[Translated article] Necrotising fasciitis: Management experience over the last two decades in our hospital.

BACKGROUND: Necrotising fasciitis is a potentially life-threatening soft tissue infection that mainly affects the fascia and deep planes, with a very high mortality rate and severe related complications. AIM: To evaluate clinical and demographic characteristics of patients with necrotising fasciitis in our hospital and to describe their diagnostic and therapeutic management. MATERIAL AND METHODS: Retrospective review of medical records of 21 patients diagnosed with necrotising fasciitis with limb involvement between January 2003 and February 2021 in our hospital. Demographic data, clinical features and details of management and prognosis were collected for each patient. RESULTS: Of 21 patients included, 15 were male (71.43%), with a mean age at diagnosis of 54.38±19.55 years. The most frequent comorbidities were insulin-dependent diabetes mellitus in seven patients (33.33%) and a history of cancer in five patients (23.81%). Infection was monomicrobial in 14 cases (66.66%), with Streptococcus pyogenes being the most frequent microorganism; multiple pathogens were isolated in 2 patients (9.52%) and no microorganism was identified in 5 patients (23.81%). All patients underwent surgery at our hospital, with a mean of 4.14±3.98 surgeries. Only one patient underwent amputation of the affected limb. The mean hospital stay was 23.14±16.44 days, with an overall mortality of 47.62% (10 cases). CONCLUSIONS: Despite being a rare disease, necrotising fasciitis is a very aggressive pathology, with a high mortality rate, especially in immunocompromised patients. Advanced age and oncological disease are potential factors of worse prognosis in the evolution of this condition.

Virulence factors and clinical patterns of multiple-clone hypermucoviscous KPC-2 producing K. pneumoniae.

Carbapenemase-producing Klebsiella pneumoniae (CRKP) are increasingly reported worldwide being necessary the local epidemiological monitoring. Our aim was to characterize the hypermucoviscous CRKP isolates collected in our hospital during a 6 months period. Carriage of the carbapenemase genes (bla KPC, bla NDM, bla VIM and bla OXA-48), extended spectrum ß-lactamases (bla SHV-2, bla CTX-M) and the virulence genes (magA, k2A, rmpA, wabG, uge, allS, entB, ycfM, kpn, wcaG, fimH, mrkD, iutA, iroN, hly and cnf-1) were determined by multiplex-PCR. Genetic relationship among the isolates was performed by PFGE and MLST. A total of 35 isolates were recovered, being the urinary and respiratory tract the most common infection sites (34.2%). The bla KPC-2 gene was present in all the isolates, coexisting with bla CTX-M-2 (45.7%), bla SHV-2 (28.6%), and bla CTX-M-2/bla SHV-2 (14.3%). The capsular serotype K2 corresponded with 68.6% of the isolates. Virulence factors frequency were variable [adhesins (97.1%), siderophores (94.3%) and phagocytosis resistance (wabG 48.5%, uge 80% and ycfM 57.1%)]. A total of 10 STs were identified although 40% of them clustered on ST25-CC65, and 17% to ST17. The incidence of KPC-2-producing K. pneumoniae reported by the hospital was 0.290 per 1000 admissions. In summary we described an epidemic scenario of multidrug resistant hypermucoviscous KPC-2 producing ST25 K. pneumoniae in our institution.

[Central nervous system neuromodulation for the treatment of epilepsy]. / Neuromodulation du système nerveux central dans le traitement des épilepsies I-Efficacité et sécurité de la méthode.

We present here a review of the work on neuromodulation - defined as application of an inhibitory or excitatory current - on intracranial structures for the treatment of drug-resistant epilepsy. Near 250 patients were treated using a neuromodulation technique of the cerebellum (paravermian cortex), the CM-pf nucleus of the thalamus, the hippocampus, epileptogenic foci, and anterior ventral nucleus of the thalamus, with a one- to 15-year follow-up. Four contact strips were used for cerebellar and functional region neuromodulation, and DBS-type depth electrodes were stereotactically implanted for CM-pf and anterior nuclei of the thalamus and hippocampal neuromodulation. Electric stimulation was cyclic in almost all trials, using low frequency (10-40 Hz) for excitation and high frequency (60-185 Hz) for inhibition. Seizure frequency reduction was variable, depending on the neuromodulation site and patient selection, although seizure duration decreased in most patients. Cerebellar neuromodulation was followed by a 78% reduction in tonic and tonic-clonic seizures, CM-pf neuromodulation by an 83% reduction in tonic-clonic seizures and atypical absence of Lennox-Gastaut syndrome, with a 17.2% seizure-free and drug-free patient rate. Hippocampal neuromodulation was followed by a 73% reduction in partial complex seizures, with a 33% seizure-free patient rate. Anterior ventral nucleus of the thalamus was followed by a 63% reduction in tonic-clonic, tonic and atonic seizures. Several prognostic factors were identified in order to improve future results. There was no mortality and morbidity was limited to skin erosion at the neurostimulator site. Seizure reduction was associated with improved neuropsychological performance and better quality of life. Neuromodulation is safe and effective for the treatment of epileptic seizures of various origins. Several targets may be associated in a single patient, especially when bilateral hippocampal seizure foci are present.

Iris metastasis as a first manifestation of lung adenocarcinoma. / Metástasis a iris como primera manifestación de adenocarcinoma pulmonar.

OBJECTIVE: To describe a case of lung adenocarcinoma for which the first clinical manifestation was an iris metastasis. CASE REPORT: A 76-year-old male patient came for consultation referring a «pinkish speck¼ on his right eye. On biomicroscopy examination, a mass was found on the iris of the right eye. Subsequent systemic work-up of the patient revealed a left lung adenocarcinoma. DISCUSSION: Although uncommon, iris metastasis secondary to lung cancer should be part of differential diagnosis in iris tumours.

[Passive smoking as a cerebrovascular risk factor]. / El fumador pasivo como factor de riesgo cerebrovascular.

INTRODUCTION: Stroke is one of the main causes of morbidity and mortality in developed countries today. Smoking is a risk factor that is associated with arteriosclerotic disease. AIM: To evaluate the risk of having a stroke associated to both active and passive smoking in a case-control study. PATIENTS AND METHODS: A case-control study was conducted which included 151 stroke patients who were admitted to hospital in the Neurology Service at the Hospital General Universitario in Alicante over a 12-month period. The control group (302) was obtained from patients who visited the emergency department at the hospital with no history of strokes and who reported clinical signs and symptoms that were not compatible with a stroke. The cases and controls were paired according to age and sex, including two controls of the same sex and whose ages were within a year of that of each case which was obtained. RESULTS: The mean age of the patients was 70.6 years (range: 59-81 years). Males predominated in the sample (57.6%). Stroke patients had a significantly higher percentage of hypertension, peripheral arterial disease, heart disease and dyslipidemia than the control group. The most frequently affected vascular territory was the carotid (33.8%). The most frequent presenting symptom of the stroke was motor syndrome together with language disorders (39.4%). The risk of suffering a stroke associated to active smoking was 1.40 (CI 95% = 0.91-2.15) and in the case of passive smoking it was 1.45 (CI 95% = 0.82-2.58). CONCLUSIONS: The findings from this study suggest there is a relevant association between environmental exposure to tobacco smoke and increased vascular risk (which confirms other results that have been published in the literature) and stress how important it is for non-smokers to find smoke-free zones.

Identification of abducens motoneurons, accessory abducens motoneurons, and abducens internuclear neurons in the chick by retrograde transport of horseradish peroxidase.

The location of the motoneurons innervating the lateral rectus, pyramidalis, and quadratus muscles of the chick has been determined by application of horseradish peroxidase (HRP) to these muscles and their nerve branches, and internuclear neurons in the abducens nucleus have been identified by injection of HRP into the oculomotor nucleus. Quantitative results were obtained by means of a semiautomatic image analyzer. Lateral rectus motoneurons were observed only in the ipsilateral principal abducens nucleus, where they numbered 500-550, and quadratus and pyramidalis motoneurons only in the ipsilateral accessory abducens nucleus. The 325-375 internuclear neurons that appeared in the principal abducens nucleus contralateral to the oculomotor nucleus injected with HRP were practically confined to the rostral two thirds of the nucleus, where they tended to surround the lateral rectus motoneurons in dorsal or lateral positions, though a minority of interneurons also mingled with the motoneurons in the center or at the medial face of the nucleus. Most interneurons were small and elongated, but a minority of larger interneurons morphologically similar to the lateral rectus motoneurons were also distinguishable. The 100-110 quadratus motoneurons and the 45-55 pyramidalis motoneurons mingled in the accessory abducens nucleus were larger than the lateral rectus motoneurons and sent their axons into the ipsilateral abducens nerve.

Esophageal lymphangioma: case report and review of the literature.

We report a 66-year-old patient with an esophageal lymphangioma. Five other cases have been reported previously. Clinical features, diagnosis, and therapy are discussed.

Calbindin-D28K cells in the hamster SCN express light-induced Fos.

Although the suprachiasmatic nuclei (SCN) have been intensively analyzed, they contain a population of cells that has not yet been characterized. In this study, we examined the distribution of cells immunoreactive (ir) for calbindin-D28K (CaBP), calretinin (CR), parvalbumin, vasopressin-associated neurophysin (NP), substance P (SP), vasoactive intestinal peptide (VIP), and light-induced Fos-like protein. Previously unidentified cells in the core of the hamster SCN contained CaBP. Photic stimulation during the night induced Fos expression in about 75% of the CaBP-positive SCN cells, and about 50% of the Fos-positive cells in the core region expressed CaBP. These findings provide new information in the search for the cellular localization of pacemaker cells in the SCN, as photic input entrains the circadian system, and cells that receive photic input must be either part of the clock itself, or an upstream component of the clock.

The postganglionic parasympathetic fibers originating in the otic ganglion are distributed in several branches of the trigeminal mandibular nerve: an HRP study in the guinea pig.

Application of HRP to the proximal stumps of the ramifications of the trigeminal nerve shows that all those belonging to the mandibular branch contain parasympathetic fibers originating in the otic ganglion. The nerve with the largest proportion of these fibers is the auriculotemporal nerve (50-60% of all labeled neurons), while the smallest percentages are found in the lingual nerve and motor root (about 5% each). The presence of otic fibers in the inferior alveolar, mylohyoid, buccal and motor branches of the trigeminal nerve has not hitherto been reported.

[Incidence of gastrointestinal complications during enteral feeding. Results of a protocol]. / Incidencia de las complicaciones gastrointestinales en la nutrición enteral. Resultados de un protocolo.

Enteral nutrition (EN) is a nutritional support technique that has been shown to be an effective alternative to total parenteral nutrition (TPN) in critical patients, unless absolute contraindications exist. This study quantified, evaluated and assessed tolerance of EN by critically ill patients and gastrointestinal (GI) complications secondary to EN. We compared continuous EN without interruption (WI) and EN with a 7-hour nightly rest (NR). Sixty-nine patients were assigned randomly to WI or NR. The complications observed were diarrhea, increased residue, vomiting and/or regurgitation, and constipation. The results disclosed no significant differences between the WI and NR groups for any variable measured. We conclude that the frequency of GI complications was no higher, as shown by the results of the EN protocol established in our unit, so we consider this to be an optimal system for artificial feeding of patients in the critical phase.

Localisation of motoneurons supplying the extra-ocular muscles of the rat using horseradish peroxidase and fluorescent double labelling.

This paper describes a qualitative and quantitative investigation into the location of the motoneurons innervating the extra-ocular muscles of the rat. Injections of horseradish peroxidase, bisbenzimide, propidium iodide and DAPI-primuline were made either in one or simultaneously in two muscles. Unlike those of the cat, rabbit and monkey, the motoneurons which make up the oculomotor nucleus of the rat are not arranged in spatially separate subgroups belonging each to its corresponding extra-ocular muscle, but instead allow a high degree of superposition among the motor pools which they compose. The motoneurons innervating the lateral rectus and inferior oblique muscles are all homolateral; those of the medial and inferior rectus muscles are mainly homolateral with a few contralateral exceptions; and those of the superior rectus, levator palpebrae and superior oblique muscles are mainly contralateral with a small minority of homolateral exceptions. As well as from the main motor pools with which they are associated, the medial rectus, inferior rectus, superior rectus, levator palpebrae, superior oblique and lateral rectus muscles all receive innervation from motoneurons lying among the fibres of the fasciculus longitudinalis medialis. All these observations are supported by quantitative data.

Topographic organization of sensory projections to the olfactory bulb.

The detection of odorant receptor mRNAs within the axon terminals of sensory neurons has permitted us to ask whether neurons expressing a given receptor project their axons to common glomeruli within the olfactory bulb. In situ hybridization with five different receptor probes demonstrates that axons from neurons expressing a given receptor converge on one, or at most, a few glomeruli within the olfactory bulb. Moreover, the position of specific glomeruli is bilaterally symmetric and is constant in different individuals within a species. These data support a model in which exposure to a given odorant may result in the stimulation of a spatially restricted set of glomeruli, such that the individual odorants would be associated with specific topographic patterns of activity within the olfactory bulb.

["Doctor, the child does not eat": a motive for consultation]. / "Doctor, el niño no me come", como demanda de consulta.

OBJECTIVES: To find the incidence of "Doctor, the child's not eating" as a motive for requesting a consultation and to check whether there is an accompanying pathology and/or poor nutritional habits. DESIGN: Descriptive, crossover study. SETTING: Rural Health Centre, Santa Amalia (Badajoz). PARTICIPANTS: Family members with 148 children, attending on their own initiative and seeking care for "he/she's not eating" between August and October 1996. RESULTS: 148 of 1,244 consultations were for "he/she not eating" (incidence 11.89%). 52.02% of them were male. The age group which attended most was from 1 to 4 years old (48.64%), followed by 36 cases between 7 and 12 months (24.32%). We observed an accompanying pathology in 71 (41.98%), most frequently catarrh of the upper passages and urinary tract infection. CONCLUSIONS: The fact that one of every 12 consultations was because a child had lost his/her appetite had two main interpretations: it is a common occurrence which worries parents quite a lot; and many parents lack information about feeding their children, as to quantity and the ways of administering the food.

A purified diet for medaka (Oryzias latipes): refining a fish model for toxicological research.

The overall nutritional adequacy of a purified casein-based diet (PC-diet) for the medaka (Oryzias latipes) was evaluated and compared with three diets: commercially available flaked fish food (FL-diet), live newly hatched Artemia (A-diet), and a combination of FL-diet plus A-diet (F/A-diet). Survival, growth, reproductive success, general and liver histopathology, and selected hepatic enzyme activities were compared in medaka from first feeding through reproductive maturity. The PC-diet proved adequate in all of the above criteria. When compared with fish fed F/A-diet, an initial lag in early growth rates (i.e., 0 to 30 days) occurred with the fish fed PC-diet. The FL-diet alone was not nutritionally adequate for medaka, resulting in poor growth, reduced reproductive success, lower survival, and emaciation. A significant number of spinal deformities (5.4%) were noted in medaka fed the F/A diet. Ethoxycoumarin 0-deethylase and glutathione S-transferase activities were monitored and a trend toward increasing activity with age was noted. This suggests that PC- and F/A-diets provide adequate nutrition for development of the xenobiotic metabolizing enzymes necessary for detoxification and activation of endogenous and foreign compounds. The PC-diet supported good survival, growth, reproduction, and normal histology. This diet provides a standardized, nutritionally adequate, and consistent alternative to undefined conventional diets and is less likely to contain the range of xenobiotics possible in whole, live food.

Quantitative histochemical study of changes with age in intracellular lipids of xiphisternal cartilage in rat and rabbit.

Histological and histochemical methods have been employed to study the histology and intracellular lipid distribution of xiphisternal cartilage in rats and rabbits of 5 different ages ranging from newborns to old adults. Xiphisternal cartilage was subdivided for the purposes of the study in 12 regions, and observations were quantified using an image analyser. Large differences in intracellular lipid distribution were observed among different cell populations of individual regions, among different regions of individual cartilages, and among cartilages from animals of different ages. The 2 species studied also differed widely as regards the distribution and quantity of intracellular lipids, even with respect to regions of similar histological characteristics occupying the same relative position within the cartilage. In particular, in the rat the chondrocytes of the lateral edges an the distal third are those possessing the greatest amounts of triglycerides whereas in rabbit these regions are the least rich in triglycerides.