Lung infection with nontuberculous mycobacteria.

OBJECTIVE: To describe the epidemiology and CT findings for nontuberculous mycobacterial lung infections and outcomes depending on the treatment. MATERIAL AND METHODS: We retrospectively studied 131 consecutive patients with positive cultures for nontuberculous mycobacteria between 2005 and 2016. We selected those who met the criteria for nontuberculous mycobacterial lung infection. We analysed the epidemiologic data; clinical, microbiological, and radiological findings; treatment; and outcome according to treatment. RESULTS: We included 34 patients (mean age, 55 y; 67.6% men); 50% were immunodepressed (58.8% of these were HIV+), 20.6% had COPD, 5.9% had known tumors, 5.9% had cystic fibrosis, and 29.4% had no comorbidities. We found that 20.6% had a history of tuberculosis and 20.6% were also infected with other microorganisms. Mycobacterium avium complex was the most frequently isolated germ (52.9%); 7 (20.6%) were also infected with other organisms. The most common CT findings were nodules (64.7%), tree-in-bud pattern (61.8%), centrilobular nodules (44.1 %), consolidations (41.2%), bronchiectasis (35.3%), and cavities (32.4%). We compared findings between men and women and between immunodepressed and immunocompetent patients. Treatment was antituberculosis drugs in 67.6% of patients (72% of whom showed improvement) and conventional antibiotics in 20.6% (all of whom showed radiologic improvement). CONCLUSION: The diagnosis of nontuberculous mycobacterial lung infections is complex. The clinical and radiologic findings are nonspecific and a significant percentage of pateints can have other, concomitant infections.

Preoperative lymphoscintigraphy and tumor histologic grade are associated with surgical detection of the sentinel lymph node.

OBJECTIVE: To study which variables involved in the process of selective sentinel node biopsy (SSNB) influence the intraoperative detection of the sentinel lymph node. MATERIAL AND METHODS: This was a prospective cross-sectional study in 210 patients (mean age, 54 years) diagnosed with breast cancer who underwent SSNB. We recorded clinical, radiological, radioisotope administration, surgical, and histological data as well as follow-up data. We did a descriptive analysis of the data and an associative analysis using multivariable regression. RESULTS: Deep injection alone was the most common route of radioisotope administration (72.7%). Most lesions were palpable (57.1%), presented as nodules (67.1%), measured less than 2 cm in diameter (64.8%), were located in the upper outer quadrant (49.1%), were ductal carcinomas (85.7%), were accompanied by infiltration (66.2%), and had a histologic grade of differentiation of ii (44.8%). Preoperative scintigraphy detected the sentinel node in 97.6% of cases and 95.7% were detected during the operation. One axillary relapse was observed. In the associative study, the variables "preoperative lymphoscintigraphy" and "histologic grade of differentiation of the tumor" were significantly associated with the detection of the sentinel lymph node during the operation. CONCLUSION: The probability of not detecting the sentinel lymph node during the surgical intervention is higher in patients with high histologic grade tumors or in patients in whom preoperative lymphoscintigraphy failed to detect the sentinel node.

[Geriatric syndromes in patients with a non-recent hip fracture seen at a primary health care unit]. / Síndromes geriátricos en pacientes con fractura de cadera no reciente en una unidad de primer nivel de atención médica.

OBJECTIVE: To identify the frequency of geriatric syndromes in patients with a non- recent hip fracture seen at a primary health care unit in the state of Puebla, Mexico. MATERIAL AND METHODS: Cross-sectional study conducted in 376 patients with a non-recent hip fracture screened for geriatric syndromes. We included demographic variables, urinary incontinence, polypharmacy, sleep disorder, nutritional status, depression and autonomy. The two latter were assessed using the Yesavage geriatric depression scale and the Katz index. We used descriptive statistics. RESULTS: The total number of patients was 376; 219 (58%) were females and 157 (42%) were males; mean age was 72.57 years (65-95 +/- 7.08), and 98.7% had at least one geriatric syndrome. Depression was detected in 303 (80.9%), 282 (75%) were on polypharmacy, 262 (69.7%) had sleep disorders, 63 (16.8%) had experienced falls, 19 (5.1%) had urinary incontinence, 15 (4%) were obese, and 3 (0.8%) had loss of autonomy. CONCLUSION: 98.7% of the patients had at least one geriatric syndrome; females were the most affected sex; depression was the most frequent syndrome, followed by polypharmacy, sleep disorders, falls, urinary incontinence, obesity and loss of autonomy.

[Usefulness of hyperbaric oxygen in the treatment of radionecrosis and symptomatic brain edema after LINAC radiosurgery]. / Eficacia del oxígeno hiperbárico en el tratamiento de la radionecrosis y el edemacerebral sintomáticos tras radiocirugía con acelerador lineal.

Radionecrosis with brain edema is a complication of radiosurgery. Three female patients harbouring a frontal pole, petrous and parasagital parietoocipital meningiomas respectively who had been treated with LINAC radiosurgery are presented. Those patients developed, between two and eight months later, a severe symptomatic radionecrosis with a huge brain edema resistant to the usual steroid therapy. Only after 40 sessions of hyperbaric oxygen, a good remission of the lesions was obtained. There are few cases reported in the literature with such a good outcome. Consequentely, this therapy must be taken into account to treat this type of radiosurgical complication before considering surgery.

[Granuloma annulare of the eyelid: an unusual presentation]. / Granuloma anular del párpado: una localización poco frecuente.

CASE REPORT: Granuloma annulare is a benign dermatosis, relatively common during childhood, usually self-limited and of unknown etiology. Localized ocular involvement is rare. We report a case of granuloma annulare involving the eyelid of a child. A biopsy taken from a similar lesion presented later on the back of a thumb confirmed the diagnosis. Treatment with topical corticosteroids was introduced. DISCUSSION: The literature on periocular granuloma annulare is reviewed. This diagnosis should be considered for any acquired papular of the periorbital area, especially if there is a history of antecedent trauma. Unnecessary surgical excision can then be avoided.

Carbamazepine hypersensitivity syndrome mimicking mycosis fungoides.

We report a case of a patient who experienced a generalized skin rash with systemic involvement 2 months after beginning carbamazepine treatment for trigeminal neuralgia. Skin biopsy specimens suggest mycosis fungoides. Complete remission of the clinical and pathologic changes after drug discontinuation and the positive result of carbamazepine from an epicutaneous test suggest a diagnosis of pseudolymphoma due to carbamazepine.

Risk factors for esophageal candidiasis.

The role of gastric acid inhibitors as predisposing factors for Candida esophagitis is unknown. A retrospective case-control study of esophageal candidiasis was conducted in human immunodeficiency virus (HIV)-negative patients diagnosed from January 1991 to December 1997. The diagnosis of esophageal candidiasis was always made on the basis of endoscopic and histological criteria. Fifty-one patients were diagnosed with esophageal candidiasis, 15 of whom had esophageal complaints and 48 of whom suffered from another previous chronic disease (17 had cancer). In addition, 20 patients had previously been treated with antibiotics, 13 with steroids and 14 with omeprazole. In the multivariate analysis, neoplasm (odds ratio, 5.50; 95% confidence interval, 1.94-15.56) and therapy with antibiotics (odds ratio, 11.97; 95% confidence interval, 3.82-37.45), steroids (odds ratio, 35.52; 95% confidence interval, 3.90-324.01) or omeprazole (odds ratio, 18.23; 95% confidence interval, 4.67-71.03) were all associated with esophageal candidiasis. These data suggest that Candida esophagitis tends to occur in patients with chronic diseases, most of whom have been previously treated with antibiotics, steroids or omeprazole. The findings support the hypothesis that treatment with omeprazole favors the development of esophageal candidiasis.

Basal cell carcinoma of the scrotum.

An 80-year-old man with a 7 year history of a slowly enlarging, asymptomatic scrotal nodule is presented. He had a negative history for sexually transmitted disease, trauma to the area, radiotherapy and chemical or arsenic exposure. The lesion was excised with a margin of 0.8 cm of normal skin. Examination of the specimen revealed a basal cell carcinoma.

Buschke-Löwenstein tumor and immunity.

We report the case of an alcoholic patient, 41 years old, with negative results of serologic tests for human immunodeficiency virus (HIV) with a perianal Buschke-Löwenstein tumor present for eight years and exceptionally large. The patient's cell-mediated immunity was evaluated by two functional tests: the Multitest IMC (Institut Mérieux, Lyon) and the dinitrochlorobenzene (DNCB) test. The patient neither responded to any Multitest antigens nor was sensitized by DNCB. We consider that the immune short-age in this patient could influence the appearance of the Buschke-Löwenstein tumor.

[Disseminated Kaposi's sarcoma with hepatosplenic involvement in AIDS]. / Sarcoma de Kaposi diseminado con afectación hepatosplénica en el SIDA.

Kaposi sarcoma (KS) is the most frequent neoplasm found in AIDS patients. The disease is often disseminated and preferentially involves the skin and the lymphatic and digestive systems. Hepatosplenic involvement which is considered as a frequent autopsy finding is rarely diagnosed at life. A 27-year-old male HIV positive patient with severe immunosuppression who developed a rapidly progressive laterocervical cutaneous KS confirmed by pathologic study is presented. Abdominal echography and thoracoabdominal CT scand demonstrated lesions highly suggestive of pulmonary, lymph node, hepatic, splenic and rectal involvement by KS. The administration of 2 chemotherapy cycles produced subjective improvement and remission of the cutaneous lesions. Severe pulmonary superinfection led to death. An autopsy study was not performed. Hepatosplenic involvement by KS, diagnosed while the patient is alive is rare. The imaging techniques are useful to diagnose with high probability visceral involvement of KS. Systemic searching for visceral involvement in KS patients would lead to a marked increase in the cases such as that herein described with evident therapeutic and prognostic implications.

[Intestinal parasitosis of the canine population in the principate of Asturias]. / Parasitosis intestinal en la población canina del Principado de Asturias.

A study is made of coprological samples from 354 dogs, 252 of them male and 102 female. Parasitism was found in 94 dogs (26.5%), of which 14 (15%) showed two or more associated parasites. The Councils with the highest degree of parasitism were: Peñamellera Baja (77.7%), Ribadedeva (57.1%), Castropol (53.8%), Ribadesella (50%), Piloña (46.6%), and Tapias de Casariego (44.4%). The parasites most frequently isolated were: Anciostoma Caninum (19.2%), Trichuris vulpis (8.2%), Cystoisospora canis (3%), Toxocara spp. (1.1%), and Toxascaris leonina (1.1%). The difference in the degree of parasitism in females over 1 year of age (26.6%), and of males over 1 year of age (19.6%) is statistically significant (p greater than 0.05). No eggs were found of Taenia spp., which points to the positive effects of the measures taken against the hydatid cyst, based on the biannual administration of Praziquantel to the canine population.