[Teaching basic life support to the general population. Alumni intervention analysis]. / Enseñando soporte vital básico a la población general. Análisis de las intervenciones de los alumnos.

OBJECTIVES: The aim of this study was to investigate the rate at which the alumni of basic life support courses witnessed and intervened in out-of-hospital emergency situations, and to identify the variables characterizing those alumni associated with a greater number of witnessing events and interventions. An analysis of the efficiency of the courses was also carried out. DESIGN: A descriptive, cross-sectional study was made. SETTING: A district in the province of Almería (Spain). PATIENTS: Alumni of a mass basic life support training program targeted to the general population «Plan Salvavidas¼ conducted between 2003-2009. INTERVENTIONS: In 2010 the alumni were administered a telephone survey asking whether they had witnessed an emergency situation since attending the program, with the collection of information related to this emergency situation. MAIN VARIABLES OF INTEREST: Rate of out-of-hospital emergencies witnessed by the alumni. Rate of intervention of the alumni in emergency situations. Variables characterizing alumni with a greater likelihood of witnessing an emergency situation. RESULTS: A total of 3,864 trained alumni were contacted by telephone. Of 1,098 respondents, 63.9% were women, and the mean age was 26.61±10.6 years. Of these alumni, 11.75% had witnessed emergency situations, an average of three years after completing the course. Of these emergencies, 23.3% were identified as cardiac arrest. The alumni intervened in 98% of the possible cases. In 63% of the cases, there was no connection between the alumni and the victim. The majority of the emergency situations occurred in the street and in public spaces. A greater likelihood of witnessing an emergency situation was associated with being a healthcare worker and with being over 18 years of age. CONCLUSIONS: The rate of out-of-hospital emergencies witnessed by these alumni after the course was 11.75%. The level of intervention among the alumni was high. The most efficient target population consisted of healthcare workers.

Intraepithelial and lamina propria leucocyte subsets in inflammatory bowel disease: an immunohistochemical study of colon and rectal biopsy specimens.

AIMS: To gain new insights into the pathogenesis and differential diagnosis of ulcerative colitis and colonic Crohn's disease. METHODS: Immunohistochemistry for different leucocyte subsets was performed in biopsy specimens of the sigmoid colon and rectum from 55 patients with inflammatory bowel disease and 11 healthy controls. RESULTS: Colonic biopsy specimens from patients with active ulcerative colitis had significantly higher numbers of CD45+ and CD3+ leucocytes compared with those from patients with inactive disease, and higher numbers of total leucocytes and macrophages than those from patients with Crohn's disease. Rectal biopsy specimens from patients with Crohn's disease had greater numbers of intraepithelial leucocytes (CD45, CD3 and CD8 cells) than specimens from patients with active or inactive ulcerative colitis, or from healthy controls. CONCLUSIONS: Because of the phenotypic differences in the inflammatory infiltrate in the mucosa from the sigmoid colon and the rectum, the segment of the intestine to be biopsied should be specified. Assessment of the leucocytic component of the intraepithelial infiltrate in rectal biopsy specimens was more useful than examination of colonic biopsy specimens in the differential diagnosis of ulcerative colitis and Crohn's disease.

Immunohistochemical study of 30 cases of cyclosporin A-induced gingival overgrowth.

Immunohistochemical techniques were used to study the presence of cyclosporin A (CsA) and leukocyte subsets in 30 gingival biopsies of renal transplant subjects with gingival overgrowth (GO). Statistical analysis revealed significant differences in the total number of inflammatory cells determined by monoclonal antibody CD45, the monocyte/macrophage (CD68) subset, the plasmatic cells (EMA), and the total of T-lymphocytes (CD3) (P < 0.001, Student t test) between the treated subjects and the healthy control group. Differences were found in the helper/inducer T lymphocytes CD4 (P < 0.001 Student t test) and cytotoxic/suppressor T lymphocyte (CD8) (P < 0.01, Student t test) subsets between both groups. The CD4/CD8 ratio was greater in the transplant subjects than in the control group (1.82 +/- 0.16 versus 1.35 +/- 0.05 respectively) (P < 0.05 Student t test). There was no significant difference in the populations CD16+, CD57+, and CD20+. The CD45+ CD4+, and CD68+ cells increased in number along with the degree of GO. The number of epithelial cells/mm2 which displayed a deposit of CsA increased in accordance with the degree of GO (P < 0.05, Kruskal-Wallis's test). Likewise, the intraepithelial deposit of CsA in the GO region was found to be related to the inflammatory infiltrate CD4+, CD8+, and CD68+ (r = 0.7432; r = 0.7346; r = 0.77005, respectively). Our findings suggest that the intraepithelial deposit of CsA and the inflammatory infiltrate play a predominantly pathogenic role and are both related to the degree of GO.

[Lymphomatoid papulosis evolving into malignant lymphoma. Clinico-pathological and immunohistochemical study of 3 cases]. / Papulosis linfomatoide con evolución a linfoma maligno. Estudio clinicopatológico e inmunohistoquímico de 3 casos.

Lymphomatoid papulosis is a disorder characterized by recurrent skin lesions with histological features suggestive of malignant lymphoma. In most cases the cutaneous lesions heal spontaneously but the course of the disease is long-lasting and an evolution into a Hodgkin's disease and non-Hodgkin lymphomas may be seen. We report herein the clinical, pathological and immunohistochemical study of three patients having a long-standing lymphomatoid papulosis, which turned into Hodgkin's disease, mycosis fungoides and nodular paragranuloma, respectively. Immunohistochemical analysis showed that the immunophenotype of atypical cells in lymphomatoid papulosis was similar to that observed in Reed-Sternberg cells in Hodgkin's disease and the neoplastic cells of mycosis fungoides. However, the immunohistochemical profile of cells in lymphomatoid papulosis differed from those observed in cells of nodular paragranuloma, developed by one of the three patients. The relationship between lymphomatoid papulosis and malignant lymphomas associated to lymphomatoid papulosis is discussed. The results show that no definitive criteria can be infered from an immunohistochemical study in lymphomatoid papulosis, in predicting the clinical evolution of the disease.

[Disseminated inflammatory pseudotumor of the lymph nodes]. / Seudotumor inflamatorio diseminado de los ganglios linfáticos.

Inflammatory pseudotumour of lymph nodes is a benign type of lymphadenopathy recently described as a peculiar nodal reaction, which displays distinctive clinical and histological features. The origin of the disease is unknown although an inflammatory etiology has been suggested. We study a new case of inflammatory pseudotumour of lymph nodes which had an unusual clinical presentation, with lymphadenopathy on both sides of the diaphragm and enlargement of liver and spleen. In addition, focal fibrinoid vascular necrosis was observed on histological examination, an unusual finding which makes difficult the differential diagnosis with other lesions, particularly vasculitis.

[Histopathologic factors with prognostic significance in mesangial proliferative glomerulonephritis]. / Factores histopatológicos de valor pronóstico en glomerulonefritis proliferativa mesangial.

To investigate the histopathological findings with prognostic significance in mesangial proliferative glomerulonephritis (MPGN), 52 patients with this disease were evaluated with sufficient clinical follow-up. A moderate but highly significant correlation was found between the final creatinine levels and the percentage of sclerosed glomeruli and number of atrophic tubuli per 10 high power fields (r = 0.530, p less than 0.001). When the patients with idiopathic MPGN and those with MPGN secondary to systemic or streptococcal disease were separately considered, there was a remarkable increase in the correlation index for the primary cases (r = 0.912, p less than 0.001). It was concluded that the finding with the highest predictive value in idiopathic forms is tubular atrophy. Three levels of disease were proposed, respectively defining patients with preserved renal function, established chronic renal failure and unpredictable outcome of renal function after a follow-up of five years.

[Pure testicular choriocarcinoma]. / Coriocarcinoma testicular puro.

We present a case of pure testicle choriocarcinoma in a 13-year-old male. Its first clinical manifestation consisted in a pattern of acute dyspnea caused by multiple pulmonary metastases. Alphafetoprotein investigation in serum and tissue proved negative. We carry out an immunohistochemical study of the case and discuss its histogenesis current classification and prognostic significance.

[Melanoma-lymphoma association]. / Associazione melanoma-linfoma.

The association of malignant melanoma with different neoplasias is uncommon but not exceptional. We present two cases of malignant melanoma associated with lymphoma, and analyze the variety of etiopathogenic factors which have been implicated in both neoplasias, with special emphasis on those that may explain this association.

High-protein diets and renal status in rats.

INTRODUCTION: High-protein (HP) diets might affect renal status. We aimed to examine the effects of a HP diet on plasma, urinary and morphological renal parameters in rats. MATERIAL AND METHODS: Twenty Wistar rats were randomly distributed in 2 experimental groups with HP or normal-protein (NP) diets over 12 weeks. RESULTS AND DISCUSSION: Final body weight was a 10%lower in the HP group (p < 0.05) whereas we have not observed differences on food intake, carcass weight and muscle ashes content. No significant clear differences were observed on plasma parameters, whereas urinary citrate was an 88% lower in the HP group (p = 0.001) and urinary pH a 15% more acidic (p < 0.001). Kidney wet mass was ~22 heavier in the HP group (p < 0.001). Renal mesangium area was a 32% higher in the HP group (p < 0.01). Glomerular 1 and 2 were also ~30 higher in the HP diet (p < 0.01 and p < 0.05, respectively) and glomerular area a 13% higher (p < 0.01). CONCLUSION: High-protein diet promoted a worse renal profile, especially on urinary and morphological markers, which could increase the risk for developing renal diseases in the long time.

Introducción: Las dietas hiperproteicas (HP) pueden afectar la función renal. El objetivo del presente estudio fue examinar los efectos de una dieta HP sobre parámetros renales plasmáticos, urinarios y morfológicos en ratas. Material y métodos: Veinte ratas Wistar fueron distribuidas aleatoriamente en 2 grupos experimentales con dieta HP o normoproteicas durante 12 semanas. Resultados y discusión: El peso corporal final fue un 10% inferior en el grupo de dieta HP (p < 0,05) mientras que no se han observado diferencias en la ingesta de comida, peso de la carcasa del animal y el contenido muscular de cenizas. No se observaron claras diferencias en los parámetros plasmáticos, mientras que el citrato urinario fue de un 88% inferior en el grupo de dieta HP (p = 0,001) y el pH urinario un 15% más ácido (p < 0,001). El peso del riñón en sustancia fresca fue un 22% más pesado en el grupo de dieta HP (p < 0,001). El área mesangial fue un 32% mayor en el grupo HP (p < 0,01). El floculo glomerular 1 y 2 fueron también ~ 30 mayores en la dieta HP (p < 0,01 y p < 0,05, respectivamente) y el área glomerular un 13% mayor (p <0,01). Conclusión: Una dieta hiperproteica promueve un peor perfil renal, especialmente en los marcadores urinarios y morfológico, que podrían aumentar el riesgo de desarrollar enfermedades renales a largo plazo.

[Methotrexate-associated lymphoproliferative disorder presenting as oral ulcers in a patient with rheumatoid arthritis]. / Ulceras orales como manifestación clínica de proceso linfoproliferativo asociado a metotrexato en una paciente con artritis reumatoide.

Methotrexate-associated lymphoproliferative disorders are a heterogeneous group of lymphoid proliferations or lymphomas that develop in patients with autoimmune diseases treated using methotrexate. These lymphoproliferative disorders are often associated with Epstein-Barr virus infection and occasionally regress after the withdrawal of methotrexate therapy. The lymphoproliferative disorder in this case was diffuse large B-cell lymphoma, unusually presenting as oral ulcers in a 79-year-old woman on treatment with methotrexate for longstanding rheumatoid arthritis. Latent membrane protein 1 positivity was detected by immunohistochemistry and Epstein-Barr-virus encoded small RNA positivity by chromogenic in situ hybridization. Clonality was confirmed by immunohistochemistry (kappa light-chain restriction), polymerase chain reaction (monoclonal immunoglobulin H gene rearrangement), and capillary electrophoresis (GeneScan). Staging procedures were negative. Withdrawal of methotrexate therapy led to complete remission within 6 weeks, and the patient is alive and disease-free 18 months after the diagnosis was made. The oral cavity is not often involved in the initial presentation of methotrexate-associated lymphoproliferative disorders, and presentation with intraoral ulcers is very rare. We have performed a review of the literature on methotrexate-associated lymphoproliferative disorders presenting as ulcers in the oral cavity.

[Pathology related to altitude: the experience on K2]. / Patología derivada de la altura: experiencia en el K2.

The pathology related with the altitude is a common entity above 3000 m. It includes mild symptoms to severe illness such as cerebral or pulmonary edema. Cold-induced injuries may produce permanent tissue loss and surgical amputation. Recognition is made mainly through symptoms. Adequate treatment of these patients allows for rapid resolution of the symptoms and improves outcome.

Epithelioid leiomyoma of the vulva.

An ultrastructural and light-microscopic study of the second published case of epithelioid leiomyoma of the vulva is reported. The tumor occurred in the right labium minus of a 26-year-old nonpregnant female. Optic microscopy revealed a clear cell neoplasm with a marked relationship to arterial vessels from which it may originate. The ultrastructure was analogous to that of similar cases reported in the uterus and stomach.