NSAID-sensitive antihistamine-induced urticaria/angioedema.

We present a case of urticaria caused by antihistamines in a patient with nonsteroidal anti-inflammatory drug (NSAID) sensitivity. A 35-year-old man experienced, on 2 separate occasions, immediate generalized urticaria during treatment with ibuprofen and naproxen, respectively. A single-blind, placebo-controlled oral challenge (SBPCOC) with piroxicam was carried out, and resulted in urticaria and angioedema 3 hours later. Two hours after initial clinical resolution, the patient developed multiple wheals on the trunk and upper limbs. He described similar delayed reactions after oral antihistamine administration on previous occasions. SBPCOCs with acetaminophen and etoricoxib were performed, with good tolerance. Skin prick and patch tests with loratadine and cetirizine were negative. After an SBPCOC with loratadine, the patient developed generalized urticaria 90 minutes after intake. Tolerance to fexofenadine 180 mg was confirmed. We describe the first case of a possible new subset of antihistamine urticaria, and suggest calling this NSAID-sensitive antihistamine-induced urticaria/angioedema.

Vitamin E protects against the mitochondrial damage caused by cyclosporin A in LLC-PK1 cells.

Cyclosporin A (CsA) has nephrotoxic effects known to involve reactive oxygen species (ROS), since antioxidants prevent the kidney damage induced by this drug. Given that mitochondria are among the main sources of intracellular ROS, the aims of our study were to examine the mitochondrial effects of CsA in the porcine renal endothelial cell line LLC-PK1 and the influence of the antioxidant Vitamin E (Vit E). Following the treatment of LLC-PK1 cells with CsA, we assessed the mitochondrial synthesis of superoxide anion, permeability transition pore opening, mitochondrial membrane potential, cardiolipin peroxidation, cytochrome c release and cellular apoptosis, using flow cytometry and confocal microscopy procedures. Similar experiments were done after Vit E preincubation of cells. CsA treatment increased superoxide anion in a dose-dependent way. CsA opened the permeability transition pores, caused Bax migration to mitochondria, and decreased mitochondrial membrane potential and cardiolipin content. Also CsA released cytochrome c into cytosol and provoked cellular apoptosis. Vit E pretreatment inhibited the effects that CsA induced on mitochondrial structure and function in LLC-PK1 cells and avoided apoptosis. CsA modifies mitochondrial LLC-PK1 cell physiology with loss of negative electrochemical gradient across the inner mitochondrial membrane and increased lipid peroxidation. These features are related to apoptosis and can explain the cellular damage that CsA induces. As Vit E inhibited these effects, our results suggest that they were mediated by an increase in ROS production by mitochondria.

Primary squamous cell carcinoma of the thyroid. Initial assessment and follow-up using 18F-FDG PET/CT. / Carcinoma epidermoide primario de tiroides. Valoración inicial y control evolutivo mediante 18F-FDG PET/TC.

Squamous cell carcinoma of thyroid is an uncommon, very aggressive neoplasm, having a poor prognosis and poor response to chemotherapy and radiotherapy. Surgery is the initial treatment of choice, although it often presents as a widespread disease at the time of diagnosis, usually with cervical swelling that causes most of the symptoms due to local infiltration or metastasis. Local infiltration from adjacent tumour and metastatic disease needs to be excluded from other primary epidermoid carcinomas, in order to make a correct diagnosis. This also requires the typical cytokeratin pattern seen in histological studies. The case is presented of a 53 year-old man with a medical history of hepatocarcinoma, with a cervical hypermetabolic lesion detected in an 18F-FDG PET/CT performed to exclude widespread disease. The follow-up of this lesion with this technique and its usefulness is also described.

Effect of erythromycin treatment on specific immunologic response in mice.

Six week old Swiss mice were sensitized by subcutaneous injection of 10(7) sheep red blood cells without adjuvant. One hour after sensitization, the mice were treated with erythromycin lactobionate for ten days. The minimal (15 mg/kg/day) and maximal (57 mg/kg/day) doses clinically used were assayed. The daily dose of erythromycin was administered intraperitoneally, in two injections, one every 12 hours. The kinetics of delayed type hypersensitivity reaction, measured by means of the foot-pad test, was evaluated by challenging different groups of fourteen mice with an eliciting dose of 10(8) SRBC injected into the foot-pad on days 1, 2, 3, 4, 5, 6, 7, 8, 9 and 10 after sensitization. Total and 2-mercaptoethanol resistant haemagglutinating antibody titres were determined in sera obtained from mice immediately after measuring the delayed type hypersensitivity reaction. Treatment with maximal erythromycin dose gave rise to a significant enhancement of the cellular immune response, and also to an acceleration of the humoral antibody response. On the other hand, treatment with minimal erythromycin dose gave rise to a slight depression of the immune cellular response and also to a depression of the antibody production at the beginning of the humoral response.

Gonadal dysgenesis and somatic stigmata in patients with 45,X/46,Xr(X) ring chromosome.

Two cases of gonadal dysgenesis and stigmata of Turner's syndrome with ring chromosome X are described. Their features support the idea that ring chromosome X should be considered as a deletion in the genetic sense, affecting both the gonadal and statural determinants. Without knowing the cytogenetic findings, these patients are usually labeled as having Turner's syndrome. Furthermore, endocrine data and histologic examination of the gonads are indistinguishable from those of individuals with 45,X or 46XX gonadal dysgenesis.

Hydatidiform mole following successful gonadotropin ovulation induction and donor artificial insemination.

A case of successful gonadotropins ovulation induction and donor artificial insemination (AID) followed by a complication of hydatidiform mole is presented. A review of the published papers related to this topic are commented. The organization of a world registry of AID depending on the World Health Organization is encouraged.

[The pattern of AIDS-indicative diseases in adults and adolescents in Spain, 1988-1993]. / Patrón de las enfermedades diagnósticas de sida en adultos y adolescentes en España, 1988-1993.

BACKGROUND: The pattern of AIDS-defining diseases in adults and adolescents in Spain from 1988-1993 has been described. METHODS: Twenty-two thousand two hundred thirty-nine cases (CDC, 1987) diagnosed in patients over the age of 12 years from 1988 to 1993 were taken from the National AIDS Registry. The percentage of cases which each of the indicative diseases on registry was evaluated and the differences based on the category of HIV transmission, sex and age were identified. RESULTS: The most frequent AIDS indicative diseases were extrapulmonary tuberculosis (29.7%), Pneumocystis carinii (28.2%) and invasive candidiasis (24.8%). The percentage of cases with extrapulmonary tuberculosis was higher among the intravenous drug users and Kaposi's sarcoma, non Hodgkin's lymphoma (NHL) and cytomegalovirus disease (CMV) among the homosexual males. The disease pattern has demonstrated some differences between sexes on adjustment by transmission category and age. Herpes simplex disease, retinitis by CMV and cerebral toxoplasmosis appeared were more frequent in women and extrapulmonary tuberculosis and NHL in males. On adjustment by transmission category and sex, extrapulmonary tuberculosis was observed with a higher frequency in patients under the age of 30 years while wasting syndrome and progressive multifocal leukoencephalopathy were more often observed in those over the age of 30 years. CONCLUSIONS: The category of HIV transmission plays and important role in the pattern of AIDS-defining diseases. Sex and age also play a role although to in a lesser degree.

Quantitative and morphometric parameters determining the development of the supraoptic nucleus in the albino rat.

The principal part of the supraoptic nucleus (SON) of the rat presents specific developmental factors. The parameters selected for their evaluation were volume of the SON, neuronal number and neuronal density. White Wistar rats of the age of 18, 19, 20, 22 and 23 intrauterine days, 15 days and 1, 3, 6, 12, 18 and 30 months were chosen for this study. The rat brains were fixed, cut into 10-micron-thick sections and stained with hematoxylin-eosin. The different measurements were carried out with a semiautomatic IBAS I image analyzer. In all stages of the rat life, an increase in volume and a decrease in neuronal density per surface unit could be observed, but there was a difference in the dynamics of these changes depending on the stage in which the parameters were determined. There were two periods in the life of the rat in which neuronal death was very significant. The first was between the embryonic and juvenile stage and the second between the adult and senile stage. The increase in the volume influences predominantly the value of neuronal density.

[Refractory depression: therapeutic alternatives]. / Depresiones resistentes: alternativas terapéuticas.

A group of 89 patients admitted to the Psychiatric Unit of a General Hospital, with diagnosis of depression according to ICD-9 criteria and randomly chosen were studied. 26 of them (29.2%) were resistant depressions and 63 (7.82%) responded to treatment. Both groups were composed retrospectively in order to analyse resistance or lack of response to a first treatment with tricyclic or tetracyclic antidepressants in effective dosages. We considered: the personality type; the associated somatic pathology; prolonged social stress; period of evolution of the disorder; previous treatments; type of disorder uni or bipolar; familial morbidity; diagnosis reconsideration; analysis of therapeutic compliance; side effects and intolerance. We observed a statistically significant difference with regard to prophylactic treatment (38.4% resistant versus 98.3% non-resistant, p less than 0.0001); a greater suspicion of psycho-organicity in the resistant group (p less than 0.05); a longer interval of time for the resistant group between the beginning of the disorder and the beginning of treatment in our service (F: 1.45, t: 2.58, p less than 0.01). The alternatives used with our patients are analysed and we propose schedules for tackling this kind of problem.

[Hysterical psychosis: clinical aspects and disease course]. / Psicosis histéricas: aspectos clínico-evolutivos.

30 patients admitted to our psychiatric service with the initial diagnosis of psychogenic psychosis, dissociative psychosis or hysterical pseudo-psychosis are studied anamnestically and in their catamnesis (average follow up 5.1 years). The objective of the study was to see if these disorders are independent nosologic entities or are masking other ones, such as affective, schizophrenic or neurotic disorders. In this study we found a greater percentage of women (3/1) with a previous hysterical personality in more than 50%; many of the patients were hospitalised in order to clarify the diagnosis; in 70% we found psychogenic triggers; a greater predominance of an abrupt onset of the disorder (which would favour the concept of reaction); 60% had fluctuating symptoms (not so common in endogenous psychosis). In almost 100% there was a complete remission during the hospitalization period (average 22.7 days), which would bring them closer to the present concept of brief reactive psychosis. With a follow up of an average of five years, the diagnosis is maintained in 93.3% of the cases. The majority of the patients fulfilled the criteria for hysterical psychosis as defined by Hollender and Hirsch. We think that these disorders are well delimited, both clinically and nosologically, not having received up until now an exact placing in modern classification systems (DSM-III, ICD-10, etc.).

[Personality and triggering life events in the affective psychoses]. / Personalidad y acontecimientos vitales desencadenantes en las psicosis afectivas.

60 bipolar patients and 30 patients with recurrent major depression, both fulfilling DSM-III criteria, were studied in terms of sociodemographic profile, personal and family antecedents, clinical psychopathology, personality type and triggers of the first episodes. We found a greater frequency in the bipolar group of personality disorders of the hypomanic, cyclothymic and sociopathic types; the melancholic-anancastic being more associated with unipolar depression. The bipolar patients in our study had a higher socioeconomical and cultural level compared with the unipolar patients. More than 50% of the depressive episodes of each group had unfavourable life event triggers; 45% of the manic episodes also had previous unfavourable life events; 44% of the patients of this later group, exhibited a previous hypomanic, sociopathic or cyclothymic personality.