performed. After surgery the patient has maintained blood pressure within the normal range. A multidisciplinary approach is necessary for the management of rare diseases. The surgical approach, if possible, should be laparoscopic.

Comparability and reproducibility of adult male anogenital distance measurements for two different methods.

The distance from the genitals to the anus, anogenital distance, reflects androgen concentration during prenatal development in mammals. The use of anogenital distance in human studies is still very limited and the quality and consistency of measurements is an important methodological issue. The aim of this study was to assess the feasibility and reproducibility of adult male anogenital distance measurements by two different methods. All men were attending an outpatient clinic at a university hospital and underwent an andrological examination and completed a brief questionnaire. Two variants of anogenital distance [from the anus to the posterior base of the scrotum (AGDAS ) and to the cephalad insertion of the penis (AGDAP )] by two methods (lithotomy or frog-legged position) were assessed in 70 men. Within and between coefficient of variations, intra-class correlation coefficients, two-way repeated-measures analysis of variance, and scatter and Bland-Altman plots were calculated. The two methods produced similar values for AGDAP but different estimates for AGDAS . Nonetheless, the overall agreement (ICC ≥ 0.80) was acceptable for both measures. Therefore, both methods are internally consistent and adequate for epidemiological studies, and may be used depending on the available medical resources, clinical setting, and populations.

Evolution of the patient characteristics of candidates for radical prostatectomy and the results obtained with the technique.

OBJECTIVES: To evaluate the oncological profile and risk of biochemical recurrence of patients with prostate cancer who underwent radical prostatectomy based on the time period in which the patients were operated. To evaluate the differences in prostate-specific antigen (PSA) at diagnosis of patients with or without biochemical recurrence based on these time periods. MATERIAL AND METHODS: Observation carried forward study of a cohort of 972 radical prostatectomies performed during 3 time periods (1994-2000, 2001-2006, 2007-2011). The importance of PSA at diagnosis on the time periods and on biochemical recurrence was assessed using a generalized linear model. The independent predictive behavior of biochemical recurrence was analyzed using Cox regression. RESULTS: The median follow-up was 38 (16-76) months. PSA levels at diagnosis were higher in the period 1994-2000 (12.97ng/mL, P<.001). Seventy-two percent of the patients from the period 2007-2011 were diagnosed as clinical stage T1c (P<.001), compared with 55% from the period 1994-2000. The percentage of extracapsular extension in the specimen decreased from 27% to 18% from the period 1994-2000 to the period 2007-2011 (p<.001). The percentage of patients with biochemical recurrence went from 38% to 14% from the first to the third period (P>.001). The difference between PSA levels at diagnosis for the patients with or without biochemical recurrence was independent of the period (P=.84). The period during which surgery was performed was not an independent predictive factor for biochemical recurrence (P=.09). CONCLUSIONS: Patients from the 2007-2011 period had less extracapsular disease in the radical prostatectomy. The period was not an independent predictive factor for biochemical recurrence.

Lung histopathological findings in fatal pandemic influenza A (H1N1).

OBJECTIVE: To describe the lung pathological changes in influenza A (H1N1) viral pneumonia. We studied morphological changes, nitro-oxidative stress and the presence of viral proteins in lung tissue. METHODS AND PATIENTS: Light microscopy was used to examine lung tissue from 6 fatal cases of pandemic influenza A (H1N1) viral pneumonia. Fluorescence for oxidized dihydroethydium, nitrotyrosine, inducible NO synthase (NOS2) and human influenza A nucleoprotein (NP) (for analysis under confocal microscopy) was also studied in lung tissue specimens. RESULTS: Age ranged from 15 to 50 years. Three patients were women, and 5 had preexisting medical conditions. Diffuse alveolar damage (DAD) was present in 5 cases (as evidenced by hyaline membrane formation, alveolo-capillary wall thickening and PMN infiltrates), and interstitial fibrosis in one case. In the fluorescence studies there were signs of oxygen radical generation, increased NOS2 protein and protein nitration in lung tissue samples, regardless of the duration of ICU admission. Viral NP was found in lung tissue samples from three patients. Type I pneumocytes and macrophages harbored viral NP, as evidenced by confocal immunofluorescence microscopy. CONCLUSIONS: Lung tissue from patients with pandemic influenza A (H1N1) viral pneumonia shows histological findings consistent with DAD. Prolonged nitro-oxidative stress is present despite antiviral treatment. Viral proteins may remain in lung tissue for prolonged periods of time, lodged in macrophages and type I pneumocytes.

Heat shock protein 70 and cellular disturbances in cochlear cisplatin ototoxicity model.

BACKGROUND: Exposure to cisplatin leads to cochlear cell death by apoptosis; these changes are most marked on the seventh day after exposure. Heat shock proteins are induced in inner ear cells in response to a variety of stimuli. This study examined the role of heat shock protein 70 in cisplatin-induced cochlear cell death. METHODS: Fifty-six Sprague-Dawley rats were involved. Some were injected with cisplatin (5 mg/kg body weight), some with cisplatin plus the caspase inhibitor Z-Asp(OMe)-Glu(OMe)-Val-Asp(OME)-fluoromethylketone (5 mg/kg body weight) and others were left as controls (being injected only with saline). Seven days later, we examined the expression of heat shock protein 70 and several other apoptosis-related proteins within the rat cochlear cells; we also assessed total superoxide dismutase activity, auditory brainstem response and auditory steady state response. RESULTS: Seven days after cisplatin injection, significantly increased expression of heat shock protein 70 was found within the rat cochleae. This correlated with increased executioner caspase levels, total superoxide dismutase activity and auditory brainstem response thresholds, and a significant elevation in auditory steady state response thresholds. Inhibition of caspase-3 activity significantly reduced cochlear heat shock protein 70 expression and total superoxide dismutase activity, and improved auditory brainstem response and auditory steady state response thresholds. CONCLUSIONS: Seven days after cisplatin exposure, we found disturbances of the cochlear cellular machinery involving heat shock protein 70, other apoptotic proteins and total superoxide dismutase.

[Cross-cultural adaptation and validation of the Picker Patient Experience Questionnaire-15 for use in the Spanish population]. / Adaptación transcultural y validación del Picker Patient Experience Questionnaire-15 para su uso en población española.

OBJECTIVE: To carry out a transcultural adaptation and validation of the Picker Patient Experience Questionnaire-15 (PPE-15). To incorporate new dimensions such as informed consent and decision making, that are not addressed in the PPE-15 but are considered relevant for Spanish patients on information and decision making in hospital. MATERIAL AND METHOD: Cross-culture adaptation and validation of the (PPE-15). A translation of the original version of the questionnaire PPE-15 has been carried out. Content validity has been studied and a new Spanish version has been designed and validated, the PPE-33 questionnaire. The original version of the PPE-15 was translated into Spanish and the content and construct validity of the PPE-33 were studied. A pilot test assessed the acceptability and feasibility of the questionnaire and eventually, construct validity, reliability and internal consistency were evaluated. RESULTS: A high concordance between the original version of the PPE-15 questionnaire and the PPE-33 (Kappa 0.872). The PPE-33 showed good stability within 15 days (McNemar's Test P>0.05). The Szigriszt Readability Score was 80 (very easy to read). The PPE-33 obtained a high internal consistency (Cronbach's alpha 0.792). CONCLUSIONS: The PPE-15 adapted to Spanish as the PPE-33, is a reliable and valid instrument to measure the perception and satisfaction of patients that have been hospitalised, regarding information, treatment received and participation in decision making.

The anticancer drug cisplatin induces an intrinsic apoptotic pathway inside the inner ear.

BACKGROUND AND PURPOSE: Ototoxicity is a known adverse effect of cisplatin (CDDP). Since apoptosis is involved in the development of some pathological conditions associated with the administration of anticancer drugs, we examined, using immunohistochemical and electrophysiological techniques, the apoptotic changes in the cochlea of Sprague-Dawley (SD) rats after an injection of CDDP (5 mgkg(-1) body weight). EXPERIMENTAL APPROACH: Luciferase assays were used to determine the different caspase activities and ATP levels in protein extracts of whole cochleae. The expression of several apoptotic-related proteins was measured by means of Western blotting. These analyses were performed 2, 7 and 30 days after the CDDP injection. The auditory brain stem response was obtained before and at the different times after the injection of CDDP, before the animals were killed. KEY RESULTS: CDDP significantly increased the levels of caspase-3/7 activity and active caspase-3 protein expression and caspase-3 immunofluorescence staining, caspase-9 activity, and Bax protein expression but decreased Bcl-2 protein expression within the rat cochleae. Threshold shifts were significantly elevated 2 days after CDDP treatment. CONCLUSIONS AND IMPLICATIONS: These findings support the hypothesis that cisplatin-related apoptosis evokes an intrinsic pathway of pro-apoptotic signalling within the rat cochleae. Thus, selective inhibition of the sequence of events involved in the intrinsic apoptotic pathway could provide a strategy to minimize cisplatin-induced ototoxicity.

Pro-inflammatory effects of early non-enzymatic glycated proteins in human mesothelial cells vary with cell donor's age.

BACKGROUND AND PURPOSE: Diabetes mellitus is prevalent in the elderly population. It is also a disease causing tissue damage through several different mechanisms. Some of these mechanisms are also activated by ageing and this overlap raises questions about how diabetes induces damage in the elderly. Early products of non-enzymatic glycation of proteins (Amadori adducts), and the ageing process share the capacity to induce oxidative stress and inflammation in human peritoneal mesothelial cells (HPMCs). We have evaluated the interactions between the age of the donor of the HPMCs and the pro-inflammatory effects of Amadori adducts in those cells. EXPERIMENTAL APPROACH: HPMCs were isolated from 20 individuals (age range 21-81 years) and grown in culture. Using different experimental approaches we determined NF-kappaB dependent transcriptional activity and different NF-kappaB-related pro-inflammatory gene and protein expressions in basal (or non-stimulated) conditions and after stimulation with two Amadori adducts; highly-glycated haemoglobin and glycated bovine serum albumin. KEY RESULTS: Amadori-induced effects on NF-kappaB dependent-transcription and on the activity of NOS, COX and several NF-kappaB-related pro-inflammatory genes (iNOS, COX-2, TNF-alpha, IL-1beta, and IL6) diminished as the donor's age increased, being practically absent in cells from donors more than 65 years old. Such decreased effects were inversely correlated with an increased basal expression and activity of these pro-inflammatory markers with age. CONCLUSIONS AND IMPLICATIONS: Pro-inflammatory effects of Amadori-adducts in HPMCs were strongly dependent on cell donor's age. This may have significant implications for the mechanisms underlying diabetes-induced tissue damage in patients of different ages.

[Lemierre's syndrome and Mycoplasma pneumoniae]. / Síndrome de Lemierre y Mycoplasma pneumoniae.

It has been suggested that a previous viral or bacterial pharyngitis may predispose to Lemierre's syndrome, an uncommon entity nowadays. A case of Lemierre's syndrome and co-infection with Mycoplasma pneumoniae is described, association published before in only 2 other cases. A 16-year-old girl with trombophlebitis of the left jugular vein, Fusobacterium necrophorum bacteremia and septic emboli in the lung requiring mechanical ventilation due to severe respiratory insufficiency. Despite early treatment with penicillin G and clindamycin, fever and part of pulmonary affectation persisted until that an antibiotic agent active against M. pneumoniae was instaurated, after its serological confirmation. The physicians should be easily recognized this disease because of its characteristic clinical findings, and co-infection with other organisms including M. pneumoniae, should be considered.

An IgG antibody response to the antigen 85 complex is associated with good outcome in Mexican Totonaca Indians with pulmonary tuberculosis.

SETTING: It is generally accepted that antibodies do not protect against Mycobacterium tuberculosis infection, as this role relies upon T-cell reactivity. Hence, most studies on antimycobacterial antibodies have been aimed at developing serologic tests, and few explore their role in disease pathogenesis. OBJECTIVE: To determine the IgG antimycobacterial antibody response of 55 Mexican Totonaca Indians with pulmonary tuberculosis and its correlation with some features of the disease. DESIGN: Study of the profile of antigen recognition by immunoblot and ELISA with isolated antigen 85 complex (Ag85) and whole culture filtrate proteins. Correlation of immunoblot and ELISA results with BCG vaccination, tuberculin reactivity, extent of the disease, clinical setting, and response to treatment. RESULTS: On immunoblot, band reactivity was very poor and the most frequently recognized antigen was the 30-32 kDa, antigen 85 complex (45.8% of serum samples). ELISA with this antigen showed a sensitivity of 72% and a specificity of 100%. Positive antibody titers to Ag85 were observed in 79.4% of patients with non-cavitary tuberculosis (P = 0.012) and in 95.8% of patients who were cured with anti-tuberculosis chemotherapy (P = 0.0001). By contrast, an antibody response to whole culture filtrate antigens had no correlation with the presence of cavitations or with prognosis. CONCLUSIONS: Our data show that an antibody response to Ag85, aside from having great potential to develop a serologic test for tuberculosis, was associated with a positive outcome in a cohort of tuberculous Mexican Indians.

High-level expression of NRAMP1 in peripheral blood cells and tuberculous granulomas from Mycobacterium bovis-infected bovines.

By Western blotting, we demonstrate high-level expression of NRAMP1 proteins in peripheral blood cells and granulomas of Mycobacterium bovis-infected bovines. Immunohistochemistry of granulomatous lesions showed heavily labeled epithelioid macrophages and Langhans cells. These data suggest that M. bovis infection enhances NRAMP1 expression and that active tuberculosis can occur despite this response.

[Description of the "new" intensive care unit of the Valladolid Río Hortega Hospital]. / Descripción de la "nueva" unidad de cuidados intensivos del Hospital Río Hortega de Valladolid.

The unit described herein forms part of the Rio Hortega Hospital in Valladolid (Spain) and is situated on the third floor. The building houses several medical and surgical specialities and has been renovated several times; the latest renovations have involved technical and structural renovation of the Intensive Care Unit. The new intensive care unit was inaugurated in February 1998 due to new technical and medical requirements. The aim of improving medical care and the degree of satisfaction among patients and their families has been achieved and the work environment is more congenial and peaceful. The unit is composed of two areas: the multipurpose intensive care unit and the cardiology intensive care unit, edowed with the same monitoring system and apparatus specific to each. Moreover, the unit is composed of an administration area, storerooms and an area for common services (a room for the cleaning of material, waste disposal, lavatories, etc.). The medical team is composed of (a) medical staff-seven staff doctors and five residents; (b) nursing staff: 18 nurses and 13 nurse's aides in the multipurpose Intensive Care Unit; 13 nurses and 8 nurse's aides in the cardiology intensive care unit: one supervisor common to both units; administrative staff: one secretary; one security guard and one cleaner. The distribution of nursing work depends on workload reflected in the patient's daily chart, protocols, nursing care plans and follow-up sheets for the nursing team. Visiting hours are divided between the morning and afternoon and information is given to the patient's relatives by the doctor before the visit. The hospital has three catholic priests who periodically visit the patients. We also try to help when the patients profess other religious faith. The type of patients who are cared for in the unit as well as their distribution according to condition, severity, death, etc, is shown in figures: the data correspond to the period from January 1 1998 to August 1 1999.

[Squamous cell carcinoma of the liver]. / Carcinoma escamoso primario de hígado.

A case of primary squamous cell carcinoma of the liver in a 38-year-old male patient is informed. We could only find 13 cases reported in the literature, all of them in male patients; in the Mexican literature this histologic type of hepatic neoplasia has not been reported. The prognosis of these lesions are extremely poor, and no case has survived over six months.